Challenge of the Week / Spine / 10.09.2020

Which of the following is a risk factor for same-level recurrent disc herniation following microdiscectomy?
    • Low-demand occupation
    • Patients with heavy lifting occupations, not low-demand occupations, have a higher risk for same-level recurrent disc herniation following microdiscectomy. Heavy lifting is thought to place great biomechanical stress on the disc, which can lead to recurrent disc herniation

 

    • Age >45 years old at the time of primary herniation
    • Younger age at the time of primary lumbar disc herniation provides a greater risk for same-level recurrent disc herniation following microdiscectomy. Younger patients have more nucleus pulposus remaining that can later herniate, and they engage in more physically demanding activity

 

    • Discrete disc herniation without fragmentation
    • A fragmented intervertebral disc has a higher risk for same-level recurrent disc herniation following microdiscectomy compared with a discrete, contained disc herniation

 

    • Annular tear defect >6 mm
    • An annular tear defect >6 mm presents a risk factor for same-level recurrent disc herniation following microdiscectomy. Carragee, et al. (2003) showed that when the defect is large, the recurrence rate approaches 30%

     

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