An Algorithmic Approach to Recurrent Lumbar Disk Herniation: Evaluation and Management

Recurrent lumbar disk herniation remains the most common complication following primary or incident lumbar limited or subtotal diskectomy. The approach to the evaluation and management is discussed with an algorithmic approach to decision-making. The vast majority of these cases can be managed nonoperatively. When surgery is indicated, the most commonly required procedure is a revision or repeat lumbar diskectomy, which is reviewed and discussed. Another option to consider when back pain and leg pain predominate in the revision setting is the addition of a fusion. This fusion can be added posterolaterally as an interbody fusion or anteriorly. More recently, total disk arthroplasty, a motion-sparing technology, may be an alternative for the recurrent lumbar disk in which back pain and leg pain predominate. The primary purpose of this article was to explain, present, and use the decision-making process through an algorithmic approach and was the emphasis of this article. The article presents examples for each alternative as well as an algorithmic flow diagram. The indications absolute and relative for repeat lumbar diskectomy are also reviewed.

Keywords: recurrent lumbar disk herniation, revision diskectomy, lumbar fusion, diagnosis and evaluation and decision-making