Study Design: randomized, prospective, and level I clinical study.Purpose: To compare the clinical outcomes and radiological findings of revision discectomy alone versus revision discectomy with fusion as surgical treatment for recurrent lumbar disc herniation (RDH).Overview of Literature: RDH is a common complication following a primary discectomy. The optimal surgical procedure for RDH is still debated.Methods: Sixty patients with RDH were randomly divided into two equal groups: the first group underwent revision discectomy alone and the second underwent revision discectomy with fusion. The primary outcomes evaluated were Visual Analog Scale (VAS) for low back and limb pains, Oswestry Disability Index (ODI), disc height indexes, foraminal height index, and disc height subsidence. Secondary outcomes included operative time, blood loss, postoperative hospital stay, and complications.Results: Revision discectomy with fusion showed superior pain relief and improved functional outcomes, including better VAS scores for both back and leg pain and ODI at 24-month follow-up. Additionally, it restored the stability of the spine better with lower disc height subsidence without significant complications. However, these advantages came at the cost of increased blood loss and longer operative time and hospital stays.Conclusions: Revision discectomy with fusion is recommended for RDH; however, the choice of the procedure should be made caseby- case basis, considering many factors related to the patient and surgical facilities.

This study aims to investigate the relationship between front-line employees’ (FLEs) extra-role behavior (ERB) and its influence on student satisfaction (SS), student loyalty (SL), and university image (UI), while also examining the moderating effect of student cynicism (SC). Drawing on the service profit chain model, this research proposes a positive relationship between ERB and SS, SL, and UI, with SC acting as a moderator for the relationship between ERB and SS. Using a survey research design, the study was conducted at a semi-government university in the United Arab Emirates (UAE) during a service encounter between FLEs and students, involving 251 students as respondents. Structural Equation Modeling (SEM) was used to analyze the data collected. The findings demonstrated a significant positive relationship between FLE ERB and SS, SL, and UI. Additionally, the study revealed that SC moderates the relationship between FLE ERB and SS, suggesting that highly cynical students are less responsive to employee extra-role behavior. These findings have significant implications for university management and policymakers. By understanding the impact of FLE ERB on student outcomes and the moderating effect of SC, universities can develop and strengthen targeted strategies to enhance SS, SL, and UI.