Discectomy And Fusion Techniques Versus Discectomy alone In Management Of Recurrent Herniated Lumbar Disc

Abstract

The results of our review denote that improvement of radicular pain is achieved in repeat discectomy alone and also by adding fusion to the repeat discectomy, however this improvement is more significant by adding fusion. While in patients with back pain along with radicular pain, adding fusion significantly improves back pain more than repeat discectomy alone in which the improvement of back pain is not significant. Fusion techniques decrease significantly the incidence of dural tear, postoperative neurological deficit and postoperative rerecurrence and spinal instability in comparison to repeat discectomy without fusion, however mean blood loss and length of operation is significantly more in fusion groups than in non fusion group (except in ALIF). There is evident gap of knowledge due to the lack of well-designed randomized control trials (RCT) of the various surgical techniques for management of recurrent lumbar disc herniation. Existing studies do not allow quantification of either relative or absolute benefits of any of the surgical methods of management and there is a compelling need for large RCT s that can provide this information. Future studies will require prospective analysis of outcomes, standardized surgical techniques, and standardization of reported results. Meaningful results will probably require a multi-centre effort.