Predicting Repeat of Disc Herniations: Chiropractic Implications
Published on November 27, 2009
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A retrospective study from the November 15th issue of Spine evaluated radiographs for biomechanical and other markers that would help identify patients at risk for repeat lumbar disc herniation. A repeat was defined as a herniation of the same disc after a “successful” first surgery where the patient was asymptomatic for a period of at least six months. The study analyzed a group of 157 disc surgery patients to determine risk factors that might help predict which patients would have repeat herniations.
 Very similar to the co-morbidities seen with low back pain in chiropractic practice, risk factors for repeat herniation included lifestyle factors; the most significant were smoking and obesity. The smoking rate of recurring disc herniation patients was 71.4% and the smoking rate for patients who did not have recurring herniation was only 38.5%. Previous studies have demonstrated that smoking promotes disc degeneration and decreases circulation that is necessary to nurture the disc and facilitate healing when there is disc damage.
In addition to smoking, disc height, reduced range of motion, and disc degeneration were significant risk factors for patients with repeat lumbar disc herniation. Patients who have had previous disc surgery are common in chiropractic practice. Educating patients about these risk factors and aiding them in making the appropriate lifestyle changes can help prevent recurrent herniation and future surgery.
Disc height and segmental motion as risk factors for recurrent lumbar disc herniation.Spine (Phila Pa 1976). 2009 Nov 15;34(24):2674-8. Kim KT, Park SW, Kim YB. Department of Neurosurgery, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea. STUDY DESIGN: Retrospective review and multivariate analysis. OBJECTIVES: Recurrent lumbar disc herniation (rLDH) is a repeated disc herniation at a previously operated disc level in patients who experienced a pain-free interval of at least 6 months after surgery. We investigated whether the preoperative radiologic biomechanical factors (disc height index [DHI] and sagittal range of motion [sROM]) have any effect on rLDH. SUMMARY OF BACKGROUND DATA: rLDH has been reported in 5% to 15% of patients. There have been many studies suggesting various risk factors for rLDH, such as disc degeneration, trauma, age, smoking, gender, and obesity. However, these factors did not reflect a biomechanical effect on the affected joint directly. Investigation of DHI and sROM would be helpful to understand the biomechanical impact on the occurrence of rLDH. METHODS: This study enrolled 157 patients who underwent surgery for L4-L5 LDH. We divided the patients into the recurrent and the nonrecurrent group and compared their clinical parameters (age, sex, body-mass index, symptom duration, diabetes, smoking, herniation type, preoperative visual analogue scale) and preoperative radiologic parameters (disc degeneration, DHI, sROM). RESULTS: rLDH occurred at 40.8+/-15.5 months (7-70 months) after primary surgery. Mean DHI was 0.37+/-0.09 and 0.29+/-0.09 in the recurrent and the nonrecurrent group, respectively (P<0.05). Mean sROM was 11.3 degrees+/-2.9 degrees and 5.9 degrees+/-3.7 degrees in the recurrent and the nonrecurrent group, respectively (P<0.05). Both smoking and disc degeneration were related with the development of rLDH (P<0.05). CONCLUSION: Together with our data, DHI and sROM showed a significant correlation with the incidence of recurrent lumbar disc herniation, suggesting that preoperative biomechanical conditions of the spine can be an important pathogenic factor in the site of lumbar disc surgery.
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