Almeida Daniel Benzecry, Prandini Mirto Nelson, Awamura Yumi, Vitola Maria Luiza, Simião Monica Pedro, Milano Jeronimo Buzetti, Bordignon Kelly Cristina, Ache Mariane Pastuch, Ramina Ricardo
Instituto de Neurologia de Curitiba, Abílio César Borges, 79/61, Curitiba, 80730-060, Brazil.
Acta Neurochir (Wien). 2008 Nov;150(11):1167-76. doi: 10.1007/s00701-008-0131-2. Epub 2008 Oct 21.
Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis.
Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, The Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI).
After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). The values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability.
The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.
腰椎手术失败综合征仍然是脊柱外科医生面临的一项挑战。它可能与多种原因有关，包括手术指征不佳、误诊、手术技术失败、椎间盘炎和纤维化。尽管纤维化在症状产生中的作用尚不清楚，但它与腰椎间盘手术预后较差有关。在本研究中，作者分析了临床结果与纤维化程度之间的任何可能相关性。
40例连续患者纳入一项前瞻性研究。他们均首次接受单节段下腰椎手术。术后3个月，对他们进行临床结果评估和问卷调查，包括腰椎和腿部疼痛的数字疼痛评分量表（NPR）、麦吉尔疼痛问卷、魁北克腰痛残疾量表（QBPD）和直腿抬高试验。这些数据与磁共振成像（MRI）显示的纤维化程度相关。
3个月后，腰椎和腿部疼痛的NPR值范围为0至8（平均分别为2.32和1.67）。术后QBPD量表的值范围为1至71（平均25.9）。每位患者在MRI上均显示出不同程度的纤维化。然而，统计分析表明纤维化与疼痛和残疾的较差临床结果之间无显著相关性。
作者发现过度纤维化与腰腿痛、残疾或直腿抵抗之间无相关性。应重新评估纤维化在腰椎间盘手术患者症状产生中的作用。
