Law J D, Lehman R A, Kirsch W M
J Neurosurg. 1978 Feb;48(2):259-63. doi: 10.3171/jns.1978.48.2.0259.
This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.
这项回顾性研究纳入了53例腰椎间盘手术失败后接受再次手术以缓解疼痛的患者。所有患者在再次手术前均有腿痛症状，其中28%的病例手术成功。大多数临床特征，如疼痛的持续存在或复发方式、疼痛的神经根性特征、直腿抬高试验阳性以及脊髓造影显示的神经根袖缺损，对于预测再次手术的成功与否并无帮助。然而，女性再次手术成功的比例明显高于男性。有既往或未决赔偿要求、存在涉及多个皮节的感觉丧失，或脊髓造影显示的硬脊膜囊压迹不像椎间盘突出所致者，再次手术效果不佳。似乎需要非常令人信服的脊髓造影缺损，才能证明在先前未手术部位进行再次手术的合理性。在这些病例中，单纯切除瘢痕或进行背根切断术均无效果。
