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Recurrent Lumbar Disc Herniation: A Narrative Review

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 37-45 | Ghanshyam Kakadiya, Viraj Gandbhir, Kshitij Chaudhary

Authors: Ghanshyam Kakadiya [1] , Viraj Gandbhir [1] , Kshitij Chaudhary [1][2]

[1] Department of Orthopaedics, Topiwala National Medical College & BYL Nair Hospital, Mumbai, Maharashtra, India
[2] Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Kshitij Chaudhary,
Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
E-mail: chaudhary.kc@gmail.com

Abstract

This narrative review aimed to identify various risk factors of recurrent lumbar disc herniation (rLDH) post-discectomy and its management. The rLDH has remained a challenging problem for spine surgeons. The incidence of rLDH is reported widely from 1% to 21%. Many possible patient-related, disc-related, and surgery-related risk factors may predispose the patient to rLDH. Moreover, the clinical and radiological diagnosis of rLDH can be challenging. Once the diagnosis is confirmed, and alternative diagnoses for leg pain have been ruled out, a course of initial non-operative treatment can be attempted. Compared to primary LDH, non-operative treatment is less likely to succeed in rLDH, possibly due to the associated epidural fibrosis and scarring. Various surgical options can be considered, including revision discectomy and fusion. Revision discectomy is usually the primary choice of surgery for the first recurrence. A fusion procedure can be chosen for those who have repeated reherniations or significant associated back pain. Precise patient selection is a must to achieve excellent surgical outcomes.
Keywords: Lumbar disc herniation, recurrent herniation, discectomy, risk factor, Epidural fibrosis, narrative review.

 

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How to Cite this Article: Kakadiya G, Gandbhir V, Chaudhary K| Recurrent Lumbar Disc Herniation: A Narrative Review | Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 37-45.

 

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Which is Better in Laborers? A Comparison Between Open and Micro Endoscopic Discectomy

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 8-12  | Hitesh N. Modi, Tushar Kunder, Neel Bhavsar, Pankaj R. Patel

Authors: Hitesh N. Modi [1][2], Tushar Kunder [1], Neel Bhavsar [1], Pankaj R. Patel [1]

[1] Department of Orthopaedics, NHL Municipal Medical College
and Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
[2] Department of Spine Surgery, Zydus Hospital and Healthcare
Research Pvt. Ltd., Ahmedabad, Gujarat, India .

Address of Correspondence
Dr. Hitesh N. Modi,
Spine Surgeon, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
Spine Surgeon, Zydus Hospital and Healthcare Research Pvt. Ltd., Ahmedabad, Gujarat, India .
E-mail: modispine@gmail.com; drmodihitesh@gmail.com

Abstract

Introduction: None of the studies compared the results of open lumbar discectomy (OLD) and microendoscopic discectomy (MED) surgeries in laborers. The aim of this study was to compare the clinical and functional impact of OLD versus MED surgery in laborers to find out which is better.

Materials and Methods: This retrospective study was performed in 91 laborers (54 males and 37 females) who underwent OLD (n = 41) versus MED (n = 50) for the single- or double-level lumbar disc herniation (LDH). All patients were operated at a single institute after a failure of conservative trial for 6 weeks. Patients with associated severe disc degeneration, stenosis, instabilities, or other pathologies were excluded from the study. The clinical results were evaluated with Oswestry Disability Index (ODI), visual analog score (VAS), and duration of return back to work.

Results: The average age of the study group was 39.8 ± 12.1 years. Average follow-up was 50.2 ± 13.9 months. The entire study group comprised manual labor work such as farming or loading work with an average income of US $53.6 ± 14.6 (approximately INR 4000) per month. The patients belonged to low socioeconomic status as per modified Kuppuswamy scale. The post-operative VAS scores were significantly reduced in both MED (7.6–2.0) and open discectomies (7.2–2.1). Improvement ODI scores also showed similar trends for MED (57.3–20.6) and for open discectomies (55.1–20.1). Average duration to return to work was significantly less in the MED group in comparison to the OLD group (18.0 vs. 25.5 days). There were total 4 (4.4%) complications perioperatively. There were one superficial wound infection in the OLD and one dural tear in the MED group. Both were managed conservatively. There was one patient from each group having recurrent disc herniation that was managed conservatively. There were one patient from the MED and two patients from the OLD group who could not return to their previous work or had to modify their work due to back pain.

Conclusion: Although clinical improvement after discectomy surgery in laborers is similar, MED is a promising alternative to OLD in laborers with respect to return to work earlier. Such studies may further throw light in differential management of laborer population with MEDs versus OLD.

Keywords: Lumbar disc herniation; Laborers; Discectomy technique; Early return to work.

 

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How to Cite this Article: Modi HN, Kunder T, Bhavsar N, Patel PR | Which  is Better in Laborers? A Comparison Between Open and Micro Endoscopic Discectomy| Back Bone: The Spine Journal | October 2020- March 2021; 1(1): 8-12.

 

(Abstract) (Full Text HTML)      (Download PDF)

.