Comparison the Recurrence Rate of Intervertebral Disc Herniation in Two Surgical Methods of Hemi laminectomy and Partial Laminectomy

Between 5% and 15% of patients with low back pain suffer from lumbar disc herniation, so intervertebral disc disease is one of the most common causes of low back pain. Surgical intervention for lumbar disc herniation is recommended in patients with severe symptoms and has hopeful results. Although surgery can reduce pain and improve physical function in the short term, its long-term effect is debatable. Recurrence of disc herniation is one of the complications of primary surgery. The reported rate of recurrent disc herniation is 5 to 15% according to the evidence in the literature. Although there are different surgical methods for the treatment of recurrent disc herniation, there is a difference of opinion among surgeons in choosing the surgical method. Lumbar intervertebral disc herniation is a major disease of the spine. Surgical treatment is recommended in cases where patients have irreversible symptoms due to this disease. However, other techniques, such as fusion surgery, laminectomy, and percutaneous endoscopic lumbar discectomy, also apply new tools in line with minimally invasive spinal surgery techniques. Gathering information about various factors influencing the recurrence of the disease, such as individual demographic variables and the type of surgical procedure, helps in better planning for the treatment of intervertebral disc herniation. Numerous studies have been performed to determine the causes of recurrence of lumbar disc herniation, and various risk factors have been suggested, including disc herniation, trauma, age, smoking, gender, and obesity. The aim of this study was to determine the frequency of recurrence of lumbar intervertebral disc herniation in both hemilaminectomy and partial laminectomy.

This study is analytical and retrospective. This study was performed on patients who have had at least 6 months since surgery for the treatment of lumbar intervertebral disc herniation and have obtained informed consent. 400 patients who were candidates for lumbar intervertebral disc herniation surgery in Mortaz Hospital in Yazd from 2016 to 2019 were divided into two groups in terms of the type of surgery, hemilaminectomy and partial laminectomy, and were evaluated and compared during six-month to three-year follow-up. Patients who were candidates for lumbar intervertebral disc herniation based on diagnosis and imaging results were used as the inclusion criteria. Patients with spinal canal stenosis, lumbar spine slippage, and dissatisfaction to participate in this study were excluded. Data included age, gender, body mass index, smoking, type of occupation (light or heavy), type of disc herniation (extruded or non-extruded), diabetes status, recurrence time, and type of surgery (partial laminectomy or hemilaminectomy). In the follow-up and review of the treatment process, information on recurrence of disc herniation was referred to. In addition to assessing the relationship between the type of surgery and recurrence of disc herniation, other possible risk factors for recurrence of disc herniation in terms of its impact on the type of surgery were studied.

The frequency of the first group consists of patients who underwent partial laminectomy and includes 338 patients (84.5%) and the second group of patients who underwent hemilaminectomy surgery which includes 62 patients (15.5%). The overall risk of recurrence, regardless of the surgical procedure, was 35 in 8.8%. In the group of 338 patients who underwent partial laminectomy, 26 patients (7.7%) had a recurrence of lumbar intervertebral disc herniation. In the group of patients who underwent hemilaminectomy, 9 out of 62 patients had a recurrence of disc herniation, which is equivalent to 14.5% of patients. In this study, no significant difference was found between the recurrence rate of lumbar intervertebral disc herniation in two methods of hemilaminectomy and partial laminectomy, which was evaluated by the Chi-square test (P = 0.08). The mean age of the samples was 47. 0.8 with a range of 15 to 79 years. In 338 patients who underwent partial laminectomy, the mean age was 47.98 years and in 62 patients who underwent hemilaminectomy, the mean age was 47.25, which was not significantly different from p = 0.689. Also, the mean duration of recurrence after partial laminectomy was approximately 6 months and in hemilaminectomy was 9 months. This relationship was evaluated by T-Test and was not significant with p = 0.135. The results of this study showed that in the sex variable, there was no difference in the recurrence rate of lumbar intervertebral disc herniation in both surgical methods of hemi laminectomy and partial laminectomy in males, but was significant in females with P = 0.036 In this study, diabetic and non-diabetic patients had no difference in recurrence rate in partial laminectomy and hemilaminectomy (p = 0.261). According to the results, there is no significant difference in the recurrence rate of lumbar intervertebral disc herniation in hemilaminectomy (P = 0.170) and partial laminectomy (P = 0.251) according to the type of disc herniation. According to the results of this study, the risk of recurrence of lumbar intervertebral disc herniation in people with light occupations in partial laminectomy surgery is lower than in hemilaminectomy surgery. Also, the risk of recurrence in non-smokers in partial laminectomy and hemilaminectomy was 7.2 and 17.3, respectively, and was significant with p = 0.030. The risk of recurrence of lumbar intervertebral disc herniation in the age range of 54-45 years was less in partial laminectomy than in hemi laminectomy. Regarding body mass index, none of the intervals had an effect on the risk of disease recurrence.

Based on the results of this study, there is no statistically significant difference in the recurrence of intervertebral disc herniation in both surgical methods of hemi laminectomy and partial laminectomy. However, the factors influencing the recurrence of intervertebral disc herniation were identified in this study, which made a difference between hemi laminectomy and partial laminectomy in the studied patients. According to these factors, risk factors can be determined to prevent the recurrence of disc herniation after surgery. Factors such as gender, age range, smoking, and type of occupation were identified in this study. Depending on the type of occupation, a suitable intervention for disc herniation surgery can be selected with fewer possible complications. In the present study, body mass index and weight were calculated on the outcome of surgery and hernia recurrence without any effect. However, due to the effectiveness of this risk factor, similar studies are needed to be more certain. To confirm the findings obtained in this study and also to compare them, it is suggested that other studies be performed with a higher number of samples and multicenter sampling.