Practice preference of revision surgery for recurrent lumbar disc herniation: an international survey of AO spine members

Objective: To explore global practice patterns and surgeon preferences in the surgical management of recurrent lumbar disc herniation (rLDH), and to identify factors influencing the choice of technique. Methods: A survey was distributed to the AOSpine members globally to ascertain rLDH surgical management preferences. Preference of surgeons for management options such as sequestrectomy, partial discectomy (PD), radical discectomy (RD) and fusion was ascertained for early (< 3 months) and late (> 3 months) rLDH scenarios following initial recovery for 6 months. Results: 714 surgeons responded to the survey. In early rLDH, PD was predominantly preferred (48.0%, n = 343) followed by RD (18.3%, n = 131), fusion (17.9%, n = 128) and sequestrectomy (14.4%, n = 103). In late rLDH, 40.2%(n = 287) of the surgeons preferred interbody fusion followed by sequestrectomy (31.7%, n = 226) and RD (21.6%, n = 154). Surgeons predominantly preferred to utilize the same approach as that of index surgery. Fusion was considered when there was a concomitant or incipient degenerative disease. Fusion in the early rLDH is significantly influenced by region, training, and volume of cases handled by the surgeons. Conclusion: Partial discectomy and interbody fusion are the predominant management of choice in both the early and late rLDH. The choice of fusion predominantly depends on the state of the index and adjacent segment, instability and degeneration respectively. Fusion in the early rLDH is significantly influenced by region, surgical training, and volume of cases handled by the surgeons.