Is spinal fusion the preferred treatment for recurrent lumbar disc herniation of the lumbar spine?

Study design: Retrospective cohort study.
Objective: To reassess the necessity of fusion in the surgical management of recurrent lumbar disc herniation (rLDH).
Introduction: Recurrent lumbar disc herniation (rLDH) is a challenging condition that often necessitates surgical intervention. The optimal surgical approach for patients with rLDH remains controversial, particularly in cases requiring repeat surgical procedures. This study aims to evaluate the outcomes of surgical management in patients who underwent hernia excision without or with spinal fusion.
Materials and Methods: We conducted a retrospective cohort study involving 95 patients who underwent surgery for rLDH, divided into two groups: Group A without fusion and Group B with fusion. The follow-up period ranged from two to three years. Hernia excision without fusion was performed on 77 patients (81.05%), while 18 patients (18.95%) underwent hernia excision with spinal fusion.
Results: Both surgical methods, with or without fusion, achieved positive clinical outcomes and demonstrated acceptable improvements in both groups. However, there was a relative preference for spinal fusion. This study provides valuable insights into the development of a unified treatment protocol and systematic method for postoperative follow-up of patients with recurrent lumbar disc prolapse.
Conclusion: Although the Japanese Orthopaedic Association scores appear similar in both groups, fusion prevents new recurrence and results in fewer complications. Therefore, fusion may be the preferred treatment option for patients with recurrent lumbar disc prolapses requiring surgical intervention.