Patients Undergoing Revision Microdiskectomy for Recurrent Lumbar Disk Herniation Experience Worse Clinical Outcomes and More Revision Surgeries Compared With Patients Undergoing a Primary Microdiskectomy.

Abstract

Recurrent disk herniation treatment aims to optimize outcomes. This study compares the demographics and patient-reported outcomes of patients who underwent primary or revision lumbar microdiskectomy surgery for recurrent disk herniation. A retrospective cohort analysis was performed of consecutive patients who underwent primary or revision lumbar microdiskectomies between January 2008 and December 2015. Patients were divided into two groups: primary (primary) and revision (recurrent). Herniated disks were confirmed preoperatively using MRI. Patient-reported outcomes included Visual Analog Scales (VAS) scores for the back and leg, Oswestry Disability Index scores, 12-Item Short Form Mental and Physical Survey scores, and the Veterans RAND 12-Item Health Mental and Physical Survey scores. One hundred ten patients met inclusion criteria: 72 from primary cohort and 38 from recurrent cohort. Recurrent patients experienced presurgical symptoms for significantly less time. On bivariate analysis, recurrent patients reported significantly worse preoperative VAS-back and VAS-leg scores. On multivariate analysis, recurrent patients reported significantly worse postoperative VAS-back, VAS-leg, and Oswestry Disability Index scores. Recurrent patients were less likely to be satisfied with surgical outcomes and to feel that surgery had met or exceeded their expectations. Patients undergoing revision microdiskectomy are likely to experience worse postoperative symptoms and disability relative to patients undergoing primary microdiskectomy.