Recidiva de hernia discal lumbar [Neurosurgery Wiki]

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====== Recidiva de hernia discal lumbar ======

===== Definición =====
En la mayoría de los estudios, se define como una [[hernia discal lumbar]] en el mismo nivel, independientemente de si es contralateral o ipsilateral, con un intervalo libre de dolor mayor de 6 meses
((Cinotti G, Gumina S, Giannicola G, Postacchini F. Contralateral recurrent lumbar disc herniation: Results of discectomy compared with those in primary herniation. Spine (Phila Pa 1976) 1999;24:800–6.))
((Cinotti G, Roysam S, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation: A prospective, controlled study. J Bone Joint Surg Br. 1998;80:825–32.))
((Fandino J, Botana C, Viladrich A, Gomez-Bueno J. Reoperation after lumbar disc surgery: Results in 130 cases. Acta Neurochir (Wien) 1993;122:102–4.))
(( O’Sullivan MG, Connolly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosurg. 1990;4:319–26. )).

===== Importancia =====
Es una causa común de malos resultados tras la [[discectomía lumbar]], y que se presenta entre el 5% al 15% de los casos((Gaston P, Marshall RW. Survival analysis is a better estimate of recurrent disc herniation. J Bone Joint Surg Br. 2003;85:535–7.))
((Babar S, Saifuddin A. MRI of the post-discectomy lumbar spine. Clin Radiol. 2002;57:969–81.))
((Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–08.))
((Mobbs RJ, Newcombe RL, Chandran KN. Lumbar discectomy and the diabetic patient: Incidence and outcome. J Clin Neurosci. 2001;8:10–3.))
((Suk KS, Lee HM, Moon SH, Kim NH. Recurrent lumbar disc herniation: Results of operative management. Spine (Phila Pa 1976) 2001;26:672–76.)).

Es además causa importante de dolor, discapacidad, y [[reintervención]] ((Cooper DF, Feuer H. Lumbar microdiscectomy. J Indiana State Med Assoc. 1982;74:674–5.))
((Ebeling U, Reichenberg W, Reulen HJ. Results of microsurgical lumbar discectomy. Review of 485 patients. Acta Neurochir (Wien) 1986;81:45–52.))
((Goald HJ. Microlumbar discectomy. follow-up of 477 patients. J Microsurg. 1980;2:95–100.)).

===== Factores de riesgo =====
Una razón importante es la falta de sellaje del anillo fibroso lo cual expone el defecto a los cambios de presión intradiscal mecánicos. 

Debilidad constitucional del anillo fibroso.

La exposición a levantamientos repetitivos o vibración, levantamiento de objetos pesados, la edad avanzada, el tabaquismo, el tamaño y el nivel preoperatorio de la hernia de disco, y la aparición de la hernia en el momento de la cirugía ((Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–08.))
((Matsui H, Terahata N, Tsuji H, Hirano N, Naruse Y. Familial predisposition and clustering for juvenile lumbar disc herniation. Spine (Phile Pa 1976) 1992;17:1323–8.))
((An HS, Silveri CP, Simpson JM, File P, Simmons C, Simeone FA, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord. 1984;7:369–73.))
(( Kelsey JL, Githens PB, O’Connor T, Weil U, Calogero JA, Holford TR, et al. Acute prolapsed lumbar intervertebral disc: An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine (Phila Pa 1976) 1984;9:608–13))