Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Risk Factors of Secondary Lumbar Discectomy of a Herniated Lumbar Disc after Lumbar Discectomy

  • Beack, Joo Yul (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Chun, Hyoung Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bak, Koang Hum (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Choi, Kyu-Sun (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bae, In-Suk (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Kim, Kee D. (Department of Neurological Surgery, University of California)
  • Received : 2019.04.04
  • Accepted : 2019.05.30
  • Published : 2019.09.01
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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.

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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 https://doi.org/10.5137/1019-5149.JTN.3394-10.1
  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 https://doi.org/10.1016/S0268-0033(00)00063-2
  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 https://doi.org/10.2106/00004623-200301000-00016
  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 https://doi.org/10.1007/s00264-013-1925-2
  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 https://doi.org/10.1302/0301-620X.80B5.0800825
  6. Cole JS 4th, Jackson TR : Minimally invasive lumbar discectomy in obese patients. Neurosurgery 61 : 539-544, 2007 https://doi.org/10.1227/01.NEU.0000290900.23190.C9
  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 https://doi.org/10.1097/BRS.0b013e31817b8f6f
  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 https://doi.org/10.1148/radiol.2352040624
  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 https://doi.org/10.1378/chest.08-0079
  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 https://doi.org/10.22203/eCM.v029a25
  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 https://doi.org/10.1381/0960892054621224
  12. Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G : MR imaging of degenerative disc disease. Eur J Radiol 84 : 1768-1776, 2015 https://doi.org/10.1016/j.ejrad.2015.04.002
  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 https://doi.org/10.1086/519864
  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 https://doi.org/10.1097/01.blo.0000141901.23322.98
  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 https://doi.org/10.1038/sj.ijo.0803430
  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 https://doi.org/10.1097/BRS.0b013e31815a59a0
  17. Ito T, Takano Y, Yuasa N : Types of lumbar herniated disc and clinical course. Spine (Phila Pa 1976) 26 : 648-651, 2001 https://doi.org/10.1097/00007632-200103150-00017
  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 https://doi.org/10.1097/00007632-198409000-00012
  19. Keskimaki 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 https://doi.org/10.1097/00007632-200006150-00008
  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 https://doi.org/10.1097/BRS.0b013e31818f9116
  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 https://doi.org/10.1016/j.spinee.2010.02.021
  22. Mobbs RJ, Newcombe RL, Chandran KN : Lumbar discectomy and the diabetic patient: incidence and outcome. J Clin Neurosci 8 : 10-13, 2001 https://doi.org/10.1054/jocn.2000.0682
  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 https://doi.org/10.1302/0301-620X.85B6.13626
  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 https://doi.org/10.14245/kjs.2012.9.3.170
  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 https://doi.org/10.1007/s00586-010-1644-y
  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 https://doi.org/10.1067/mtc.2002.122306
  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 https://doi.org/10.3171/spi.2003.98.2.0149
  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 https://doi.org/10.1016/S0022-5223(03)00200-9
  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 https://doi.org/10.1227/01.neu.0000317318.33365.f1
  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 https://doi.org/10.3171/spi.2007.6.4.1
  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 https://doi.org/10.14245/kjs.2016.13.1.1
  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 https://doi.org/10.1016/j.clinbiomech.2005.04.005
  35. Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG : Obesity and selfreported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery 63 : 956-960, 2008 https://doi.org/10.1227/01.NEU.0000313626.23194.3F
  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 https://doi.org/10.1097/01.brs.0000259059.90430.c2
  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 https://doi.org/10.1097/00007632-200103150-00024
  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 https://doi.org/10.1097/BOT.0b013e31813347ac
  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

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