Recurrent Disc Herniation: Treatment Options and Risks

Herniated disc 1

Hello, I had surgery for a herniated disc between the fourth and fifth lumbar vertebrae on January 12, 2016.
I felt that my recovery was quite good after the surgery.
After resting at home for a month, I returned to work, but not long after, I experienced pain and had to return for a follow-up.
On April 26, 2016, I was diagnosed with a recurrence, and the herniation was found to be more extensive than what was previously diagnosed.
The doctor has suggested another surgery.
I would like to ask if, in this situation, it is possible to undergo rehabilitation therapy, or if having another surgery would carry additional risks or complications.
Thank you!

Mr. Wang, 40~49 year old female. Ask Date: 2016/04/28

Dr. Lai Zhaokang reply Neurosurgery

If there is a recurrence, and it is more than before...
1.
Rehabilitation generally only helps to manage pain and does not provide a fundamental cure.
2.
It is still recommended to consider surgery again.
3.
However, this time you need to consider the possibility of an artificial implant; if it is just a removal again, there is still a chance of a third occurrence.
4.
As for the details of the surgery, you can consult your original physician or come to my clinic for a consultation.
Wishing you a speedy recovery.
// Director Lai Chao-Kang, Department of Spine and Neurosurgery, Changhua Hospital.

Reply Date: 2016/04/28

More Info

Recurrent disc herniation is a common concern for patients who have undergone spinal surgery, particularly for conditions like lumbar disc herniation. The situation you described, where you experienced a recurrence of symptoms after an initial surgery, is not uncommon. The decision to pursue further surgical intervention or to continue with conservative treatment options can be complex and should be made in consultation with your healthcare provider.

Understanding Recurrent Disc Herniation
Recurrent disc herniation occurs when the disc material that was previously removed during surgery either re-herniates or when adjacent discs become herniated due to the increased stress on the spine. Factors contributing to this recurrence can include:
1. Biomechanical Changes: After surgery, the mechanics of the spine may change, placing additional stress on adjacent discs.

2. Inadequate Rehabilitation: Insufficient rehabilitation or premature return to activities can lead to re-injury.

3. Underlying Conditions: Conditions such as degenerative disc disease or spinal instability can predispose individuals to further herniation.

Treatment Options
1. Conservative Management: Before considering another surgery, many physicians recommend a conservative approach, which may include:
- Physical Therapy: Tailored exercises to strengthen the core and improve flexibility can help alleviate pain and prevent further injury.

- Pain Management: Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) or corticosteroids may be prescribed to manage pain and inflammation.

- Epidural Steroid Injections: These can provide temporary relief by reducing inflammation around the affected nerve roots.

2. Surgical Options: If conservative management fails and symptoms persist, surgery may be necessary. The options include:
- Repeat Discectomy: This involves removing the herniated portion of the disc again.

- Spinal Fusion: In cases where there is significant instability, fusion may be recommended to stabilize the spine.

- Minimally Invasive Techniques: These can reduce recovery time and minimize damage to surrounding tissues.

Risks and Considerations of Surgery
While surgery can be effective, it is not without risks. Potential complications include:
- Infection: As with any surgical procedure, there is a risk of infection.

- Nerve Damage: Although rare, there is a possibility of nerve damage during surgery, which could lead to persistent pain or neurological deficits.

- Scar Tissue Formation: Post-surgical scar tissue can develop, potentially leading to pain or nerve compression.

- Recurrent Herniation: There is still a risk of recurrence even after a second surgery.

Conclusion
In your case, it is essential to weigh the benefits and risks of further surgical intervention against the potential for improvement through conservative management. Discussing your specific symptoms, the results of imaging studies, and your overall health with your healthcare provider will help determine the best course of action.
If you are considering surgery, ensure you have a thorough discussion with your surgeon about the expected outcomes, potential complications, and the likelihood of recurrence. Additionally, engaging in a structured rehabilitation program post-surgery can significantly improve your chances of a successful recovery and reduce the risk of future herniations.
Ultimately, the goal is to manage your symptoms effectively while minimizing the risk of further complications. Regular follow-ups with your healthcare provider will be crucial in monitoring your condition and adjusting your treatment plan as necessary.

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