Lumbar disc herniation is commonly encountered in the community, causing disabling symptoms and is often managed effectively with discectomy. Although discectomy generally results in immediate pain relief, recent data have shown that nearly a third of discectomy patients are dissatisfied with their surgical outcomes at 12 months follow-up The reasons for this include recurrent disc herniation, collapsed of index disc level, spinal instability and epidural fibrosis. Management of these complications include revision discectomy, lumbar fusion, nerve root injection and conservative management. Revision surgery is usually more complicated and satisfactory outcome is usually less favourable compared to the primary surgery.
We present a review on risk factors for revision surgery after discectomy. Many authors have looked into different radiological parameters in order to help them predict patients that are high risk of having recurrent lumbar disc herniation although some of these are conflicting. These parameters include type of herniation, direction of herniation, degree of disc degeneration, Modic changes of vertebral endplate, degree of facet joint degeneration, disc protrusion volume, disc height index, sagittal range of motion (sROM), central angle of lumbar lordosis, presence of scoliosis, presence of retrolisthesis and presence of lumbarization or sacralization.
We present a review a review on radiological predictors on recurrent disc herniation. The main objective of this study is to assess characteristics of preoperative MRI lumbar spine that can predict the chances of revision surgeries in patients who previously had a discectomy. Main reasons for revision surgery are recurrent disc herniation, spinal instability and collapsed of the index disc level leading to foraminal stenosis. This knowledge is important as some patients with increased risk of revision surgery might potentially benefit from conservative management or other surgical options including lumbar fusion and insertion of annular closure device as opposed to having primary discectomy.
An understanding of morphological features that may be suggestive of revision surgery or failure may provide useful information for the clinician in determining the most optimal treatment method for patients with lumbar disc herniation.