Department of Neurosurgery, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2009 Nov 15;34(24):2674-8. doi: 10.1097/BRS.0b013e3181b4aaac.
Retrospective review and multivariate analysis.
Recurrent lumbar disc herniation (rLDH) is a repeated disc herniation at a previously operated disc level in patients who experienced a pain-free interval of at least 6 months after surgery. We investigated whether the preoperative radiologic biomechanical factors (disc height index [DHI] and sagittal range of motion [sROM]) have any effect on rLDH.
rLDH has been reported in 5% to 15% of patients. There have been many studies suggesting various risk factors for rLDH, such as disc degeneration, trauma, age, smoking, gender, and obesity. However, these factors did not reflect a biomechanical effect on the affected joint directly. Investigation of DHI and sROM would be helpful to understand the biomechanical impact on the occurrence of rLDH.
This study enrolled 157 patients who underwent surgery for L4-L5 LDH. We divided the patients into the recurrent and the nonrecurrent group and compared their clinical parameters (age, sex, body-mass index, symptom duration, diabetes, smoking, herniation type, preoperative visual analogue scale) and preoperative radiologic parameters (disc degeneration, DHI, sROM).
rLDH occurred at 40.8+/-15.5 months (7-70 months) after primary surgery. Mean DHI was 0.37+/-0.09 and 0.29+/-0.09 in the recurrent and the nonrecurrent group, respectively (P<0.05). Mean sROM was 11.3 degrees+/-2.9 degrees and 5.9 degrees+/-3.7 degrees in the recurrent and the nonrecurrent group, respectively (P<0.05). Both smoking and disc degeneration were related with the development of rLDH (P<0.05).
Together with our data, DHI and sROM showed a significant correlation with the incidence of recurrent lumbar disc herniation, suggesting that preoperative biomechanical conditions of the spine can be an important pathogenic factor in the site of lumbar disc surgery.
回顾性分析和多变量分析。
复发性腰椎间盘突出症（rLDH）是指患者在手术后至少经历了 6 个月的无痛间隔期后，在先前手术的椎间盘水平再次出现椎间盘突出。我们研究了术前影像学生物力学因素（椎间盘高度指数[DHI]和矢状位运动范围[sROM]）是否对 rLDH 有影响。
rLDH 在 5%至 15%的患者中发生。已有许多研究表明 rLDH 的多种危险因素，如椎间盘退变、外伤、年龄、吸烟、性别和肥胖。然而，这些因素并没有直接反映对受累关节的生物力学影响。研究 DHI 和 sROM 将有助于了解生物力学对 rLDH 发生的影响。
本研究纳入了 157 例因 L4-L5 腰椎间盘突出症而行手术治疗的患者。我们将患者分为复发性和非复发性组，并比较了他们的临床参数（年龄、性别、体重指数、症状持续时间、糖尿病、吸烟、突出类型、术前视觉模拟评分）和术前影像学参数（椎间盘退变、DHI、sROM）。
rLDH 在初次手术后的 40.8+/-15.5 个月（7-70 个月）发生。复发性组和非复发性组的平均 DHI 分别为 0.37+/-0.09 和 0.29+/-0.09（P<0.05）。复发性组和非复发性组的平均 sROM 分别为 11.3 度+/-2.9 度和 5.9 度+/-3.7 度（P<0.05）。吸烟和椎间盘退变均与 rLDH 的发生有关（P<0.05）。
与我们的数据一起，DHI 和 sROM 与复发性腰椎间盘突出症的发生率有显著相关性，这表明脊柱术前生物力学状况可能是腰椎间盘手术部位的一个重要致病因素。
