Suk K S, Lee H M, Moon S H, Kim N H
Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Spine (Phila Pa 1976). 2001 Mar 15;26(6):672-6. doi: 10.1097/00007632-200103150-00024.
A retrospective evaluation of 28 patients with recurrent lumbar disc herniation.
To analyze the outcome of the revisions (repeat discectomy), the risk factors of recurrent disc herniation, and the factors that influenced the outcomes of repeat discectomy.
Recurrent herniation following disc excision has been reported in 5-11% of patients. There have been many studies on recurrent disc herniation, but these studies have analyzed mixed patient populations.
Recurrent lumbar disc herniation was defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval greater than 6 months. Eight women and 20 men were studied. The levels of disc herniation were L4-L5 (19 cases) and L5-S1 (9 cases). Gadolinium-enhanced magnetic resonance imaging was performed in all patients. Revision surgery was performed in all patients by using conventional open discectomy. The pain-free interval, side and degree of herniation, operation time, duration of hospital stay, and clinical improvement rate were recorded.
The mean pain-free interval was 60.8 months. There were 21 cases of ipsilateral herniation and 7 cases of contralateral herniation. The degrees of herniation in revision were protrusion (14 cases), subligamentous extrusion (3 cases), transligamentous extrusion (8 cases), and sequestration (3 cases). The degrees of herniation in the previous discectomy were protrusion (17 cases), subligamentous extrusion (10 cases), and transligamentous extrusion (1 case). The length of surgery was significantly different (P = 0.003) between the revision surgery and the previous discectomy. There were no significant differences between revision and previous surgery in terms of hospital stay or clinical improvement rates. Age, gender, smoking, professions, traumatic events, level and degree of herniation, and pain-free interval did not affect the clinical outcomes.
Conventional open discectomy as a revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of primary discectomy. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation.
对28例复发性腰椎间盘突出症患者进行回顾性评估。
分析翻修手术（再次椎间盘切除术）的结果、椎间盘突出复发的危险因素以及影响再次椎间盘切除术后结果的因素。
椎间盘切除术后复发的椎间盘突出症在5%至11%的患者中有所报道。关于复发性椎间盘突出症已有许多研究，但这些研究分析的是混合患者群体。
复发性腰椎间盘突出症定义为同一节段的椎间盘突出，无论为同侧或对侧突出，且无痛间隔大于6个月。共研究了8名女性和20名男性。椎间盘突出节段为L4-L5（19例）和L5-S1（9例）。所有患者均进行了钆增强磁共振成像检查。所有患者均采用传统开放式椎间盘切除术进行翻修手术。记录无痛间隔、突出的侧别和程度、手术时间、住院时间以及临床改善率。
平均无痛间隔为60.8个月。同侧突出21例，对侧突出7例。翻修时的突出程度为膨出（14例）、后纵韧带下挤出（3例）、经后纵韧带挤出（8例）和游离（3例）。初次椎间盘切除术时的突出程度为膨出（17例）、后纵韧带下挤出（10例）和经后纵韧带挤出（1例）。翻修手术与初次椎间盘切除术之间的手术时长存在显著差异（P = 0.003）。翻修手术与初次手术在住院时间或临床改善率方面无显著差异。年龄、性别、吸烟、职业、外伤史、突出节段和程度以及无痛间隔均不影响临床结果。
传统开放式椎间盘切除术作为复发性腰椎间盘突出症的翻修手术显示出令人满意的结果，与初次椎间盘切除术相当。基于本研究结果，对于复发性腰椎间盘突出症的治疗可推荐再次椎间盘切除术。
