What Are the Odds of Reherniation after Microdiscectomy?

Understanding the Risk: Chances of Reherniation after Microdiscectomy

Microdiscectomy is a common surgical procedure used to treat herniated discs in the lumbar spine. While generally successful, one concern for patients undergoing this surgery is the possibility of reherniation. In this article, you will learn about the odds of reherniation after microdiscectomy, factors that influence these rates, and strategies to minimize the risk of recurrence.

Microdiscectomy Explained

Before discussing reherniation rates, it is essential to understand what microdiscectomy entails. Microdiscectomy is a minimally invasive surgical procedure used to remove herniated disc material that is pressing on nerve roots or the spinal cord. This procedure is typically performed on patients with persistent leg pain, numbness, or weakness caused by a herniated disc in the lumbar spine.

Reherniation Rates: What the Data Shows

The likelihood of disc reherniation after microdiscectomy varies depending on several factors, but overall, the rates are relatively low. Studies have reported different figures, but most fall within a similar range:

• General reherniation rates - Research suggests reherniation occurs in approximately 5 to 15 percent of cases following microdiscectomy.
  

• Specific study findings -
  

• A study published by the National Institutes of Health found a recurrence rate of around 9 percent.
• Another study reported reherniation rates ranging from 2.3 to 11.8 percent.
• Some sources suggest rates as high as 10 to 25 percent for patients who have had surgery for herniated discs.

It is important to note that these figures represent overall statistics and may not reflect individual risk factors or specific cases.

Factors Influencing Reherniation Risk

Several factors can influence the likelihood of disc reherniation after microdiscectomy:

• Disc characteristics

Larger herniations and those with significant disc degeneration carry higher reherniation risks. Patients with contained herniations typically face lower risks compared to those with extruded fragments.

• Size of annular defect

The size of the hole left in the disc after surgery plays a significant role in reherniation risk. A study published in The Journal of Bone and Joint Surgery found that patients who had extruded fragments and massive posterior annular loss had:

• Up to a 27 percent risk of reherniation
• A 21 percent risk of needing another operation
  
  

• Age and gender

Younger patients, particularly women under 50 years old, may be at higher risk for reherniation. Some data suggests this group may have up to 10 times the average risk.

• Surgical technique

The method used during the initial procedure can influence reherniation rates. Factors such as incomplete removal of herniated disc material or inadequate closure of a significant gap in the annulus may increase the risk of recurrence.

• Patient behavior and lifestyle

Postoperative care and patient behavior play crucial roles in preventing reherniation. Factors such as the following can all contribute to an increased risk of reherniation:

• Smoking
• Engaging in high-impact activities too soon after surgery
• Poor lifting techniques
• Failure to follow rehabilitation guidelines
  
  

• Body mass index

Patients with a BMI over 30 face approximately double the risk of reherniation compared to those with normal BMI. This increased risk relates to greater mechanical stress on the disc and potentially compromised healing.

Timeline of Reherniation Risk

The risk of reherniation is not uniform throughout the recovery period. Understanding the timeline can help patients and healthcare providers stay vigilant during critical periods:

• Immediate postoperative period - The risk is generally low immediately after surgery, as patients are typically instructed to limit activities.
• First few months - As patients begin to resume normal activities, the risk may increase. A study of patients who experienced reherniation found it occurred at 5, 8, 9, and 10 months postoperatively.
  
  
• Long-term risk - While the risk decreases over time, it is important to note that reherniation can occur even years after the initial surgery. However, the likelihood diminishes significantly as time progresses.

Success Rates of Microdiscectomy

Despite the risk of reherniation, it is crucial to consider the overall success rates of microdiscectomy:

• Short-term success - Studies consistently report high success rates in the short term, with 80–90 percent of patients experiencing significant improvement in symptoms.
  
  
• Long-term outcomes - A 10-year follow-up study found that the initial success rate of 91 percent at 6 months post-surgery only slightly declined to 83 percent after a decade. This suggests that the positive outcomes of microdiscectomy are generally maintained long-term.

Signs of Potential Reherniation

Understanding warning signs can ensure prompt intervention if reherniation occurs:

• Return of radiating pain similar to pre-surgery symptoms
• New onset of neurological symptoms
• Progressive weakness or numbness
• Changes in bladder or bowel function

Treatment Options for Reherniation

Treatment for reherniation can range from conservative to surgical, depending on the severity of symptoms and patient preference:

• Conservative management
  

• Physical therapy - Strengthening the core muscles and improving posture can alleviate symptoms.
• Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs) and pain relievers may help patients manage discomfort.
• Epidural steroid injections - These can reduce inflammation and pain in some patients.
  
  

• Revision surgery

In cases where conservative treatments fail, a second surgery might be necessary. Revision surgery may involve another microdiscectomy or a more extensive procedure like spinal fusion surgery, especially if there is significant spinal instability.

Strategies to Minimize Reherniation Risk

While it is impossible to eliminate the risk of reherniation entirely, there are several strategies patients can employ to reduce their chances of experiencing this complication:

• Follow post-operative instructions

Adhering to your surgeon’s guidelines for activity restriction and gradual return to normal activities is crucial. This typically includes:

• Avoiding bending, lifting, and twisting for a specified period
• Gradually increasing activity levels as directed by your healthcare provider
• Participating in prescribed physical therapy exercises
  
  

• Adopt proper body mechanics

Learning and implementing proper lifting techniques and body mechanics can significantly reduce stress on the spine. This includes:

• Bending at the knees, not the waist, when lifting objects
• Avoiding twisting motions while lifting
• Using assistive devices when necessary
  
  

• Maintain a healthy lifestyle

Certain lifestyle factors can contribute to disc health and overall spine wellness:

• Maintaining a healthy weight to reduce stress on the spine
• Quitting smoking, as it can impair healing and increase the risk of reherniation
• Staying hydrated to support disc health
• Engaging in regular low-impact exercise as approved by your healthcare provider

• Consider preventive measures

In some cases, surgeons may recommend additional preventive measures during the initial surgery, such as:

• Using annular closure devices, which have shown promise in reducing reherniation rates in patients with large annular defects
• Employing surgical techniques that aim to preserve as much of the natural disc structure as possible

When to Seek Medical Attention

While the risk of reherniation decreases over time, it is essential for patients to remain vigilant and seek medical attention if they experience:

• Recurrence of leg pain, numbness, or weakness
• New or worsening back pain
• Loss of bladder or bowel control (This is a medical emergency and requires immediate attention)

Early intervention can often lead to better outcomes and may prevent the need for more extensive procedures.

Microdiscectomy remains an effective treatment option for herniated discs, with generally low rates of reherniation. While the risk of recurrence exists, understanding the factors that influence this risk and implementing strategies to minimize it can significantly improve long-term outcomes. By following postoperative instructions, adopting healthy lifestyle habits, and remaining aware of potential warning signs, patients can maximize the benefits of their surgery and reduce the likelihood of experiencing reherniation.

Remember, every patient’s situation is unique, and it is essential to discuss individual risk factors and concerns with your healthcare provider. Your doctor can provide personalized advice and guidance to ensure the best possible outcome following microdiscectomy surgery.

Although microdiscectomy surgery is generally a very successful procedure, a hole is left in the outer wall of the disc. Patients with a large hole in the outer ring of the disc are more than twice as likely to reherniate after surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce the likelihood of a reherniation, was specifically designed to close the large hole often left in the spinal disc after microdiscectomy. In a large-scale study, 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us today.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.