However, reherniation is a real area of concern for patients after lumbar discectomy surgery. And oftentimes, reoperations that address a second herniation aren’t as successful as the first surgery1. In fact, one study showed that patients had 25 percent less improvement in function, 44 percent were not satisfied with outcomes, and 88 percent used opioids and at higher doses2 two years following reoperation.
This article provides an overview of the common risk factors for recurrent disc herniation, as well as the impact and outcomes that are frequently associated with reoperation.
While every lumbar discectomy patient has a chance of experiencing reherniation after surgery, there are certain risk factors that can increase the likelihood. Being aware of whether or not you’re considered at high risk of recurrent disc herniation can help you better prepare and take steps to lower the odds.
Research shows that roughly two-thirds of reoperations3 after lumbar discectomy surgery can be attributed to actual reherniation of the same disc. The following risk factors can contribute to the increased likelihood of recurrent disc herniation and potential repeat surgery:
Each of these risk factors can increase the odds of experiencing reherniation after surgery—some more so than others. For example, patients with large holes in the treated disc, which account for around 30 percent10 of the lumbar discectomy population, have nearly a one in four chance of reherniation11.
If you’re considering lumbar discectomy surgery and fall within one of the higher-risk groups, we recommend meeting with a spine specialist to ask questions, discuss your options, and learn which steps you can take to reduce the likelihood of reherniation.
Of course you want to do everything you can to prevent reherniation from occurring at all, but when prevention seems unlikely or impossible, reoperation may be a necessary next step. However, reoperation for recurrent lumbar disc herniation is less than ideal for a number of reasons.
In many cases, repeat operations are not as successful as the first surgery. In fact, reoperations following lumbar discectomy are often associated with worse clinical outcomes and patient morbidity12.
Another study13 found that at two years of follow-up post-surgery, reoperated patients had significantly higher (worse) scores on the Oswestry Disability Index (ODI), a scale used to measure pain and quality of life, in comparison to their non-reoperated counterparts. Furthermore, besides the potential for a poor surgical outcome, there’s no guarantee even after reoperation that a third surgery (a second revision procedure) will not be necessary to try to relieve residual painful symptoms.
One of the biggest downfalls to reoperation is another cycle of preparing for, undergoing, and recovering from lumbar discectomy surgery. To support proper healing and minimize the risk of post-surgical complications, lumbar discectomy patients must follow aftercare instructions provided by a spine specialist. This process can often be painful, time-consuming, and frustrating—especially if you’ve already been through it before.
In addition to dealing with discomfort and activity restrictions, reoperation likely means you’ll need another round of aftercare assistance from family and friends. For example, in the days following lumbar discectomy surgery, most patients require assistance with daily responsibilities like cooking and cleaning to aid in a smooth recovery process.
Repeat surgery ultimately means more downtime and the need to take more time off of work to recover. It can also lead to the need to go on short-term disability, because different patients bounce back at different rates and may require additional healing time. Patients with desk jobs are advised to return to work 6-8 weeks14 following their procedure. Those with more strenuous jobs that require frequent heavy lifting, bending, or twisting may need up to 12 weeks away from work15 to ensure adequate healing and reduce the risk of increased pain or reinjury.
Cost is also a factor. Reoperations are often associated with a greater financial burden for patients, because they can lead to increased out-of-pocket expenses and lost wages due to time away from work. One study found that the total estimated direct medical costs for reoperation were $13,802 per patient16.
Many risk factors, such as age and diabetes, cannot be controlled. However, other known risk factors, such as lifestyle choices and BMI, may be possible to modify. Plus, research shows that for patients with large holes in their herniated lumbar disc(s), implantation of an annular closure device greatly reduces the risk of reherniation and reoperation.
Barricaid is the only FDA-approved device on the US market designed to close large holes in herniated lumbar discs. The implant significantly improves the odds of achieving a more durable outcome following lumbar discectomy surgery.
For example, one study17 found that a significantly greater number of patients (16 percent) who had a discectomy without Barricaid underwent a revision surgery within two years, in comparison to patients implanted with a bone-anchored Barricaid device (9 percent). Closing large holes in a herniated lumbar disc with Barricaid can reduce the chance of reoperation by nearly 50 percent18.
I hope this information will be helpful in navigating the options for surgery if a discectomy is offered as an option for treatment. It is not only ‘ok,’ but good for patients to ask questions regarding any particular surgical option. Doctors and their staff should be more than willing to take whatever time necessary help with this process. Remember that the ‘patient is in charge’ and deserves to have full information so they can make truly informed decisions with their doctor.
While this blog is meant to provide you with information you need to make an informed decision about your treatment options, it is not intended to replace professional medical care or provide medical advice. If you have any questions about the Barricaid, please call or see your doctor, who is the only one qualified to diagnose and treat your spinal condition. As with any surgical procedure, you should select a doctor who is experienced in performing the specific surgery that you are considering.
If you have any questions about the Barricaid device, you may ask your doctor. For additional information, please visit www.barricaid.com. For complete risk-benefit information: www.barricaid.com/instructions-for-use.
References
1 Dante Leven et al, "Risk Factors For Reoperation In Patients Treated Surgically For Intervertebral Disc Herniation," The Journal Of Bone And Joint Surgery-American 97, no. 16 (2015): 1316-1325, doi:10.2106/jbjs.n.01287; Jeffrey A O’Donnell et al, "Treatment Of Recurrent Lumbar Disc Herniation With Or Without Fusion In Workers’ Compensation Subjects," Spine 42, no. 14 (2017): E864-E870,
2 Dante Leven et al, "Risk Factors For Reoperation In Patients Treated Surgically For Intervertebral Disc Herniation," The Journal Of Bone And Joint Surgery-American 97, no. 16 (2015): 1316-1325, doi:10.2106/jbjs.n.01287.
3 Robert Abdu et al, “Reoperation for Recurrent Intervertebral Disc Herniation In The Spine, Patient Outcomes Research Trial: Analysis of Rate, Risk Factors and Outcomes,” Spine 42, no. 14 (2017): 1106-1114, doi: 10.1097/brs.0000000000002088.
4 Daniel D. Bohl et al, “Does Greater Body Mass Index Increase the Risk for Revision Procedures Following a Single-Level Minimally Invasive Lumbar Discectomy?” Spine 41, no. 9 (2016): 816-821, doi: 10.1097/BRS.0000000000001340.
5 Mesut E. Yaman et al, “Factors That Influence Recurrent Lumbar Disc Herniation,” Hong Kong Medical Journal 23, no. 3 (2017): 258-263, doi: 10.12809/hkmj164852.
6 See note #3.
7 Shinji Miwa et al, “Risk Factors of Recurrent Lumbar Disk Herniation: Clinical Spine Surgery,” Journal of Spinal Disorders and Techniques 28, no. 5 (2015): E265-269, doi: 10.1097/BSD.0b013e31828215b3; Mesut E. Yaman et al, “Factors That Influence Recurrent Lumbar Disc Herniation,” Hong Kong Medical Journal 23, no. 3 (2017): 258-263, doi: 10.12809/hkmj164852.
8 Larry E. Miller et al, “Association of Annular Defect Width After Lumbar Discectomy With Risk of Symptom Recurrence and Reoperation: Systematic Review and Meta-Analysis of Comparative Studies,” Spine 43, no. 5 (2018): E308-E315, doi: 10.1097/BRS.0000000000002501.
9 William C. Watters and Matthew J. McGirt, "An Evidence-Based Review Of The Literature On The Consequences Of Conservative Versus Aggressive Discectomy For The Treatment Of Primary Disc Herniation With Radiculopathy," The Spine Journal 9, no. 3 (2009): 240-257, doi:10.1016/j.spinee.2008.08.005.
10 Larry E. Miller et al, “Association of Annular Defect Width After Lumbar Discectomy With Risk of Symptom Recurrence and Reoperation: Systematic Review and Meta-Analysis of Comparative Studies,” Spine 43, no. 5 (2018): E308-E315, doi: 10.1097/BRS.0000000000002501.
11 Frederic Martens et al, “Patients at the Highest Risk for Reherniation Following Lumbar Discectomy in a Multicenter Randomized Controlled Trial,” JB & JS Open Access 3, no. 2 (2018): E0037, doi: 10.2106/JBJS.OA.17.00037; Eugene J Carragee et al, “Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence,” The Journal of Bone and Joint Surgery 85, no. 1 (2003): 102-108, https://journals.lww.com/jbjsjournal/Abstract/2003/01000/Clinical_Outcomes_After_Lumbar_Discectomy_for.16.aspx; Claudius Thomé et al, “Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial,” The Spine Journal 18, no. 12 (2018): 2278-2287, doi: 10.1016/j.spinee.2018.05.003.
12 Dante Leven et al, "Risk Factors For Reoperation In Patients Treated Surgically For Intervertebral Disc Herniation," The Journal Of Bone And Joint Surgery-American 97, no. 16 (2015): 1316-1325, doi:10.2106/jbjs.n.01287; Jeffrey A O’Donnell et al, "Treatment Of Recurrent Lumbar Disc Herniation With Or Without Fusion In Workers’ Compensation Subjects," Spine 42, no. 14 (2017): E864-E870, doi:10.1097/brs.0000000000002057; Junyoung Ahn et al, "Primary Versus Revision Single-Level Minimally Invasive Lumbar Discectomy," Spine 40, no. 18 (2015): E1025-E1030, doi:10.1097/brs.0000000000000976.
13 Peter D. Klassen et al, “Post-Lumbar Discectomy Reoperations That Are Associated with Poor Clinical and Socioeconomic Outcomes Can Be Reduced through Use of a Novel Annular Closure Device: Results from a 2-Year Randomized Controlled Trial,” ClinicoEconomics and Outcomes Research 10 (2018): 349-357, doi: 10.2147/CEOR.S164129.
14 Rune Tendal Paulsen, MD, et al, "Return to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises," The Spine Journal 20, no. 1 (2020): 41-47, doi: 10.1016/j.spinee.2019.09.019.
15 Ibid
16 Peter D. Klassen et al, “Post-Lumbar Discectomy Reoperations That Are Associated with Poor Clinical and Socioeconomic Outcomes Can Be Reduced through Use of a Novel Annular Closure Device: Results from a 2-Year Randomized Controlled Trial,” ClinicoEconomics and Outcomes Research 10 (2018): 349-357, doi: 10.2147/CEOR.S164129.
17 Ibid.
18 Ibid.