Newswise — RUDN University doctors compared the classic approach to surgical treatment of recurrent intervertebral hernia with a modified one. The traditional technique is the simple removal of the intervertebral disc; in the modified surgery, the vertebrae are united together afterward. The first option is cheaper, but the second eliminates the risk of relapse. The results were published in Annals of Medicine and Surgery.
Destruction of the intervertebral disc can lead to intervertebral herniation - protrusion of the disc nucleus into the intervertebral canal. Hernias do not always require surgery, but if necessary, a discectomy is usually performed. The intervertebral disc is completely or partially removed. However, a few months after the discectomy, the hernia may return, and to the same extent. In this case, a repeat discectomy can be performed. Recent studies indicate the effectiveness of a spinal fusion method when after removing the disc, the vertebral bodies are united together with plates and screws. The purpose of this operation is to limit the mobility of the vertebrae. RUDN doctors compared the results of classic repeat discectomy and spinal fusion.
“Repeat discectomy is widely recommended due to its minimal invasiveness, rapid patient recovery, and low cost of surgery. However, it carries a risk of recurrence and vertebral instability. Spinal fusion is more expensive and requires a longer hospital stay. We compared postoperative outcomes in patients who underwent repeat discectomy with and without spinal fusion,” - Musa Gerald, an assistant at the Department of Neurology and Neurosurgery with a course of comprehensive rehabilitation at RUDN University said.
The study was conducted retrospectively among 74 patients with recurrent lumbar disc herniation from 2018 to 2023. 40 patients underwent discectomy without fusion of the vertebrae, the remaining 34 underwent spinal fusion. To ensure that patients had similar degrees of disease, they were selected based on X-rays taken before surgery. Spinal fusion was prescribed to patients with severe vertebral instability if the displacement was more than 4 mm or the angle of inclination exceeded 10°. All patients had previously undergone discectomy and had no complaints for at least a month after it.
Discectomy causes less blood loss - on average 88.75 ml versus 111.47 ml for spinal fusion. However, the latter showed better results on the ODI back pain score - 4.21 instead of 9.27 for discectomy. Finally, 22% of patients with repeat discectomy experienced recurrent herniation. After spinal fusion, no recurrent cases were identified at all.
“Spinal fusion and repeat discectomy for recurrent lumbar disc herniation are comparable in terms of blood loss during surgery, the duration of the operation itself, and hospital stay. However, in terms of pain, spinal fusion is easier to tolerate than discectomy. This is associated with instability in discectomy patients. After spinal fusion, these processes are eliminated and slowed down, no relapses were observed,” Musa Gerald, assistant at the Department of Neurology and Neurosurgery with a course of comprehensive rehabilitation at RUDN University said.
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