The evidence-based approach for surgical complications in the treatment of lumbar disc herniation
- 54 Downloads
The purpose of this article is to review the evidence-based approach for surgical complications following disc herniation.
A search of the primary English literature was conducted for research examining the outcomes and complications of surgical discectomy. Special regard was given to high-quality prospective randomized studies.
The most commonly reported complications of surgical treatment of disc herniation are included in this review. Medical complications, and surgical complications including infection, durotomy, neurological injury, symptomatic re-herniation, and revision surgery are defined and systematically reviewed in detail for incidence, evaluation, and management.
This article provides the clinician and surgeon with a review of the evidence-based evaluation and management of surgical complications following disc herniation, offering best practice guidelines for informed discussions with patients in shared decision-making.
KeywordsDisc herniation Lumbar microdiscectomy Complications Durotomy Re-herniation
Compliance with ethical standards
Conflict of interest
Eric Klineberg MD declares personal fees from Depuy Synthes, personal fees from Stryker, personal fees from K2M, personal fees from Springer, personal fees from Trevena, personal fees from Allosource, grants and personal fees from AO Spine, personal fees from Medicrea, outside of the submitted work.
Robert Harper MD declares that he has no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, Chan L (2006) Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine 31(17):1957–1963; discussion 1964. https://doi.org/10.1097/01.brs.0000229148.63418.c1 CrossRefPubMedGoogle Scholar
- 3.Best NM, Sasso RC (2006) Success and safety in outpatient microlumbar discectomy. J Spinal Disord Tech 19(5):334–337. https://doi.org/10.1097/01.bsd.0000210119.47387.44 CrossRefPubMedGoogle Scholar
- 4.Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, Herkowitz H, Weinstein JN (2014) Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine 39(1):3–16. https://doi.org/10.1097/BRS.0000000000000088 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Thome C, Klassen PD, Bouma GJ, Kursumovic A, Fandino J, Barth M, Arts M, van den Brink W, Bostelmann R, Hegewald A, Heidecke V, Vajkoczy P, Frohlich S, Wolfs J, Assaker R, Van de Kelft E, Kohler HP, Jadik S, Eustacchio S, Hes R, Martens F, Annular Closure RCTSG (2018) Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial. Spine J. https://doi.org/10.1016/j.spinee.2018.05.003
- 17.McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 34(19):2044–2051. https://doi.org/10.1097/BRS.0b013e3181b34a9a CrossRefPubMedGoogle Scholar
- 19.Wera GD, Dean CL, Ahn UM, Marcus RE, Cassinelli EH, Bohlman HH, Ahn NU (2008) Reherniation and failure after lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy. J Spinal Disord Tech 21(5):316–319. https://doi.org/10.1097/BSD.0b013e31813e0314 CrossRefPubMedGoogle Scholar
- 20.Watters WC 3rd, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9(3):240–257. https://doi.org/10.1016/j.spinee.2008.08.005 CrossRefPubMedGoogle Scholar
- 21.Shin EH, Cho KJ, Kim YT, Park MH (2018) Risk factors for recurrent lumbar disc herniation after discectomy. Int Orthop. https://doi.org/10.1007/s00264-018-4201-7
- 25.Papadopoulos EC, Girardi FP, Sandhu HS, Sama AA, Parvataneni HK, O'Leary PF, Cammisa FP Jr (2006) Outcome of revision discectomies following recurrent lumbar disc herniation. Spine 31(13):1473–1476. https://doi.org/10.1097/01.brs.0000219872.43318.7a CrossRefPubMedGoogle Scholar