Spine Unit. ICATME.Institut Universitari DexeusBarcelona.Spain

Hernia recurrence after discectomy: Incidence and Prognosis.

S.Martinez Martos, MT.Ubierna, A.Garcia de Frutos, G.Saló, A. Matamalas and E.Cáceres

ObjectiveTo study the incidence of recurrent disc herniation on patients diagnosed of herniated disc that required surgical treatment.

To find risk factors related with recurrent disc herniation.

Material and methods

Preoperative - Age - Gender - Level and type of hernia - Modic changes on MRI - Disc degeneration (Pfirrmann) - Type of surgery performed - Physical activity at work - Sports activity

Postoperative - Oswestry Disability Index - Physical activity at work - Sports activity - Recurrence ocurrence and percentatge

Retrospective study of 239 pacients who underwent discectomy

List of variables in the study:

Results. Epidemiology 201 pacients• Mean age 42.9 y (19-76) ; 60.25 % ♂• Follow up from 1 to 8 y

60.2%

35.4%

3.5%

0.8%

0 20 40 60 80

L5-S1

L4-L5

L3-L4

L2-L3

83.3% lateral16,7% foraminal 51.1% left side

Results:Disc Degeneration Modic Changes and kind of surgery

Magnetic Resonance Classification of Lumbar Intervertebral DiscDegeneration Pfirrmann, Christian W. A.;Spine. 26(17):1873-1878, September 1, 2001

58.7% D type (Pfirrmann) , followed by C type 23.9%

33.5% Modic changes, being the type 2 the most common

Results. Oswestry Oswestry mean result 12.7 (0-96) with better results in

♂ (p=0.00). Worst results Unemployed (p=0.00).

Best results Sports (Spe. -0.292)

No correlation between Modic changes, disc degeneration or type of surgery with Oswestry results.

Results. Hernia recurrence

0 20 40 60 80 100

Treatment Surgery

Epidural infiltration

Physical therapy

No differences between the type of surgery performed in the recurrence with the result in the Oswestry Index (p=0.513)

19.3% (35) hernia recurrence at same level.13% underwent surgery (28).

Results. Age & physical activity related with recurrence

No statistically significant Significant- gender (p=0.665)- sport (p=0.828) - type of hernia(p=0.702)- level of the hernia(p=0.979)- disc degeneration (p=0.526)- extruded (p=0.342)- type of primary surgery (p=0.549)

- age (< 40 years) - physical activity at work

DiscusionAge ♂

♀Smoking DD BMI Modic level Disc

heightwork

Cinotti n=66

Suk n=28

Kim n=350

Swatz n=123

Kyoung- Taen=350

Etsuron=131

Our serien=201

Conclusion 1.- Good results in the Oswestry index after

surgery for lumbar disc herniation 2.- Hernia recurrence after surgery hasn´t been an

uncommon fact 3.- Younger people (<40 y) and physical activity at

work are related with recurrent lumbar disc herniation

4.- Discectomy or dicectomy plus arthrodesis shows similar results in the revision surgery after hernia recurrence