The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review

Background: Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, particularly since there are currently no generally accepted guidelines for surgical care. Objective: To review previous publications comparing the available operative options, with the aim of determining if any of the available interventions gives better outcomes compared to others. Methods: A systematic literature review of previous publications comparing various techniques employed in the surgical treatment of recurrent disc herniation. Results: All publications investigated in this review clearly demonstrated quite comparable outcomes, with no superiority of one method over the other. Conclusion: In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. We suggest the management strategy for surgical treatment of each case of recurrence to be simply based on the experience of the surgeon, the available facilities and equipment. Fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.