====== Recurrent Lumbar Disc Herniation Outcome ======

O'Donnell et al., analyzed outcomes after operative management of recurrent lumbar disc herniation (RLDH) in the workers' compensation (WC) population. WC patients receiving revision discectomy combined with fusion (RDF) had lower returned to work (RTW) rates, higher costs, and a longer duration of postoperative opioid use than those receiving revision discectomy (RD) alone. This information allows for informed patient management decisions and suggests that fusion should be reserved for patients with clear indications for its use. They were unable to conclude what treatment method is best, but rather they provided a baseline for future studies
((O'Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU.
Treatment of Recurrent Lumbar Disc Herniation With or Without Fusion in Workers' 
Compensation Subjects. Spine (Phila Pa 1976). 2017 Jul 15;42(14):E864-E870. doi: 
10.1097/BRS.0000000000002057. PubMed PMID: 28700387.
)).

rLDH patients do not only present higher postoperative VAS scores, compared to fLHD patients, but also that these scores are correlated with increased inflammation and may contribute to pain chronicity
((Andrade P, Hoogland G, Teernstra OP, van Aalst J, van Maren E, Daemen MA,
Visser-Vandewalle V. Elevated levels of TNF-α and TNFR1 in recurrent herniated
lumbar discs correlate with chronicity of postoperative sciatic pain. Spine J.
2015 Oct 30. pii: S1529-9430(15)01623-X. doi: 10.1016/j.spinee.2015.10.038. [Epub
ahead of print] PubMed PMID: 26523959.
)).