Dai Li-Yang, Zhou Qing, Yao Wei-Fang, Shen Lei
Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200092, China.
Surg Neurol. 2005 Sep;64(3):226-31; discussion 231. doi: 10.1016/j.surneu.2004.11.003.
Recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery. The purpose of the current study was to address the outcome in the patients who had recurrent disc herniation treated with repeat discectomy and to identify the factors that may influence the outcome.
Thirty-nine patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Of these patients, 27 had recurrent disc herniation at the L4 to L5 level, 11 at the L5 to S1, and 1 at the L3 to L4. They almost had the typical presentation of sciatica. The time from prior discectomy to that of recurrence ranged 6 months to 17 years (average, 5 years and 4 months). The Japanese Orthopaedic Association (JOA) score averaged 12 (range, -3 to 18). All patients had a follow-up evaluation at 1 and 15 years (average, 7 years and 8 months) after surgery.
Their JOA score increased to 12 to 29 (average, 24), with the recovery rate of 29% to 100% (average, 72%). Twenty-nine patients returned to their previous work status or normal daily activity, 7 had significant improvement, and 3 needed analgesic drugs although they had pain relief to different degrees.
The outcomes of repeat discectomy for recurrent disc herniation were satisfactory. No factors such as age, sex, traumatic events, times of prior surgery, level of herniation, side of recurrence, pain-free interval, duration of recurrence symptoms, walking capacity, the preoperative JOA score, associated spinal stenosis, procedures of revision surgery, and dural tear were found to be of predictive value for a prognosis of revision surgery for recurrent disc herniation (P>.05).
椎间盘切除术后复发性椎间盘突出症相对缺乏具体研究，通常与椎间盘手术失败的其他原因一起进行综述。本研究的目的是探讨复发性椎间盘突出症患者行再次椎间盘切除术的疗效，并确定可能影响疗效的因素。
回顾性分析39例行再次椎间盘切除术治疗复发性腰椎间盘突出症的患者。其中，27例为L4至L5节段复发性椎间盘突出症，11例为L5至S1节段，1例为L3至L4节段。他们几乎都有典型的坐骨神经痛表现。从上次椎间盘切除到复发的时间为6个月至17年（平均5年4个月）。日本骨科学会（JOA）评分平均为12分（范围为-3至18分）。所有患者在术后1年和15年（平均7年8个月）进行随访评估。
他们的JOA评分提高到12至29分（平均24分），恢复率为29%至100%（平均72%）。29例患者恢复到以前的工作状态或正常日常活动，7例有明显改善，3例虽有不同程度的疼痛缓解但仍需要止痛药。
复发性椎间盘突出症再次椎间盘切除术的疗效令人满意。未发现年龄、性别、外伤史、既往手术次数、突出节段、复发侧、无痛间隔时间、复发症状持续时间、步行能力、术前JOA评分、合并椎管狭窄、翻修手术方式及硬脊膜撕裂等因素对复发性椎间盘突出症翻修手术的预后具有预测价值（P>0.05）。
