Spinal disc reherniation disc can occur after discectomy surgery or after organic resolution of a previous intervertebral bulge. Reherniation is actually a very common event that affects a significant percentage of postoperative discectomy and IDET patients, as well as many patients who are told that a previous MRI-verified disc prolapse has corrected itself.
Reherniation is an occurrence that most patients never even consider and most surgeons will not make their patients aware of the possibility of reherniation following disc surgery. We take major issue with this, as it is a fact that every discectomy candidate should know before deciding on whether or not disc surgery is right for them.
This essay examines the possibility of suffering a recurrence of herniation in a surgically-treated disc, as well as in normal intervertebral bulges that do not require any formal treatment. We will explore why recurrences of herniations happen and why we take such offense that surgeons are not more forthcoming with this information prior to their patients going to sleep on their operating tables.
What is Spinal Disc Reherniation?
Reherniation describes a condition where a previously bulging or herniated disc once again demonstrates a bulge or herniation after the initial structural abnormality resolves. There are 2 primary circumstances wherein spinal disc reherniation can occur:
Doctors now know that intervertebral bulging is a completely normal aspect of the lifecycle of a spinal disc. Discs often bulge temporarily in response to stresses and mechanical adjustments in the spine. Some bulging discs are truly transitory, only lasting minutes, while others are “semi-permanent”, enduring for days, weeks or months. When one of these transient or temporary bulges organically corrects itself (and this occurrence is very normal also), there is the chance that the disc can reherniate at some point in the future. In fact, cyclical herniation seems to be a regular occurrence in the spine and may lead to permanent herniation, as well as eventual intervertebral rupture.
The second scenario involving reherniation of a spinal disc is following corrective discectomy surgery. In these circumstances, patients receive invasive treatment for a pathological herniated disc, usually in the form of minimally invasive discectomy, but also including the possibility for IDET or nucleoplasty techniques, as well. The surgery is deemed a success and the follow-up imaging shows that the disc herniation has been “cured”. However, at some point immediately or eventually, the disc reherniates, placing the patient right back to the starting line when it comes to treatment.
What Causes Disc Reherniation?
In cases where organic amelioration of a disc bulge occurs, reherniation is just part of the continuing cycle of intervertebral degeneration and aging. In essence, the reherniation is normal and not preventable. Medical research shows that disc desiccation causes the outer disc wall, called the annulus fibrosus, to weaken with the passage of time and with physical activity. After all, the disc must bend and flex continuously throughout its lifetime and all this wear will produce structural deterioration.
Following disc surgery, the operation itself may be considered a primary causation of reherniation. Remember that all forms of disc surgery utilize practices that pierce the outer disc wall, causing a defect and weakening the structural integrity of the tissue. Furthermore, the spine must continue to perform as it is organically designed to do and stress will continue to be applied to the now compromised spinal disc. It is no surprise that the disc often reherniates and sometimes actually worsens significantly in its clinical presentation post-discectomy treatment.
Warnings for Spinal Disc Reherniation
There is no way to predict or prevent organic spinal disc reherniation from occurring. It is just part of the normal spinal processes that we all endure as we age. Furthermore, it is important to note that virtually all bulging discs, and most herniated discs, are not symptomatic or pathological in any way. They are merely there and when bulging resolves or returns, most patients will never even be aware of the structural changes continuously occurring in their spinal columns. However, we do have several dire warnings for patients who are considering herniated disc surgery:
The vast majority of disc surgery is not needed. There is often no proof that the disc is pathological. Most disc diagnoses are nothing more than scapegoats for incidental back or neck pain.
Given that a disc is truly pathological, it is logical to decide upon curative treatment. However, surgery will inherently damage the disc more by compromising its structural integrity and creating ample opportunity for the herniation to worsen when it recurs due to destruction of the outer disc wall. Of course, this point is only relevant for intact herniated discs that are to be treated surgically. Ruptured discs have already been breached and surgery will not do any damage that nature has not already itself committed.
Given that a herniation was indeed pathological and surgery was successful, spinal disc reherniation occurs in a significant number of patients. We have concluded that this number ranges between 35% to 50% of postoperative patients, depending on the nature of the disc issue treated and the variation of surgery performed.
Finally, we must make sure that patients are aware that virtually all disc surgeries fail to deliver satisfying outcomes over timelines of 7 years. The vast majority of postoperative patients suffer unsuccessful surgery and continuing pain, spinal disc reherniation and recurring pain, or demonstrate a new herniation at a neighboring level and recommencement of pain.
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