Comparative Study in Recurrent Disc Surgery between Posterior Lumbar Fusion with Interbody Fusion versus Posterior Lumbar Fusion Alone

Background

Although surgical treatment of lumbar disc herniation is successful in most patients, discectomy can lead to unsatisfactory outcomes, such as recurrent or increased and/or sciatic pain. Standard open discectomy is associated with a 5% to 20% failure rate

The main causes of this clinical entity, known as failed back surgery syndrome, include inadequate diagnosis, improper patient selection, inadequate surgical decompression (e.g. failure to recognize lateral recess stenosis, lateral disc herniation or sequestrated free fragments), recurrent disc herniation at the operated level or at another level, and epidural fibrosis. Recurrent herniation is one of the most common reasons for an unsatisfactory outcome and occurs in 5%–11% of surgically treated patients

Aim of the Work

is to evaluate and compare the results of recurrent disc surgery with transpedicular screw fixation alone and transpedicular screw fixation with interbody fusion using either in posterior lumbar interbody fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) techniques and outcome and complications of both techniques.

Patients and Methods

This study was 60 patients with recurrent lumbar disc herniation divided into two groups:

Group A

treated by a repeat discectomy with postero-lateral fusion and transpedicular screw insertion.

Group B

treated by a repeat discectomy with transpedicular screw insertion and interbody fusion either by (PLIF) or (TLIF).

Result

In Our study was conducted on 60 patients with first time recurrent lumbar disc herniation after exclusion of cases with disc herniation with other pathology such as (multi segmental spinal canal stenosis, adjacent level disc herniation, spondylolythesis, and spinal deformities). After a mean follow-up of 14.13 (±2.39 STD) months, in 30 patient undergo recurrent discectomy with pedicle screw fixation only, a mean follow-up of 10.50 (±1.81STD) months, in 30 patient undergo recurrent discectomy with pedicle screw fixation with interbody fusion. Considering these data, we can note that both pedicle screw fixation alone comparing it with in pedicle screw fixation with inter body fusion have comparable results when used with revision discectomy but PLF has significantly less total cost than PLF+Interbody fusion.

However, the complication occurs in pedicle screw fixation with inter body fusion is more than that occur in pedicle screw fixation alone, more time consuming in the theater and more total prosthetic cost.

Conclusion

repeat discectomy with posterolateral fusion and interbody fusion for true recurrent lumbar disc herniation with evident recurrent sciatica and low back pain is more effective than discectomy with posterolateral fusion alone.

Abbreviations

PLIF: posterior lumbar interbody fusion; TLIF: Transforaminal Lumbar Interbody Fusion