Patients Undergoing Revision Microdiskectomy for Recurrent Lumbar Disk Herniation Experience Worse Clinical Outcomes and More Revision Surgeries Compared With Patients Undergoing a Primary Microdiskectomy

Introduction: Recurrent disk herniation treatment aims to optimize outcomes. This study compares the demographics and patient-reported outcomes of patients who underwent primary or revision lumbar microdiskectomy surgery for recurrent disk herniation. Methods: A retrospective cohort analysis was performed of consecutive patients who underwent primary or revision lumbar microdiskectomies between January 2008 and December 2015. Patients were divided into two groups: primary (primary) and revision (recurrent). Herniated disks were confirmed preoperatively using MRI. Patient-reported outcomes included Visual Analog Scales (VAS) scores for the back and leg, Oswestry Disability Index scores, 12-Item Short Form Mental and Physical Survey scores, and the Veterans RAND 12-Item Health Mental and Physical Survey scores. Results: One hundred ten patients met inclusion criteria: 72 from primary cohort and 38 from recurrent cohort. Recurrent patients experienced presurgical symptoms for significantly less time. On bivariate analysis, recurrent patients reported significantly worse preoperative VAS-back and VAS-leg scores. On multivariate analysis, recurrent patients reported significantly worse postoperative VAS-back, VAS-leg, and Oswestry Disability Index scores. Recurrent patients were less likely to be satisfied with surgical outcomes and to feel that surgery had met or exceeded their expectations. Conclusion: Patients undergoing revision microdiskectomy are likely to experience worse postoperative symptoms and disability relative to patients undergoing primary microdiskectomy.