Table 2. Treatment of Recurrent Disc Herniation with Spinal Fusion Studies.
EBL: Estimated Blood Loss; VAS: Visual Analog Scale; ODI: Oswestry Disability Index; LOS: Length of Stay; PLF: Posterior Lumbar Fusion; PLIF: Posterior Lumbar Interbody Fusion; NR: Not Reported; UTI: Urinary Tract Infection; TLIF: Transforaminal Lumbar Interbody Fusion; MIS: Minimally Invasive Surgery; DVT: Deep Vein Thrombosis; JOA: Japanese Orthopedic Association; PSI: Pedicle Screw Instrumentation; UTD: Unable to Determine; PSF: Posterior Spinal Fusion
| Article | Surgery Type | N (% Female) | Study Type | Average Follow-Up, Months (Range) | OR Time, Minutes (Range) | EBL, mL (Range) | Costs | Percent Change in VAS | Percent Change in ODI | Postop LOS, Days (Range) | Outcomes | Percent Showing Good or Excellent Outcomes | Complications in Repeat Surgery | |
| 1 | Niu, 2005 [41] | PLF/PLIF by Dual Cages | 14 (43%) | Prospective | 25 (14-36) | 230 (150 - 350) | 623 (200 - 1,300) | NR | NR | NR | NR | No neurological deficits. | 93% | Superficial wound infection x2, UTI x1, wedged disc x1 |
| 2 | Li, 2015 [48] | TLIF | 73 (42%) | Retrospective, Unrandomized, case control | 49 (12-85) | 105 (70 - 260) | 260 (90 - 800) | NR | Leg: -86.5%; Back: -84.9% | -55.70% | 8.5 | No implant failure. Successful fusion in 92.3%. No permanent neurological deficit | 91.80% | Dural laceration x3, transient neuro deficits x5, revision surgery x3 |
| 3 | Omid-Kashani, 2014 [47] | TLIF | 51 (59%) | Retrospective | 31.4 (25-50) | NR | NR | NR | Leg: -54%; Back: -55.1% | -61.90% | NR | Fusion rate 100%, no instrument failure | 74.60% | Iatrogenic partial L5 root injury x1 |
| 4 | Niesche, 2014 [43] | MIS-TLIF | 14 | Retrospective | 52 (48 - 59) | 140 (95 - 190) | 150 (120 - 370) | NR | -56.52% | -64.71% | 5 (3 - 7) | Solid radiographic fusion at 24 months; no development of adjacent disc disease | 85% | None |
| Open-TLIF | 19 | 130 (80 - 190) | 380 (350 - 620) | NR | -56.52% | -64.71% | 10 (8-14) | Solid radiographic fusion at 24 months; improvement in VAS and ODI not as significant compared to MIS | 68.30% | 4 revisions due to wound healing disorders, 2 with neurologic deterioration due to radiculopathy | ||||
| 5 | Lequin, 2014 [21] | PLIF | 26 | Retrospective | 15.3 | NR | NR | NR | -46.02% | NR | NR | 85% with subjective improvement after reoperation | 46% with good recovery | 2 hematomas, 2 dural tears, 4 with increased/new neurologic deficits, 1 superficial wound infection |
| 6 | El Shazly, 2013 [27] | Discectomy | 15 (46.7%) | Prospective, Randomized, Comparative | 38.6 ± 7.73 | 125.3 ± 25.32 | 256.7 ± 67.13 | $1,520 ± 36.84 | +52.17% in JOA score | NR | 3.4 | Overall, all three methods showed significant improvements postoperatively. Discectomy with fusion was associated with better improvement in pain and less complications. PLF was more cost-effective compared to TLIF | 86.70% | Recurrent herniation x1, postop instability x1, postop neurological deficit x2, dural tear x 4 |
| Discectomy with TLIF | 15 (40%) | 36.3 ± 8.06 | 194 ± 25.58 | 653.3 ± 183.68 | $2,776.7 ± 56.27 | +70.0% in JOA score | NR | 3.5 | 93.30% | Postop neurological deficit x1, dural tear x2, DVT x1 | ||||
| Discectomy with PLF | 15 (46.7%) | 36.1 ± 8.05 | 186 ± 16.82 | 660 ± 164.97 | $2,186.7 ± 52.33 | +60.71% in JOA score | NR | 3.3 | 86.70% | Dural tear x1, superficial wound infection x1 | ||||
| 7 | Sonmez, 2013 [2] | Unilateral MIS-TLIF with Pedical Screw Instrumentation | 10 (60%) | Prospective | 24 | 100 | 150 | 2,900 Turkish Lira | -78.82% | -55.07% | 2.2 | Unilateral MIS TLIF with PSI had comparable results to bilateral instrumentation in improving back pain and was much more cost-effective | NR | None |
| Bilateral MIS-TLIF with Pedical Screw Instrumentation | 10 (50%) | 147 | 165 | 4,700 Turkish Lira | -79.76% | -50.68% | 2.3 | NR | None | |||||
| 8 | Chen, 2009 [49] | TLIF | 43 | UTD | 45 (24-72) | NR | NR | NR | +62.8% in JOA score | NR | NR | The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit. The fusion rate was 100% two years postoperatively. No implant failure | 86.1% based on JOA score | Three patients (7%) had transient neurological deficits |
| 9 | Fu, 2005 [22] | Discectomy | 23 | Retrospective | 88.7 (60 –134) | 100.9 ± 22.8 | 162.7 ± 106.8 | NR | +62.45% in JOA score | NR | 4.7 ± 1.4 | Intraoperative blood loss, length of surgery, and length of hospitalization were significantly less in patients undergoing discectomy alone than in patients with fusion. | 78.3% based on JOA score | 3 dural tears |
| Discectomy with PLF | 18 | 166.3 ± 26.7 | 546.7 ± 206.1 | NR | +66.02% in JOA score | NR | 6.2 ± 1.1 | 83.3% based on JOA score | 1 superficial infection, 2 dural tears, and 3 residual donor site pain | |||||
| 10 | Huang, 2002 [42] | PLIF with single, central cage and bilateral PSF | 28 (64.3%) | Retrospective | 14.4 (8-39) | NR | NR | NR | NR | NR | NR | Rate of bony fusion was 82.14%. Several patients with improved economic and functional status | 92.86% | 1 dural tear, 1 with transient paresthesias, and 1 with transient bladder atony |