The Debate on Most Ideal Technique for Managing Recurrent Lumbar Disc Herniation: Where are we?

Background: Though different techniques have been previously employed in the treatment of recurrent lumbar disc herniation, the one which is most ideal has remained a controversial issue, particularly with no current generally accepted guidelines for surgical care. Objectives: We 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. Method: A systematic literature review of previous publications on the various techniques employed in the surgical treatment of recurrent disc herniation. Results: All publications investigated in this review clearly demonstrate quite comparable outcomes, and none of the studies shows any superiority of one method over the other. In spite of less time, less cost, faster recovery and early return to work commonly associated with the minimally invasive techniques, their overall results and outcomes still remain quite comparable to the older conventional techniques and they appear to have no overall advantage over the older techniques. We suggest that where the expertise is available, revision by minimally invasive techniques should be preferred to the conventional open surgical approaches. If otherwise, the choice of operative technique should simply be based on the experience of the surgeon, the armamentarium of available facilities and equipment. Fusion should not be undertaken in all recurrences or for subsequent herniations but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.