Prognosis and Necessity of Fixation in the Recurrent Lumbar Disc Herniation

Kim, Eui Jung; Choi, Byung Kwan; Choi, Chang Hwa

Abstract

OBJECTIVE
The fusion procedure can be an option on reoperative HNP cases. It is done routinely or on case-by-case basis. There have been no clear guideline and results about the instability rate that really needs fusion procedure. This study is done to clarify the need of fusion procedure and prognosis in the reoperation of lumbar disc herniation by regarding stability rate. METHODS: Total 27 cases with reoperative lumbar disc surgery were reviewed. Instability was tested preoperatively with X-ray findings which method was proposed by Dupuis in 1976. All operative procedures were done under microscopic magnification. The laminectomy and facetectomy amount was measured by the difference between the pre and postoperative X-ray findings. The stability test and final outcome were rated at least 6 months after the reoperation. The final results were categorized into excellent, good, fair, poor group according to the back, leg pain, walking ability, restriction of average daily life and use of analgesics. RESULTS: The average translation were 4.95%(flexion) with 5.04%(extension) for lumbar joints and 3.39%(flexion) with 4.17%(extension) for lumbosacral junction. Average flexion angulation were -2.3degrees for lumbar joints and 9.1degrees for lumbar sacral junction. The average amount of removed facet joint was 10.2%. Average 68.1% of facet joint remains after the reoperation. CONCLUSION: Fusion procedure is needed only in limited cases of recurrent disc herniation for the reason of possible instability. Routine fusion procedure should be avoided regarding stability problem. In literatures, the fusion rates shows extreme ranges from 0 to 100 % according to the authors. The prognosis was comparable with previous reports where most of the average good or excellent outcomes were ranging 60~70% of the cases without fusion procedures.