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Recurrent Disc Herniation
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Failed back surgery syndrome (FBSS)
              • Recurrent protrusion/extrusion
            • Definitions

              • Focal extension of disc material beyond endplate margins at previously operated intervertebral disc level

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Mroz TE et al: Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 14(10):2334-43, 2014
                                              2. Ambrossi GL et al: Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery. 65(3):574-8; discussion 578, 2009
                                              3. McGirt MJ et al: A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976). 34(19):2044-51, 2009
                                              4. Ruetten S et al: Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech. 22(2):122-9, 2009
                                              5. Schofferman J et al: Failed back surgery: etiology and diagnostic evaluation. Spine J. 3(5):400-3, 2003
                                              6. Babar S et al: MRI of the post-discectomy lumbar spine. Clin Radiol. 57(11):969-81, 2002
                                              7. Barrera MC et al: Post-operative lumbar spine: comparative study of TSE T2 and turbo-FLAIR sequences vs contrast-enhanced SE T1. Clin Radiol. 56(2):133-7, 2001
                                              8. Suk KS et al: Recurrent lumbar disc herniation: results of operative management. Spine. 26(6):672-6, 2001
                                              9. Ross JS: Magnetic resonance imaging of the postoperative spine. Semin Musculoskelet Radiol. 4(3):281-91, 2000
                                              10. Bradley WG: Use of contrast in MR imaging of the lumbar spine. Magn Reson Imaging Clin N Am. 7(3):439-57, vii, 1999
                                              11. Loupasis GA et al: Seven- to 20-year outcome of lumbar discectomy. Spine. 24(22):2313-7, 1999
                                              12. Grane P: The postoperative lumbar spine. A radiological investigation of the lumbar spine after discectomy using MR imaging and CT. Acta Radiol Suppl. 414:1-23, 1998
                                              13. Wilmink JT et al: MRI of the postoperative lumbar spine: triple-dose gadodiamide and fat suppression. Neuroradiology. 39(8):589-92, 1997
                                              14. Fiume D et al: Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir Suppl (Wien). 64:116-8, 1995
                                              15. Djukic S et al: The lumbar spine: postoperative magnetic resonance imaging. Bildgebung. 59(3):136-46, 1992
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Failed back surgery syndrome (FBSS)
                                                          • Recurrent protrusion/extrusion
                                                        • Definitions

                                                          • Focal extension of disc material beyond endplate margins at previously operated intervertebral disc level

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nonvascular Interventions

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Mroz TE et al: Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 14(10):2334-43, 2014
                                                                                          2. Ambrossi GL et al: Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery. 65(3):574-8; discussion 578, 2009
                                                                                          3. McGirt MJ et al: A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976). 34(19):2044-51, 2009
                                                                                          4. Ruetten S et al: Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech. 22(2):122-9, 2009
                                                                                          5. Schofferman J et al: Failed back surgery: etiology and diagnostic evaluation. Spine J. 3(5):400-3, 2003
                                                                                          6. Babar S et al: MRI of the post-discectomy lumbar spine. Clin Radiol. 57(11):969-81, 2002
                                                                                          7. Barrera MC et al: Post-operative lumbar spine: comparative study of TSE T2 and turbo-FLAIR sequences vs contrast-enhanced SE T1. Clin Radiol. 56(2):133-7, 2001
                                                                                          8. Suk KS et al: Recurrent lumbar disc herniation: results of operative management. Spine. 26(6):672-6, 2001
                                                                                          9. Ross JS: Magnetic resonance imaging of the postoperative spine. Semin Musculoskelet Radiol. 4(3):281-91, 2000
                                                                                          10. Bradley WG: Use of contrast in MR imaging of the lumbar spine. Magn Reson Imaging Clin N Am. 7(3):439-57, vii, 1999
                                                                                          11. Loupasis GA et al: Seven- to 20-year outcome of lumbar discectomy. Spine. 24(22):2313-7, 1999
                                                                                          12. Grane P: The postoperative lumbar spine. A radiological investigation of the lumbar spine after discectomy using MR imaging and CT. Acta Radiol Suppl. 414:1-23, 1998
                                                                                          13. Wilmink JT et al: MRI of the postoperative lumbar spine: triple-dose gadodiamide and fat suppression. Neuroradiology. 39(8):589-92, 1997
                                                                                          14. Fiume D et al: Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir Suppl (Wien). 64:116-8, 1995
                                                                                          15. Djukic S et al: The lumbar spine: postoperative magnetic resonance imaging. Bildgebung. 59(3):136-46, 1992