Cheng‑Huan Penga,b, Ing‑Ho Chena,b, Tzai‑Chiu Yua,b, Jen-Hung Wangc, Wen‑Tien Wua,b*, Kuang‑Ting Yeha,b,d*
aDepartment of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, cDepartment of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, dGraduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
ABSTRACT
Objectives: Discectomy is the most common surgery for lumbar herniated intervertebral disc (HIVD) disease. However, 5%–24% of patients undergo a second surgery due to recurrent disc herniation. Materials and Methods: This study was aimed to identify the
risk factors for reoperation after discectomy of lumbar HIVD and recommend treatment forpatients with a high risk of reoperation. We recruited patients diagnosed as having single‑levellumbar HIVD who underwent open discectomy from January 1, 2000, to December 31, 2012in our hospital. We used a survival curve to inspect the survival time and reoperation rateafter surgery. We discussed the correlation of reoperation rate with discectomy level, body mass index, heavy lifting after surgery, sex, and age. Furthermore, we investigated the correlation between the experience of a surgeon and the reoperation rate. Results: A total of 619 patients were enrolled in our study. Most patients were 40–60 years old (48.8%), and most of them had herniation at L4/5 level (48.9%). The 8‑year survival rate was 92%. Weight lifting after surgery may increase the reoperation rate by 115 and 18 times for those >60 years and <40 years, respectively. In addition, less experience of the surgeon and female sex had a high reoperation rate. Conclusion: Postoperative working modification may be very important for preventing patients from recurrent HIVD. For elderly people with HIVD, a more conservative therapy could be selected. If patients with lumbar spine hypermobility or severe degeneration require wide laminectomy, primary fusion should be considered.
Keywords: Discectomy, Heavy lifting after surgery, Herniated intervertebral disc,
Reoperation rate, Survival rate
