Recurrence after SurgeryIn Lumbar Disc Protrusions


Background: Persistent symptoms after operation
for lumbar disc protrusions may be due to: (1) disc
prolapse at another level; (2) residual disc material in
the spinal canal; (3) nerve root pressure by a
hypertrophic facet joint or a narrow lateral recess
(‘root canal stenosis’). After careful investigation, any
of these may call for re-operation; but second
procedures don’t have a high success rate.
Objective: This study is designed to verify the
possible causes of recurrence after surgery for lumbar
disc prolapse and their appropriate treatment
regarding re-exploration.
Methods: A follow-up and result of treatment in
100 cases operated upon for lumbar disc prolapse is
presented. Clinical & radiological assessments
including myelography and magnetic resonance
imaging were done post-operatively in persistent
symptoms including backache or sciatica.
Results: In this series, twelve patients required reexploration,
9 patients had only one re-exploration
and 3 patients had two explorations each. One patient
had one re-exploration was subjected to sacro-iliac
fusion, which improved his symptoms.
Conclusion: In the majority of patients the causes
of persistence of symptoms are beyond the control of
the surgeon. Removal of disc prolapse is effective in
most instances in relieving the pain in lower extremity
but a large number of patients continue to suffer from
further backache and a few from further leg pain of
varying intensity. Re-exploration carries a bad
prognosis but if a disc prolapse is found at reexploration
then the result is much more favorable
Keywords: Sciatica, recurrent lumbar disc, reexploration.