Is surgery for recurrent lumbar disc herniation worthwhile or futile? A single center observational study with patient reported outcomes

OBJECTIVE: To examine outcomes and complications following microdiscectomy for recurrent lumbar disc herniation. METHODS: Prospectively collected data for patients operated at the Department of Neurosurgery, St. Olavs University Hospital, Norway, were obtained from the Norwegian Registry for Spine Surgery from May 2007 through July 2016. All patients underwent lumbar microdiscectomy. The primary outcome was change in the Oswestry Disability Index (ODI) at one year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions (EQ-5D), back and leg pain measured with numerical rating scales (NRS), complications, and duration of surgery and hospital stays. RESULTS: 276 patients were enrolled in the study. A total of 161 patients (58.3%) completed one-year follow-up. The mean improvement in ODI at one year was 27.1 points (95% CI 23.1 to 31.0, P <0.001). The mean improvement in EQ-5D at one year of 0.47 points (95% CI 0.40–0.54, P <0.001), representing a large effect size (Cohens D ​= ​1.3). The mean improvement in back pain and leg pain NRS were 4.3 points (95% CI 2.2–3.2, P <0.001) and 3.8 points (95% CI 2.8–3.9, P <0.001), respectively. Nine patients (3.3%) experienced intraoperative complications, and 15 (5.5%) out of 160 patients reported complications within three months following hospital discharge. CONCLUSIONS: This study shows that patients operated for recurrent lumbar disc herniation in general report significant clinical improvement.