Recurrence of sciatica following hemilaminectomy for disc herniation

This retrospective study investigated the causes of ipsilateral sciatica following formal hemilaminectomy and discectomy for disc herniation and analyzed the factors that influence the outcome of revision surgery for recurrence. From a series of 1,016 patients who were operated upon for primary lumbar disc herniation, 64 patients were revised because of persistent or recurrent sciatica and back pain. Successful outcome was achieved in 81% of the patients with pain recurrence within 6 months following unilateral disc herniation at another level, residual disc herniation, recurrence of disc herniation, pseudomeningocele, and epidural hematoma. In contrast, not successful results were noted in the other 19% of reoperated patients later than 6 moths following primary operation for epidural fibrosis, lateral spinal stenosis, or combined. In this series, the outcome following revision surgery was not related to any specific clinical symptoms and physical examination findings, but mainly to the operative findings during revision surgery and the time lapsed between primary and revision surgery. Computed tomography (CT) was less reliable than magnetic resonance imaging (MRI) in detecting pathology prior to revision surgery, particularly in distinguishing between disc prolapse and fibrosis. Operative findings and pain-free interval between primary discectomy and revision surgery determined the outcome of revision surgery for recurrent ipsilateral sciatica, while MRI seems to be the imaging method of choice. Revision surgery for ipsilateral radicular pain following discectomy in this series showed satisfactory results that were comparable with those of primary discectomy.