الفهرس 
Anatomy of the Lumber SpineOnly 14 pages are availabe for public view
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Abstract
Recurrent disc herniation can be defined, as is the presence of herniated disc material at the same level, ipsi- or contralateral, in a patient who has experienced a pain-free interval of at least 6 months following a discectomy surgery.
In this study we operated upon 40 cases with recurrent sciatic pain due to a multiple etiologies.
We concluded the following:
The recurrence rates are higher in males due to higher physical effort.
The most common presentation was sciatic pain and the most common sign was sensory hyposthesia and positive stretch sign.
MRI with contrast is a very sensitive tool for diagnosis and highly specific.
All patients in this study had dynamic X-ray films and if the patient was stable discectomy were done only, if unstable, discectomy and fusion were done. If intra-operative instability was found, fixation added. If inevitable aggressive medial facetectomy was done, fixation also added. Fusion for the recurrent disc patients had a better outcome regarding the back pain and equal to discectomy without fusion regarding the sciatic pain and return to work.
The most common complications of these surgeries were dural tears.
It is widely accepted that the results after repeated surgery are comparable to those of the first intervention.
Co-existence of two discrete types of compressive lesions, recurrent disc & epidural fibrosis, predicted a high risk of bad outcome. Fortunately, preoperative diagnosis of such a co-existence will not be problematic, especially with MRI.
The newer trends worldwide are to utilize the minimally invasive anterior and lateral approaches for the spine like OLIF and DLIF to spare the back muscles.
With the evolution of the modern spinal abdominal retractors the OLIF and the mini ALIF can be done safely and quickly allowing multiple level discectomies throw the same small incision utilizing a sliding window and with a minimal hospital stay and excellent outcome.
In conclusion, surgery for recurrent lumbar disc can be very successful provided proper patient selection, good and thorough examination and investigations and proper surgical technique. Patients with recurrent disc herniation, associated stenosis or instability can achieve potentially good results with repeat surgery.