Hernia recurrence after discectomy: Incidence and Prognosis.

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Hernia recurrence after discectomy: Incidence and Prognosis. S.Martinez Martos, MT.Ubierna, A.Garcia de Frutos, G.Saló, A. Matamalas and E.Cáceres Spine Unit. ICATME.Institut Universitari Dexeus Barcelona.Spain

Objective To 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.

List of variables in the study: Material and methods Retrospective study of 239 pacients who underwent discectomy List of variables in the study: 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

Results. Epidemiology 201 pacients Mean age 42.9 y (19-76) ; 60.25 % ♂ Follow up from 1 to 8 y 83.3% lateral 16,7% foraminal 51.1% left side

Results:Disc Degeneration Modic Changes and kind of surgery 58.7% D type (Pfirrmann) , followed by C type 23.9% 33.5% Modic changes, being the type 2 the most common Magnetic Resonance Classification of Lumbar Intervertebral DiscDegeneration Pfirrmann, Christian W. A.; Spine. 26(17):1873-1878, September 1, 2001

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 19.3% (35) hernia recurrence at same level. 13% underwent surgery (28). No differences between the type of surgery performed in the recurrence with the result in the Oswestry Index (p=0.513)

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

Discusion Age ♂♀ DD BMI Modic level Smoking Disc height work Cinotti Suk n=28 Kim n=350 Swatz n=123 Kyoung- Tae Etsuro n=131 Our serie n=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