J Korean Neurosurg Soc.  2019 Sep;62(5):586-593. 10.3340/jkns.2019.0085.

Risk Factors of Secondary Lumbar Discectomy of a Herniated Lumbar Disc after Lumbar Discectomy

• Beack JY
• Chun HJ
• Bak KH
• Choi KS
• Bae IS
• Kim KD

• KMID: 2457949
• DOI: http://doi.org/10.3340/jkns.2019.0085

Abstract

OBJECTIVE
To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.
METHODS
Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.
RESULTS
The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4-5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).
CONCLUSION
Patients with high BMI or severe disc degeneration should be informed of HLD revision.

Keyword

Body mass index; Diskectomy; Recurrence; Reoperation

MeSH Terms

Body Mass Index
Diskectomy*
Follow-Up Studies
Humans
Intervertebral Disc Degeneration
Recurrence
Reoperation
Retrospective Studies
Risk Factors*

Figure

• 

  Fig. 1. Kaplan-Meier curves of cumulative hazards of revision surgery stratified by BMI categories (normal weight <25.0, overweight 25.0–30.0, obesity ≥30.0 kg/m2). log-rank test, p<0.001. BMI : body mass index.

• 

  Fig. 2. A : MRI at the time of initial surgery decision. B : MRI at the time of recurrence of symptoms. C : MRI at the time of revision surgery decision. MRI : magnetic resonance image.

Reference

References

1. Akyol S, Eraslan BS, Etyemez H, Tanriverdi T, Hanci M. Catabolic cytokine expressions in patients with degenerative disc disease. Turk Neurosurg. 20:492–499. 2010.

2. Callaghan JP, Mcgill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin Biomech (Bristol, Avon). 16:28–37. 2001.

3. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 85:102–108. 2003.

4. Cheng J, Wang H, Zheng W, Li C, Wang J, Zhang Z, et al. Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop. 37:1511–1517. 2013.

5. Cinotti G, Roysan GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent disc herniation. A prospective, controlled study. J Bone Joint Surg Br. 80:825–832. 1998.

6. Cole JS 4th, Jackson TR. Minimally invasive lumbar discectomy in obese patients. Neurosurgery. 61:539–544. 2007.

7. Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976). 33:1789–1792. 2008.

8. Dora C, Schmid MR, Elfering A, Zanetti M, Hodler J, Boos N. Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy? Radiology. 235:562–567. 2005.

9. Dossett LA, Heffernan D, Lightfoot M, Collier B, Diaz JJ, Sawyer RG, et al. Obesity and pulmonary complications in critically injured adults. Chest. 134:974–980. 2008.

10. Emanuel KS, Vergroesen PP, Peeters M, Holewijn RM, Kingma I, Smit TH. Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system. Eur Cell Mater. 29:330–340. 2015.

11. Fabris de Souza SA, Faintuch J, Valezi AC, Sant’Anna AF, Gama-Rodrigues JJ, de Batista Fonseca IC, et al. Postural changes in morbidly obese patients. Obes Surg. 15:1013–1016. 2005.

12. Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G. MR imaging of degenerative disc disease. Eur J Radiol. 84:1768–1776. 2015.

13. Friedman ND, Sexton DJ, Connelly SM, Kaye KS. Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol. 28:1060–1065. 2007.

14. Gepstein R, Shabat S, Arinzon ZH, Berner Y, Catz A, Folman Y. Does obesity affect the results of lumbar decompressive spinal surgery in the elderly? Clin Orthop Relat Res. 426:138–144. 2004.

15. Gilleard W, Smith T. Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion. Int J Obes (Lond). 31:267–271. 2007.

16. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 32:E708–E712. 2007.

17. Ito T, Takano Y, Yuasa N. Types of lumbar herniated disc and clinical course. Spine (Phila Pa 1976). 26:648–651. 2001.

18. Kelsey JL, Githens PB, O'Conner T, Weil U, Calogero JA, Holford TR, et al. Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine (Phila Pa 1976). 9:608–613. 1984.

19. Keskimäki I, Seitsalo S, Osterman H, Rissanen P. Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations. Spine (Phila Pa 1976). 25:1500–1508. 2000.

20. Kim MS, Park KW, Hwang C, Lee YK, Koo KH, Chang BS, et al. Recurrence rate of lumbar disc herniation after open discectomy in active young men. Spine (Phila Pa 1976). 34:24–29. 2009.

21. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 10:575–580. 2010.

22. Mobbs RJ, Newcombe RL, Chandran KN. Lumbar discectomy and the diabetic patient: incidence and outcome. J Clin Neurosci. 8:10–13. 2001.

23. Morgan-Hough CV, Jones PW, Eisenstein SM. Primary and revision lumbar discectomy. A 16-year review from one centre. J bone Joint Surg Br. 85:871–874. 2003.

24. Oh JT, Park KS, Jung SS, Chung SY, Kim SM, Park MS, et al. Surgical results and risk factors for recurrence of lumbar disc herniation. Korean J Spine. 9:170–175. 2012.

25. Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J. 20:585–591. 2011.

26. Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM, Fraser VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg. 124:136–145. 2002.

27. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg. 98:149–155. 2003.

28. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 90:62–69. 2008.

29. Olsen MA, Sundt TM, Lawton JS, Damiano RJ Jr, Hopkins-Broyles D, Lock-Buckley P, et al. Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 126:992–999. 2003.

30. Park P, Upadhyaya C, Garton HJ, Foley KT. The impact of minimally invasive spine surgery on perioperative complications in overweight or obese patients. Neurosurgery. 62:693–699. 2008.

31. Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 6:291–297. 2007.

32. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 246:1873–1878. 2001.

33. Rim DC. Quantitative Pfirrmann disc degeneration grading system to overcome the limitation of Pfirrmann disc degeneration grade. Korean J Spine. 13:1–8. 2016.

34. Rodacki AL, Fowler NE, Provensi CL, Rodacki Cde L, Dezan VH. Body mass as a factor in stature change. Clin Biomech (Bristol, Avon). 20:799–805. 2005.

35. Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery. 63:956–960. 2008.

36. Schmidt H, Kettler A, Heuer F, Simon U, Claes L, Wilke HJ. Intradiscal pressure, shear strain, and fiber strain in the intervertebral disc under combined loading. Spine (Phila Pa 1976). 32:748–755. 2007.

37. Suk KS, Lee HM, Moon SH, Kim NH. Recurrent lumbar disc herniation: results of operative management. Spine (Phila Pa 1976). 26:672–676. 2001.

38. Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus. 15:E10. 2003.

39. Tucker MC, Schwappach JR, Leighton RK, Coupe K, Ricci WM. Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study. J Orthop Trauma. 21:523–529. 2007.

40. Yar T. Spinal shrinkage as a measure of spinal loading in male Saudi university students and its relationship with body mass index. Saudi Med J. 29:1453–1457. 2008.