Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Kamrul Ahsan; Shahidul Islam Khan; Naznin Zaman; Nazmin Ahmed; Nicola Montemurro; Bipin Chaurasia

doi:10.4103/jcvjs.JCVJS_153_20

Fusion versus nonfusion treatment for recurrent lumbar disc herniation

J Craniovertebr Junction Spine. 2021 Jan-Mar;12(1):44-53. doi: 10.4103/jcvjs.JCVJS_153_20. Epub 2021 Mar 4.

Authors

Kamrul Ahsan¹, Shahidul Islam Khan¹, Naznin Zaman², Nazmin Ahmed³, Nicola Montemurro⁴, Bipin Chaurasia⁵

Affiliations

¹ Departments of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
² Department of Anesthesiology, Sarkari Karmachari Hospital, Dhaka, Bangladesh.
³ Department of Neurosurgery, Ibn Sina Hospital, Dhaka, Bangladesh.
⁴ Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
⁵ Department of Neurosurgery, Terai Hospital and Research Centre, Birgunj, Nepal.

Abstract

Background: Recurrent lumbar disc herniation (RLDH) is one of the major causes for failure of primary surgery. The optimal surgical treatment of RLDH remains controversial.

Aim: Retrospectively, we evaluate 135 patients and compare the clinical outcomes between fusion and nonfusion treatment of RLDH.

Methods: Records of 75 men and 35 women aged 28-60 years for conventional revision discectomy alone (nonfusion) and 15 men and 10 women aged 30-65 years for revision discectomy with transforaminal lumbar interbody fusion (TLIF) and transpedicular screw fixation (fusion) were reviewed. Demographics, surgical data, and complications were collected and pre- and postoperative assessment were done by the Visual Analogue Scale (VAS) scale and Japanese Orthopaedic Association (JOA) score. The results after surgery were assessed according to the recovery rate as excellent, good, fair, and poor.

Results: The mean follow-up period was 28.8 and 24.6 months in Group A (nonfusion) and Group B (fusion group), respectively. The preoperative data between both the groups showed no statistically significant difference. The postoperative mean VAS and JAO scores, recovery rate, and satisfaction rate showed no statistically significant difference except postoperative low back pain and occasional radicular pain and neurological deficit in nonfusion group which was significantly higher than that of fusion group. In comparison to fusion group, nonfusion group required significantly less operative time, less intraoperative blood loss, less postoperative hospital stay, no blood transfusion, and less total cost of the procedure. Satisfaction rate was 80% and 88% in nonfusion and fusion groups, respectively.

Conclusions: Both convention revision discectomy (nonfusion) and discectomy with instrumented fusion (TLIF) surgery are effective in patients with RLDH.

Keywords: Conventional revision discectomy alone (Non fusion); recurrent lumbar disc herniation; transforaminal lumbar interbody fusion and stabilization.