Tuncer GÖKER, Ali DALGIÇ, Oktay GÜRCAN, AHMET GÜRHAN GÜRÇAY, Mutlu Kağan TUN

Nüks lomber disk hernilerinde tedavi yaklaşımları

Management approach in relapsing lumbar disc hernia

ntroduction: The main aim of recurrent disc herniation is to provide neural decompression, to fuse the levels if there are signs of instability, to eliminate the other reasons responsible for back pain or to mobilize the patient as soon as possible so as to have a normal life. Material and Method: 24 patients with recurrent disc herniation were retrospectively reviewed in Ankara Numune Education and Research Hospital Neurosurgery Department between March 2006 and December 2009. The Visual Analog Pain Scale (VAS), clinical findings and imaging technics were the main diagnostic methods. Result: In patients whose mean improvement in quality of life (QOL) time was 62,96 (1-350) months were admitted to our clinic with same complaints. 17 of 24 patients (70.9%) were treated by applying discectomy, 5 of 24 patients (%20.8) by discectomy and granulation tissue excision and 2 of 24 patients (8.3%) by stabilization with pedicle screws. VAS were obtained from the time of presentation, from the time of hospital discharge, and from the most recent follow-up visit. The mean VAS was 9,08 (6-10) at presentation and 2,33 (0- 5) at final follow-up (P<.001). Discussion: As we examined the lordosis angle in the postoperative period, we found statistically not significant incline in the lumbar lordosis angle. Rediscectomy must be the first step, fusion surgery has to be performed when instability has been diagnosed. Conclusion: We found that there was a marked and statistically significant decline in the disc height and statistically significant increase in signs of degeneration after lumbar disc surgery. In the management of recurent lumbar disc herniation, good assesment should be made in terms of lumbar segmental instability because of increasing in signs of degeneration. We stated that majority of the patients benefited from the repeated discectomy surgery

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1. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br 1998;80(5):825-32.
2. Dvorak J, Gauchat MH, Valach L. The outcome of surgery for lumbar discherniation. A 4-17 years follow-up with emphasis on somatic aspects. Spine 1988;13:1418-22.
3. Jin J, Zhao ZG, Weng XS, Yang Xy, Zhao Y, Qiu GX. Reoperative treatment of lumbar disc herniation. Zhongguo Yi Xue Yuan Xue Bao 2005;27(2):160-4.
4. Loupasis GA, Stamos K, Katonis PG. Seven to 20 year outcome of lumbar discectomy. Spine 1999;24:2313-7.
5. Davis RA. A long term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 1994;80:415-22.
6. Ozgen S, Naderi S, Ozek MM, Pamir MN. Finding and outcome revision lumbar disc surgery. J Spinal Disord 1999;12(4):287-92.
7. Finnegan WJ, Fenlin JM, Marvel JP, Nardini PJ, Rothman RH. Results of surgical intervention in the symptomatic multiple operated back patients: analysis of sixty seven cases followed three to seven years. J Bone Joint Surg Am 1979;61:1077-82.
8. OSullivan MG, Connoly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosurg 1990;4:319-26.
9. Kim HJ, Chung S, Kim S, Shin H, Lee J, Kim S, et al. Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine 2006;15:409- 14.
10. Evcik D, Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int 2003;23:163-5.
11. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation. J Bone Joint Surg Br 1998;80:825-32.
12. Resnick DK, Choudhri TF, Dailey AT. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine 2005;2:673-8.