Article
Lumbar discectomy patients at the highest risk for reherniation within a multi-center randomized clinical trial
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Authors
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Adisa Kuršumović
- DONAUISAR Klinik Deggendorf, Neurochirurgie, Wirbelsäulenchirurgie und interventionelle Neuroradiologie, Deggendorf, Deutschland
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Frederic Martens
- Onze-Lieve-Vrouw Hospital, Aalst, Belgien
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Martin Barth
- Universitätsklinikum Knappschaftskrankenhaus Bochum, Klinik für Neurochirurgie, Bochum, Deutschland
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Richard Bostelmann
- Heinrich-Heine-Universität, Universitätsklinikum, Neurochirurgische Klinik, Düsseldorf, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: The purpose of this study was to 1) confirm the at-risk nature of large anular defect, limited discectomy patients in experiencing recurrent lumbar disc herniation (rLDH) and 2) assess potential risk factors within this population.
Methods: The study patient population was extracted from the control cohort of a prospective, randomized, multi-center clinical trial investigating the efficacy of an anular closure device following standard limited discectomy. All control subjects received limited discectomy for the treatment of a single-level symptomatic posterior or posterolateral lumbar disc herniation (LDH). Only patients presenting with a large anular defect (6-10mm wide by 4-6mm tall) were included in the study (n=278). Baseline demographic, clinical, and surgical characteristics were recorded. Follow-up occurred at 6 weeks, and at 3, 6, 12, and 24 months. Imaging modalities included MRI, Low-dose CT, and x-rays. Symptomatic rLDH was defined as any symptomatic post-operative herniation, on either side of the index level. A multi-variate logistic regression analysis of demographic and surgical variables associated with rLDH incidence was performed.
Results: Mean anular defect area was 39.3mm2 (+/- 9.06mm2) and mean excised nuclear tissue volume was 1.3mL (+/- 0.82mL). At 2-years, symptomatic rLDH incidence was 25.3% (64/253) occurring at a mean time of 264 days from index surgery. Of the 64 patients with rLDH, 36 received a subsequent surgical intervention. Logistic regressions identified an increased risk for rLDH by 2.2 times in females and by 1.3 times in patients with greater anular defect widths. Further, multi-variate logistic regression analyses revealed a significant interaction between age/gender (p<0.05).
Conclusion: Study outcomes provided the most substantial evidence to date in confirming previous reports of a high-risk, large anular defect population. Females experience as high as ~10 times greater risk of rLDH up until ~50 years of age, providing clarification on which patients are at the highest risk among those with large anular defects (width >6mm). Surgical techniques that include a discectomy with limited nucleus removal followed by effective anular repair or closure are recommended.
