instrumented transforaminal lumbar interbody fusion in surgical treatment of recurrent disc herniation

background :the incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation (ldh), is regularly reported as 5-15%. in this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion (tlif) in the patients suffering from recurrent ldh.   methods : we retrospectively studied 51 patients (30 female, 21 male) from august 2007 to october 2011. the mean age and follow-up of the patients was 46.4±14.8 (ranged 29-77 years old) and 31.4±6.8 (ranged 25-50 months), respectively. clinical improvement was assessed by oswestry disability index (odi), visual analogue scale (vas), and subjective satisfaction rate, while fusion was appraised radiologically. data analysis was by one sample kolmogorov-smirnov, paired t, and mann-whitney tests.   results : surgery could significantly improve mean leg and lumbar vas and odi from preoperative 7.4±2.5, 7.8±3.1, and 72.1±21.5 to postoperative 3.4±3.6, 3.5±2.6, and 27.5±18.0, respectively at the last follow-up visit. subjective satisfaction rate was excellent in 24 patients (47.1%), good in 14 (27.5%), fair 11 (21.6%), and poor in two (3.9%). we had one patient with iatrogenic partial l5 nerve root injury and one with unknown late onset refractory postoperative back pain. fusion rate was 100% and instrument failure was nil.   conclusion : in surgical treatment of the patients with recurrent ldh, bilaterally instrumented tlif is a relatively safe and effective procedure and can be associated with least instrument failure and highest fusion rate while no postoperative bracing is also needed.