SURGICAL TREATMENT OF PAIN SYNDROME RECURRENCE AFTER REMOVAL OF LUMBAR INTERVERTEBRAL DISC HERNIA

Abstract

Objective. To define optimal pathogenetic surgical techniques for pain syndrome recurrence after lumbar discectomy.

Materials and Methods. The study included 176 patients operated on for pain syndrome recurrence. Decompressive and decompressive-stabilizing (posterior or anterior interbody fusion, dynamic fixation with DYNESYS instrumentation) reoperations were performed. The results were followed for 3 to 24 months. The dynamics of neurologic status and pain syndrome intensity were assessed with visual-analog scale and Osvesty index.

Results. The main causes of pain syndrome recurrence were a herniation of the operated disc (52.8 %) and its combination with degenerative stenosis (9.7 %). Degenerative stenosis alone was a cause of pain recurrence in 21.6 % of cases. Hernia recurrence of the operated disc caused a pain syndrome more frequently within 2 years after surgery. Degenerative stenosis both alone and in combination with operated disc hernia occurred more often in a later follow-up period. Hypertrophic articular processes and vertebral arches, osteophytes, thickened yellow ligament and peridural fibrosis were the pathomorphologic substrate of stenosis. Fibrous changes were revealed intraoperatively in all cases. Peridural fibrosis never was a single cause of neurovascular compression but always was combined with other stenosing factors. Treatment results were better in patients who underwent decompressive-stabilizing surgery. Repeated recurrences of pain syndrome occurred in 9.8 % of cases after surgical decompression and in 1.4 % after decompressivestabilizing surgery.

Conclusion. Decompressive-stabilizing surgery with posterior interbody fusion is a pathogenetical and technically adequate surgical treatment of pain syndrome recurrence after lumbar disc hernia removal.