Recurrence After Primary Lumbar Discectomy: Rate, Reoperation, and Risk Factors in A Single‐Center Cohort Over A 10‐Year Study Period
Year: 2026
Type: article
Abstract: ABSTRACT Objective Recurrent lumbar disc herniation after primary discectomy is a clinically important complication whose temporal pattern, revision surgical profile, and associated comorbidities remain incompletely characterized in long‐term cohorts. We aimed to define the rate and timing of reoperation‐confirmed recurrence, characterize the revision profile, and examine associated risk factors. Methods This retrospective cohort study included 432 consecutive patients who underwent primary lumbar discectomy between January 2015 and December 2024, with a median follow‐up of 85 months (interquartile range 50–103). Recurrence was defined as reoperation‐confirmed, same‐level ipsilateral reherniation after an initial pain‐free interval. Follow‐up status and external reoperations were verified through the national electronic health record system up to the study end date (6 March 2026), with no loss to follow‐up. Associations were examined using multivariable logistic regression (with Firth penalization) and Cox proportional hazards modeling. Results Reoperation‐confirmed recurrence occurred in 28 patients (6.5%); this represents the reoperation‐confirmed recurrence rate rather than the overall incidence of recurrent herniation, since conservatively managed recurrences were not counted. Recurrence was predominantly late, with 68% of events beyond the first postoperative year (median 18.5 months). At reoperation, 21 patients (75%) required instrumented posterolateral fusion for objective segmental instability, with a mean segmental translation of 4.2 ± 1.1 mm and a mean angulation of 12.2° ± 2.1° on dynamic flexion–extension radiographs, both exceeding the predefined instability thresholds. The remaining 7 patients (25%) underwent revision discectomy alone. No second recurrence occurred over a median post‐revision follow‐up of 61.5 months. In the primary logistic model, hypertension was associated with recurrence (adjusted odds ratio [OR] 3.42, 95% confidence interval [CI] 1.04–11.21; p = 0.043), whereas the association of diabetes mellitus was of similar magnitude but did not reach statistical significance (OR 3.17, 95% CI 0.97–10.35; p = 0.056). Diabetes mellitus reached significance only in the secondary Firth penalized and time‐to‐event analyses. Active smoking was not associated with recurrence (OR 0.64; p = 0.321). Given the limited number of events ( n = 28), these findings should be regarded as hypothesis‐generating rather than confirmatory; in particular, the study was not powered to overturn existing evidence linking smoking with recurrence, and the 10‐year survival estimate is exploratory given few patients at risk beyond 5 years. Conclusion In this 10‐year single‐center cohort, reoperation‐confirmed recurrence occurred in 6.5% of patients and was predominantly late (median 18.5 months), indicating that postoperative surveillance should extend beyond the first year. Three quarters of revisions required instrumented fusion for objective instability. No second recurrence was observed. Hypertension was associated with recurrence in the primary analysis, whereas the association of diabetes mellitus did not reach significance in the primary model and was supported only by secondary analyses. Both comorbidities should be investigated further in adequately powered multicenter studies.
Source: Orthopaedic Surgery
DOI: 10.1111/os.70460
Institution: Afyonkarahisar Sağlık Bilimleri Üniversitesi
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
OpenAlex ID: W7225611686