Identifying predisposing factors for recurrence after successful surgical treatment of lumbar disc herniation

Background: Recurrent lumbar disc herniation (rLDH) comprises one of the most common complications of lumbar discectomy occurring in about 1-21% of the operated patients. Aim: This study aims to elucidate the role of predisposing factors in producing rLDH in the patients with previous successful lumbar discectomy. Materials and Methods: In this retrospective study, we reviewed 213 patients (133 male; 62%) who underwent simple primary lumbar discectomy in our Orthopedic Department from August 2009 to January 2014. Mean age and follow-up period were 38.1 ± 9.8 years and 48.2 ± 7.3 months, respectively. The term of rLDH referred to those cases who have suffered a relapsed sciatalgia after a primary pain improvement period. We repeated magnetic resonance imaging (MRI) scanning only in those cases with recurrent complaints. Chi-square, Fisher, and Student's t-tests were used for statistics. Results: Recurrent sciatalgia occurred in 39 patients (18.3%), while true rLDH on MRI scanning was detected in 32 patients (15%). Younger age, heavier smoking, and less severity of herniation on primary MRI scanning (protrusion vs. sequestration) play as predisposing roles in creating rLDH, while gender, level or side of LDH, the presence of Modic changes, or body mass index (BMI) have no significant effect. The most common sites of rLDH were same level same side, different level, and same level contra-lateral side, respectively. Conclusion: In the patients who had been successfully treated by simple primary lumbar discectomy, younger age, heavier smoking state, and less protrusion of the herniated disc at the time of the index surgery, were all correlated with more probability of the future rLDH, while BMI, Modic change, sex, level, and side of LDH had no significant role