Introduction and Aims: Recurrent disc herniation or sciatica is one of the major complications of discectomy, often leading to a cascade of surgical procedures of increasing magnitude, but decreasing surgical outcome. We undertook a study to see if prolapsed disc fragment type can predict the possibility of recurrence of disc herniation or sciatica.
There were 18 patients in group A – they were all subjected to further examination with MRI scan. In five of the patients, the scan showed recurrence of disc herniation. It was an ipsilateral reherniation in four patients and contralateral in one patient. Eight of these 18 patients required repeat surgery. In the five patients with reherniation (7.69% of whole series), the repeat surgery was a discectomy. In another three patients the surgery was a wide decompression and fusion. On further analysing the pathology found at the initial discectomy, in the group A patients, six (33%) had extruded discs and 12 (66%) had contained discs. In group B, 34 (72%) had extruded discs and 13 (27%) had contained discs. The statistical significance in this small series is debatable.
The aim of this study was to assess whether the pro-lapsed disc fragment type was predictive of recurrent disc herniation or sciatica after discectomy. The records of 39 patients treated by lumbar discectomy only were reviewed. Within two months of surgery, the type of disc fragment prolapse and state of the annulus were assessed on CT scans or MRI. Patients who presented later with recurrent sciatica or disc prolapse were reviewed with MRI. All other patients were contacted and asked whether they had had recurrent sciatica or had undergone repeat surgery elsewhere. The follow-up period was three years. The results suggest that patients in whom discs required annulotomy at surgery had poorer results than those with extrusion through an annular fissure. The degree of annular competence can be used to assess the risk of recurrence of herniation or sciatica.