Long term follow-up after second lumbar disc surgery: 10-years experience

In this retrospective study, 50 patients suffering from persistent or recurrent low back and/or leg pain after lumbar discectomy, without spinal instability, and which underwent a second surgical procedure were analysed (40 cases at the same level: group I; 10 cases at different levels: group II). Analysis of operative findings showed presence of recurrent disc herniation or residual disc fragments alone in 15 patients (30%), retained disc fragments associated with fibrosis in 22 (44%) and prevalence of epidural scarring in 13 (26%). Surgical results are as follow: in the first group 25 patients (62.5%) had a good outcome, 10 (25%) unchanged status and 5 (12.5%) worsened; in the second group 8 patients (80%) had a good outcome, 2 (20%) unchanged status and none worsened. Totally 33 patients (66%) had clinical improvement, 12 (24%) were unchanged and 5 (10%) worsened. The functional recovery of the lumbar spine (stated as mobility), considering all patients was good in 78% of the cases (31 patients in first group and 8 in second group) and poor in 22% (9 patients in first group and 2 second group). A substantial reduction in the degree of the physiological lordosis was seen and recorded in 96% of the all patients, despite 88% of patients who completely recovered the work capacity and 2% who gained only a partial recovery. Results were not related to age, gender and occupation, but were related to the type of underlying lesion, with significant correlation if considered the different groups separately: the patients affected by fibrosis alone did worse than the other groups. The best results were independent from the presence and length of a pain-free interval between the first and the second surgical procedure.