Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy

Clinical article

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Object

The use of minimally invasive surgical techniques, including microscope-assisted tubular lumbar microdiscectomy (tLMD), has gained increasing popularity in treating lumbar disc herniations (LDHs). This particular procedure has been shown to be both cost-efficient and effective, resulting in outcomes comparable to those of open surgical procedures. Lumbar disc herniation recurrence necessitating reoperation, however, remains an issue following spinal surgery, with an overall reported incidence of approximately 3–13%. The authors' aim in the present study was to report their experience using tLMD for single-level LDH, hoping to provide further insight into the rate of surgical recurrence and to identify potential risk factors leading to this complication.

Methods

The authors retrospectively reviewed the cases of 217 patients who underwent tLMD for single-level LDH performed identically by 2 surgeons (J.B., R.H.) between 2004 and 2008. Evaluation for LDH recurrence included detailed medical chart review and telephone interview. Recurrent LDH was defined as the return of preoperative signs and symptoms after an interval of postoperative resolution, in conjunction with radiographic demonstration of ipsilateral disc herniation at the same level and pathological confirmation of disc material. A cohort of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH.

Results

Of the 147 patients for whom the authors were able to definitively assess symptomatic recurrence status, 14 patients (9.5%) experienced LDH recurrence following single-level tLMD. The most common level involved was L5–S1 (42.9%) and the mean length of time to recurrence was 12 weeks (range 1.5–52 weeks). Sixty-four percent of the patients were male. In a comparison with patients without recurrence, the authors found that relatively lower body mass index was significantly associated with recurrence (p = 0.005), such that LDH in nonobese patients was more likely to recur.

Conclusions

Recurrence rates following tLMD for LDH compare favorably with those in patients who have undergone open discectomy, lending further support for its effectiveness in treating single-level LDH. Nonobese patients with a relatively lower body mass index, in particular, appear to be at greater risk for recurrence.

Abbreviations used in this paper: BMI = body mass index; LDH = lumbar disc herniation; tLMD = tubular lumbar microdiscectomy.

Article Information

Address correspondence to: John A. Boockvar, M.D., Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, 525 East 68th Street, Box 99, New York, New York 10021. email: jab2029@nyp.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Magnetic resonance images. The initial axial T2-weighted image taken prior to the first surgery demonstrating an LDH on the right side at L4–5 (left) and the postoperative axial T2-weighted image revealing postlaminotomy defect and ipsilateral recurrent disc herniation at the same level (right).

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