Revision Microdiscectomy for Recurrent Disc Herniation

Clinical Indications

The American College of Radiology recommends MRI for diagnosing recurrent disc herniation with nerve root compromise, which correlates with clinical symptoms of lower extremity weakness, numbness, and radicular pain 1
The American Association of Neurological Surgeons suggests that patients with recurrent disc herniation and severe or progressive neurological deficits, such as motor weakness, may require urgent surgical intervention 2
The American Association of Neurological Surgeons guidelines state that fusion at revision discectomy is recommended primarily for patients with associated lumbar instability, radiographic degenerative changes, chronic axial low-back pain, or spondylolisthesis 2
The American Association of Neurological Surgeons guidelines conclude that there does not appear to be evidence to support the routine use of fusion at the time of an index discectomy operation, and the increase in morbidity, cost, and potential complications associated with the use of fusion are not justified in routine situations 2

The American Association of Neurological Surgeons guidelines support discectomy alone for recurrent herniation, stating that patients with "simple" recurrent herniation did not undergo fusion 2
The American Association of Neurological Surgeons guidelines recommend against routine fusion in patients with recurrent disc herniation without instability, spondylolisthesis, or chronic mechanical back pain 3