Protruded Disc Disease Has Higher Recurrence of Disc HerniationActive people between the ages of 20 and 40 years can be susceptible to developing a back injury called a herniated disc (bulging disc, slipped disc). If nonsurgical treatments don't work, then many undergo surgery to help relieve the pain and allow them to resume an active lifestyle. However, there are always some patients who either don't respond well to surgery or they do well, but they herniate another disc later on.
The authors of this article worked on estimating the recurrence rate of lumbar (lower back) disc herniation after surgery in active young men. To do this, they reviewed the charts of 241 patients, all male police officers or soldiers, who had open discetomies, surgery to remove the injured disc. The researchers looked at the records and test results, and then had the patients respond to telephone surveys after to see if any new symptoms had developed.
The results of the stud showed that 17 patients had recurrent herniations. That leaves a rate of 91.5 percent of patients not having recurrence at 14 years after surgery. Fourteen of the recurrences (6.8 percent) occurred in patients between the ages of 20 to 29 years. The other three patients were between 30 and 39 years.
Sixty-five percent of the patients had their herniation at the L4 to L5 levels of the spine, which is the lowest part of the lower back before it becomes the sacrum, or the lowest part of the back. The herniation was between L5 and S1 (highest part of the sacrum) in 33.2 percent of the patients, and between L3 and L4 in 1.2 percent. The recurrences occurred in the L4 to L5 region in 8.2 percent of the patients and at L5 to S1 in 5 percent. The researchers also found that most of the recurrences happened in disc herniations that protruded.
The authors point out that their study did have limitations, such as their definition of recurrence was as seen by imaging and reports of pain. They didn't include patients who had evidence of protrusion on the images but didn't report any pain. The greatest limitation though, they write, is that the follow-up was that they lost quite a few patients to follow up and follow up time.
In conclusion, the authors write that the recurrence rate was significantly higher among patients who had protruding disc herniations.
Min Seok Kim, MD, et al. Recurrence Rate of Lumbar Disc Herniation After Open Discectomy in Active Young Men. In Spine. January 2009. Vol. 34. Pp. 24 to 29.
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