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2026, Vol: 51, Issue: 1
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Review Article 


Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review

Mustafa Habeeb Alshawi, Thamer Ahmed Hamdan, Ali Hussein Aldiwan, Mazin Saad Muhammed.


Abstract
Objective: To assess the incidence, risk factors, and surgical indications related to recurrent lumbar disc herniation (rLDH) and persistent postoperative pain following lumbar discectomy.
Methodology: A systematic review of randomized controlled trials (RCTs), cohort studies, and large case series published between 2010 and 2025 was conducted. Searches were performed in PubMed, MEDLINE, and Cochrane Library databases following PRISMA guidelines. Studies involving adult patients with lumbar discectomy were included, focusing on recurrence, persistent pain, and indications for reoperation.
Results: Recurrence rates ranged from 5-15%, typically occurring within 1-5 years. Persistent postoperative pain affected up to 27% of patients. Key risk factors included smoking, diabetes, obesity, Modic changes, disc extrusion, and incomplete disc removal. Reoperation rates varied between 0.5% at one year and up to 19% in long-term follow-up. Fusion surgery was indicated in selected cases with instability or repeated recurrence.
Conclusion: Both recurrent herniation and persistent pain require a comprehensive, individualized approach. Early identification of risk factors and precise surgical execution are critical to minimizing complications. Future research should emphasize predictive modeling and evidence-based criteria for second surgery.

Key words: Lumber disc, disc prolapse, persistent pain.


 
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How to Cite this Article
Pubmed Style

Alshawi MH, Hamdan TA, Aldiwan AH, Muhammed MS. Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. RMJ. 2026; 51(1): 291-294. doi:10.5455/rmj.20250903102900

Web Style

Alshawi MH, Hamdan TA, Aldiwan AH, Muhammed MS. Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. https://www.rmj.org.pk/?mno=281872 [Access: February 21, 2026]. doi:10.5455/rmj.20250903102900

AMA (American Medical Association) Style

Alshawi MH, Hamdan TA, Aldiwan AH, Muhammed MS. Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. RMJ. 2026; 51(1): 291-294. doi:10.5455/rmj.20250903102900


Vancouver/ICMJE Style

Alshawi MH, Hamdan TA, Aldiwan AH, Muhammed MS. Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. RMJ. (2026), [cited February 21, 2026]; 51(1): 291-294. doi:10.5455/rmj.20250903102900


Harvard Style

Alshawi, M. H., Hamdan, . T. A., Aldiwan, . A. H. & Muhammed, . M. S. (2026) Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. RMJ, 51 (1), 291-294. doi:10.5455/rmj.20250903102900


Turabian Style

Alshawi, Mustafa Habeeb, Thamer Ahmed Hamdan, Ali Hussein Aldiwan, and Mazin Saad Muhammed. 2026. Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. Rawal Medical Journal, 51 (1), 291-294. doi:10.5455/rmj.20250903102900


Chicago Style

Alshawi, Mustafa Habeeb, Thamer Ahmed Hamdan, Ali Hussein Aldiwan, and Mazin Saad Muhammed. "Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review." Rawal Medical Journal 51 (2026), 291-294. doi:10.5455/rmj.20250903102900


MLA (The Modern Language Association) Style

Alshawi, Mustafa Habeeb, Thamer Ahmed Hamdan, Ali Hussein Aldiwan, and Mazin Saad Muhammed. "Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review." Rawal Medical Journal 51.1 (2026), 291-294. Print. doi:10.5455/rmj.20250903102900


APA (American Psychological Association) Style

Alshawi, M. H., Hamdan, . T. A., Aldiwan, . A. H. & Muhammed, . M. S. (2026) Recurrent lumbar disc prolapse and post-discectomy pain persistence: Incidence, risk factors, and indications for second surgery; A systematic review. Rawal Medical Journal, 51 (1), 291-294. doi:10.5455/rmj.20250903102900


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