TY - JOUR
T1 - Comparing outcomes of fusion versus repeat discectomy for recurrent lumbar disc herniation
T2 - A systematic review and meta-analysis
AU - Kerezoudis, Panagiotis
AU - Goncalves, Sandy
AU - Cesare, Joseph D.
AU - Alvi, Mohammed Ali
AU - Kurian, Dennis P.
AU - Sebastian, Arjun S.
AU - Nassr, Ahmad
AU - Bydon, Mohamad
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/8
Y1 - 2018/8
N2 - Objectives: Current surgical treatment options for one-time recurrent lumbar disc herniation (RLDH) include repeat discectomy or discectomy supplemented with fusion. Significant contention exists within the surgical spine community with regard to the most effective treatment modality. The objective of this study is to compare reoperation rates and patient reported outcomes following fusion versus repeat discectomy for RLDH. Patients and Methods: The electronic literature search was performed in Ovid Medline/Pubmed, EMBASE and Cochrane, Scopus and China National Knowledge Infrastructure for human studies directly comparing repeat discectomy with fusion for ipsilateral or contralateral RLDH. Random effects meta-analysis was conducted to pool the estimates of effect, using mean differences (MD) and odds ratios (OR) for continuous and categorical outcomes, respectively. Results: A total of 1405 patients with RLDH (746 fusions and 659 repeat discectomies) from 15 studies (13 observational and 2 randomized controlled trials) were analyzed. Mean time to reherniation was 54.4 ± 30.4 months, while average follow-up time was 40 ± 11.7 months (range: 12–92.6). No difference was found between fusions and repeat discectomies with regards to related reoperations (OR: 0.68; 95% C.I: 0.14–3.2). Changes in PRO scores from baseline to last follow-up were also similar between the two groups, including VAS-back pain (MD, −0.3; 95% CI, −1.4 to 0.7), VAS-leg pain (MD, −0.3; 95% CI, −1.4 to 0.7), ODI (MD, 0.6; 95% CI, −0.2 to 1.4), JOA (MD: 1.0; 95% CI: 0.02 to 2.0) and MacNab satisfaction (OR: 1.5; 95% CI, 0.9 to 2.3). Conclusion: Available evidence shows that in treating one-time recurrent disc herniations, repeat discectomy and fusion are associated with comparable reoperation rates, incidence of dural tears, functional outcomes as well as satisfaction with surgical treatment at last follow-up. Future longitudinal, randomized controlled trials should be completed to validate any associations found in this study.
AB - Objectives: Current surgical treatment options for one-time recurrent lumbar disc herniation (RLDH) include repeat discectomy or discectomy supplemented with fusion. Significant contention exists within the surgical spine community with regard to the most effective treatment modality. The objective of this study is to compare reoperation rates and patient reported outcomes following fusion versus repeat discectomy for RLDH. Patients and Methods: The electronic literature search was performed in Ovid Medline/Pubmed, EMBASE and Cochrane, Scopus and China National Knowledge Infrastructure for human studies directly comparing repeat discectomy with fusion for ipsilateral or contralateral RLDH. Random effects meta-analysis was conducted to pool the estimates of effect, using mean differences (MD) and odds ratios (OR) for continuous and categorical outcomes, respectively. Results: A total of 1405 patients with RLDH (746 fusions and 659 repeat discectomies) from 15 studies (13 observational and 2 randomized controlled trials) were analyzed. Mean time to reherniation was 54.4 ± 30.4 months, while average follow-up time was 40 ± 11.7 months (range: 12–92.6). No difference was found between fusions and repeat discectomies with regards to related reoperations (OR: 0.68; 95% C.I: 0.14–3.2). Changes in PRO scores from baseline to last follow-up were also similar between the two groups, including VAS-back pain (MD, −0.3; 95% CI, −1.4 to 0.7), VAS-leg pain (MD, −0.3; 95% CI, −1.4 to 0.7), ODI (MD, 0.6; 95% CI, −0.2 to 1.4), JOA (MD: 1.0; 95% CI: 0.02 to 2.0) and MacNab satisfaction (OR: 1.5; 95% CI, 0.9 to 2.3). Conclusion: Available evidence shows that in treating one-time recurrent disc herniations, repeat discectomy and fusion are associated with comparable reoperation rates, incidence of dural tears, functional outcomes as well as satisfaction with surgical treatment at last follow-up. Future longitudinal, randomized controlled trials should be completed to validate any associations found in this study.
KW - Back pain
KW - Discectomy
KW - Dural tear
KW - Fusion
KW - Leg pain
KW - Lumbar disc herniation
KW - Modified Japanese orthopedic scale
KW - Oswestry disability index
KW - Patient reported outcomes
KW - Recurrent
KW - Reoperation
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U2 - 10.1016/j.clineuro.2018.05.023
DO - 10.1016/j.clineuro.2018.05.023
M3 - Article
AN - SCOPUS:85047820190
SN - 0303-8467
VL - 171
SP - 70
EP - 78
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
ER -