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Mamajanov B.S.
Doctor of Medical Sciences Associate Professor
Department of Traumatology, Orthopedics, and Neurosurgery
Andijan State Medical Institute. Andizhan.
Qodirov D.R.
Assistant
department of surgical diseases, Central Asian Medical Institute.
Fergana.
Eshboyev E.A. - PhD, Associate Professor Republican Pathoanatomical Center of the Ministry of Health
of the Republic of Uzbekistan. Tashkent.
DIAGNOSTIC ASPECTS OF RECURRENT LUMBAR DISC
HERNIATIONS
Annotation. This research analyzes the specific diagnostic features of recurrent lumbar disc herniation. The study focuses on assessing the role of clinical, imaging, and laboratory parameters in predicting recurrence likelihood. It highlights the clinical signs of recurrent disc herniation, visualization capabilities using MRI and CT, and the importance of modern diagnostic methods for monitoring inflammatory processes. This work contributes to improving patient quality of life and optimizing treatment strategies by establishing accurate diagnostics for recurrent herniation.
Keywords: recurrent disc herniation, diagnostics, magnetic resonance imaging, computer tomography, low back pain, inflammation, laboratory examination, surgery, disability.
Relevance of the topic - Lumbar disc herniation disease is widespread worldwide and causes pain in the back and legs [1-2]. Surgical treatment of this disease is widely used [1,2]. However, there is a possibility of recurrence of hernia even after surgical intervention [2,3]. The average rate of recurrence is 5-15% [4,2]. Recurrent disc herniation is one of the main causes of spine pain and disability [6,5-1]. In addition, pain in the lumbar region of the spine and in the legs occurs due to compression of the nerve root as a result of spinal canal stenosis or cauda equina syndrome [8,11,12,13,14]. Clinical guidelines recommend a history and physical examination to rule out lumbar disc herniation (including recurrent disc herniation) [6,7,8]. However, the above two methods are not enough to diagnose the disease [8,9,10]. Diagnostic imaging methods can also be used before operations to determine this condition [15]. Diagnostic imaging can be performed by magnetic resonance imaging (MRT), computed tomography (CT). The widespread use of these effective and relatively safe tests in medicine has
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dramatically reduced the need for X-rays and myelography. Currently, the MRI examination method is less harmful to the body through ionizing radiation and has the ability to see especially soft tissues [13,16].
The purpose of the study. The purpose of this study is to choose and implement an adequate examination method in recurrent lumbar disc herniation.
Research methods and materials. This retrospective study was conducted from January 2024 to August 2024 on 185 patients who underwent spinal disc herniation surgery at the neurosurgery department of Andijan State Medical Institute clinics. Clinical and anamnestic data of patients with recurrent lumbar disc herniation were analyzed. Magnetic resonance imaging (MRI) or computed tomography (CT) was recommended in postoperative patients with persistent or recurrent leg pain. Medical indicators and MRI, CT images of all patients were evaluated.
Research results and their evaluation. The obtained results were as follows: complaints, anamnesis, and clinical neurological examinations of all patients raised doubts about the diagnosis of disc herniation. Then, magnetic resonance imaging (MRI) or computed tomography (CT) was recommended to the patients. Among them, 23 (12.4%) had a recurrence, 162 (87.6%) had a primary disc herniation.
Summary. Patients' complaints, medical history, clinical neurological and physical examinations play an important role in the diagnosis of herniated lumbar vertebrae (including primary disc herniation). However, for preoperative diagnosis and selection of surgical tactics, computed tomography (MRT) or computed tomography (CT) examinations are the gold standard.
Used literature
1. Guo J, Li G, Ji X, Wu X, Zhang G, Zhou C, Ma X. Clinical and Radiological Risk Factors of Early Recurrent Lumbar Disc Herniation at Six Months or Less: A Clinical Retrospective Analysis in One Medical Center. Pain Physician. 2022Oct;25(7):E1039-E1045. PMID: 36288589.
2. Huang W, Han Z, Liu J, Yu L, Yu X. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Jan;95(2):e2378. doi: 10.1097/MD.0000000000002378. PMID: 26765413; PMCID: PMC4718239.
3. McGirt MJ, Ambrossi GL, Datoo G, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 2009; 64: 338-344 discussion 344-335.
4. Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus. 2003;15:E10.
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6. Corniola MV, Tessitore E, Schaller K, Gautschi OP. Hernie discal lombaire--diagnosis et prise en charge [Lumbar disc herniation--diagnosis and treatment]. Rev Med Suisse. 2014 Dec 10;10(454):2376-82. French. PMID: 25632633.
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7. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14:180-91.
8. Kim JH, van Rijn RM, van Tulder MW, Koes BW, de Boer MR, Ginai AZ, Ostelo RWGJ, van der Windt DAMW, Verhagen AP. Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropr Man Therap. 2018 Aug 21; 26:37.
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10. Van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain: a systematic review. Cochrane Database Syst Rev. 2010; 2:CD007431.
11. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016; 352:h6234.
12. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268:760-5.
13. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137:586-97.
14. De Schepper EI, Koes BW, Veldhuizen EF, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA. Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract. 2016;33:51-6.
15. Takashima H, Takebayashi T, Yoshimoto M, Terashima Y, Ida K, Yamashita T. Efficacy of diffusion-weighted magnetic resonance imaging in diagnosing spinal root disorders in lumbar disc herniation. Spine (Phila Pa 1976). 2013; 38:E998-E1002.
16. Wassenaar M, van Rijn RM, van Tulder MW, et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21:220-7.
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