An interesting article by colleagues from Australia (PMID: undefined
undefined 33254135). Michael Brooks and colleagues make a very thorough analysis of the literature about recurrent disc herniations.
Lumbar discectomy in the treatment of lumbar disc herniation
is a common procedure. Excellent patient results are almost always reported. However, recurrence of the hernia remains one of the most common complications of the procedure, often requiring reoperation. It is known that the risk of recurrent hernia depends on various factors and in this systematic review the authors aim to examine the radiological predictors of recurrence. A systematic review and meta-analysis was conducted to identify studies analyzing radiological predictors of recurrent disc herniation
. A search was conducted in Medline and EMBASE. Both retrospective and prospective comparative studies measuring the radiological parameters of patients after lumbar discectomy are included. All factors were considered independently of imaging and a meta-analysis of the data was performed, in which 5 or more studies were analyzed analyzing the same parameters. A total of 1626 studies were reviewed, 23 of which were included in this review, of which 13 were suitable for meta-analysis. Three factors, namely the disc height index, the modified changes and the sagittal range of motion, are significantly correlated with an increased recurrence rate of lumbar disc herniation
. Some variables were considered in only 1 or 2 different studies.
Findings for links between radiological parameters and recurrent lumbar disc herniation < suggest the role of hypermobility or instability in the spinal segment in the development of relapse. Understanding the physiological factors associated with instability is important because although early degenerative disc changes may predispose patients to recurrence of lumbar disc herniation
, more advanced degeneration probably reduces segmental movement and at the same time reduces the risk of recurrence.