Recurrence of lumbar disk herniation after microdiscectomy: a two-center retrospective analysis of 1214 cases and identification of risk factors

Authors: BÜLENT GÜLENSOY, EBRU GÜZEL, MÜGE KUZU KUMCU, HÜSEYİN KARASU, SERKAN ŞİMŞEK, ASLAN GÜZEL

Abstract: Background/aim: To present the incidence of recurrent lumbar disc herniation (RLDH) and to identify radiological and patient-related risk factors that lead to recurrence after lumbar disc herniation (LDH) treatment with microdiscectomy. Materials and methods: Between January 2013 and December 2021, 1214 patients who had undergone microdiscectomy for LDH were included in this retrospective study. Patients were divided into two groups, the recurrent group and the non-recurrent group, and their demographic, clinical and radiologic characteristics were recorded. The association between the variables and RLDH was assessed by univariate and multivariable logistic regression analyses. Results: Mean ages were similar in the recurrent (51.48 ± 13.63) and non-recurrent(50.38 ± 14.53) groups (p=0.232). Males represented 59.6% of the recurrent group and49.8% of the non-recurrent group (p=0.002). Multivariable logistic regression revealedthat being a male (p=0.009), diabetes mellitus (p=0.038), smoking (p<0.001), grade 4&5disc degeneration (p<0.001), and having protruded (p=0.002), extruded LDH (p<0.001),paracentral (p=0.008) and foraminal LDH (p=0.008) were independently associated withrecurrence. Conclusion: To reduce RLDH frequency and need for revision surgery, modifiable riskfactors should be minimized before and after the initial surgery. Also, in patients withunmodifiable risk factors, patients should be clearly informed about the risk forrecurrence and possible alternative treatment methods should be considered.

Keywords: Recurrent lumbar disc herniation, microdiscectomy, risk factors, thePfirrmann grading system

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