Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation

A Retrospective Analysis of Three Hundred Twenty-One Cases

Zhonghai Li, MD; Hao Yang, MD; Mozhen Liu, MD; Ming Lu, MD; Jin Chu, MD; Shuxun Hou, MD; Tiesheng Hou, MD


Spine. 2018;43(21):1463-1469. 

In This Article

Abstract and Introduction


Study Design: Retrospective clinical series.

Objective: To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China.

Summary of Background Data: rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent.

Methods: Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis.

Results: There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P < 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH.

Conclusion: Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery.


Lumbar disc herniation (LDH) is one of the most frequent disorders of the lumbar spine. The most common surgical procedure performed for the treatment of LDH causing back and leg pain is lumbar discectomy.[1,2] However, lumbar discectomy has an unsatisfactory outcome in 5% and 20% of cases.[3–7] The most common cause of ongoing disability after discectomy is recurrent LDH (rLDH), which is reported to occur in 5% to 15% of cases, with an increasing incidence over time.[3,5,8–13] rLDH is defined as ipsilateral or contralateral disc herniation at the same level after a pain-free interval of at least 6 months following conventional discectomy.[3,7,8,12–18] rLDH may be caused by further disc material extruding from the disc space, with or without associated scar tissue; retained disc fragments at the time of the first discectomy; or compression of the neural elements by parts of the disc endplate including bone, annulus, and other reactive tissues.[6,19] Secondary surgery will be more difficult due to epidural fibrosis and scarring. Moreover, reoperations lead to physical and psychological suffering for patients and substantial costs for society. It is important to analyze the risk factors of rLDH to prevent recurrence.

Risk factors for rLDH are increasingly being investigated.[3,6,14,20–31] Many estimated risk factors have been reported in previous studies, such as age, sex, body mass index (BMI), smoking, herniation type, diabetes, and herniation level. However, results in these previous studies were not always consistent. Because of inconsistent results, reliable conclusions could not be drawn on these risk factors. In addition, data on studies investigated the effects of biomechanical factors, such as disc height index (DHI), sagittal range of motion (sROM), and some pelvic parameters, on rLDH appear only rarely in the literature.[15,20] To the best of our knowledge, this study is the first report to investigate preoperative facet joint parameters (facet orientation [FO] and facet tropism [FT] as risk factors for rLDH. In this study, we investigated the frequency of rLDH and evaluated risk factors of rLDH in Chinese population by comparing preoperative clinical and biomechanical parameters.