ABSTRACT
Recurrent lumbar herniated nucleus pulposus is often associated with severe, disabling symptoms. Much like the treatment of symptomatic primary lumbar disc herniation, conservative treatment options, including nonsteroidal anti-inflammatory drugs, oral steroids, physical therapy, and epidural injections, should be used for the initial management of recurrent lumbar disc herniation. The approach and operation performed for addressing recurrent lumbar disc herniation are largely based on whether this was the initial reherniation, the approach to the initial procedure, and the surgeon's preference. Patients presenting with symptoms of recurrent disc herniation should be worked up for potential infection/abscess, epidural fibrosis, scar tissue, a second primary herniation, and ultimately reherniation. For a traditional revision microdiscectomy, the patient is positioned in the prone position on a Jackson table or Andrews frame, allowing the abdomen to be free and the hips to be flexed in order to open the posterior lumbar interspaces.
