News Study evaluates the best treatment method for recurrent disc herniation

Most patients only experience one herniated disc in their lives. However, if herniation recurs, a crucial treatment question arises, namely whether to remove part of the intervertebral disc again (microsurgical decompression with removal of the prolapse) or whether stabilising surgery (spinal fusion [spondylodesis]) is the better choice in the long term.

A recent study by our Spine Research Group has investigated precisely this question and systematically compared the two methods.

At Schulthess Klinik, we have been surveying our patients after surgery at regular intervals for over 20 years to find out how they are doing. This data set served as the basis for this study and enabled the analysis of the world’s largest cohort of patients with recurrent disc herniation who were followed over a long period of time.

This combination of case numbers, systematic data collection and long-term follow-up is unique and, for the first time, enables reliable conclusions to be drawn about which treatment is more successful in the long term in the event of recurrent disc herniation.

The results clearly show that both surgical procedures are basically effective. However, the decisive difference lies in the long-term course and the risk of re-intervention.

The study shows that treatment success depends on patient-specific factors. When deciding on a method, the following factors must be taken into account:

• Condition of the spine, e.g. height of the intervertebral disc, osteoarthritis of the facet joint
• Body weight / BMI: a BMI above 30 increases the risk of recurrence
• Number and type of previous operations
• Symptoms: what pain there is and where the pain occurs
• Age and activity level 

The results of the study have a direct impact on our treatment:

• More tailored treatment decisions:
  The choice of surgical method can be tailored to the individual initial situation in a more targeted manner.
• Greater chance of a lasting solution:
  Making the right initial decision in the event of recurrence can reduce the risk of further relapses.
• Fewer follow-up procedures:
  A differentiated indication helps to avoid repeat operations.
• More transparency and security:
  Patients can better understand why which therapy is recommended.

Link to the article in the Journal of Bone and Joint Surgery: The Journal of Bone and Joint Surgery, Inc.