Zhuo Xianglong, Hu Jianzhong, Li Bing, Sun Hongzhi, Chen Yaohui, Hu Zhaohui
Department of Spinal Surgery, the People's Hospital of Liuzhou, Liuzhou Guangxi, 545006, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Dec;23(12):1422-6.
To compare the therapeutic effect of conventional discectomy, posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) on the recurrent lumbar disc protrusion (RLDP).
From January 2000 to January 2008, 65 patients with RLDP underwent different surgical procedures, namely conventional discectomy (group A, 25 cases), PLIF (group B, 22 cases), and TLIF (group C, 18 cases). There were 44 males and 21 females aged 26-65 years old (average 41 years old). All the patients were single-level protrusion, including 33 cases at the L4,5 level and 32 cases at the L5, S1 level. The primary procedure included laminectomy discectomy in 39 patients, unilateral hemilaminectomy discectomy in 15 patients, and bilateral laminectomy and total laminectomy discectomy in 11 patients. The recurrent time to the primary operation was 13-110 months (average 64 months). The location of recurrent disc protrusion was at the ipsilateral side in 47 cases and the contralateral side in 18 cases. No significant differences among three groups were evident in terms of baseline data (P > 0.05).
The incision all healed by first intention. The incidence of perioperative complication in group A (24.0%) and group B (22.3%) was significantly higher than that of group C (5.6%) (P < 0.05), and there was no significant difference between group A and group B (P > 0.05). The operation time and bleed loss during operation of group B were obviously higher than that of group A and group C (P < 0.05), and there was no significant difference between group A and group C (P > 0.05). There were no significant differences among three groups in terms of the length of hospitalization (P > 0.05). Six-one patients were followed up for 12-36 months (average 20 months). At 1 week after operation, the satisfied rate of patients was 84.0% in group A, 81.8% in group B, and 88.9% in group C (P > 0.05). All the patients in group B and group C achieved fusion uneventfully. There were no significant differences among three groups in terms of visual analogue scale (VAS) and Oswestry disability index (ODI) when compared the preoperative value with the final follow-up value (P > 0.05). There was significant difference within group A, B, and C in terms of VAS and ODI when compared the preoperative value with the final follow-up value (P < 0.05), but there were no significant differences among three groups in the improvement rate (P > 0.05). The intervertebral space grading method proposed by Roberts et al. was adopted to evaluate the intervertebral space height (ISH), the preoperative value was 2.04 +/- 0.93 in group A, 2.18 +/- 0.91 in group B, and 2.11 +/- 0.90 in group C, and at the final follow-up, the value was 2.64 +/- 0.58 in group A, 1.05 +/- 0.59 in group B, and 1.06 +/- 0.42 in group C. There were significant differences among three groups in the ISH when compared the properative value with the final follow-up value (P < 0.05).
All of the three surgical procedures are effective for RLDP, but conventional discectomy and PLIF have more complications than TLIF. Conventional discectomy may result in the further narrow of the intervertebral space and the occurrence of segment instability, whereas TLIF is safer, more effective, and one of the ideal methods to treat RLDP.
比较传统椎间盘切除术、后路腰椎椎间融合术（PLIF）和经椎间孔腰椎椎间融合术（TLIF）治疗复发性腰椎间盘突出症（RLDP）的疗效。
2000年1月至2008年1月，65例RLDP患者接受了不同的手术治疗，即传统椎间盘切除术（A组，25例）、PLIF（B组，22例）和TLIF（C组，18例）。患者年龄26 - 65岁，共44例男性和21例女性（平均41岁）。所有患者均为单节段突出，其中L4、5节段33例，L5、S1节段32例。初次手术方式包括椎板切除椎间盘切除术39例，单侧半椎板切除椎间盘切除术15例，双侧椎板切除及全椎板切除椎间盘切除术11例。初次手术后复发时间为13 - 110个月（平均64个月）。复发椎间盘突出位于同侧47例，对侧18例。三组患者的基线资料差异无统计学意义（P > 0.05）。
切口均一期愈合。A组（24.0%）和B组（22.3%）围手术期并发症发生率显著高于C组（5.6%）（P < 0.05），A组和B组之间差异无统计学意义（P > 0.05）。B组手术时间和术中出血量明显高于A组和C组（P < 0.05），A组和C组之间差异无统计学意义（P > 0.05）。三组患者住院时间差异无统计学意义（P > 0.05）。61例患者随访12 - 36个月（平均20个月）。术后1周，A组患者满意率为84.0%，B组为81.8%，C组为88.9%（P > 0.05）。B组和C组所有患者均顺利实现融合。术前与末次随访时比较，三组患者视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）差异无统计学意义（P > 0.05）。A组、B组和C组术前与末次随访时比较，VAS和ODI差异有统计学意义（P < 0.05），但三组间改善率差异无统计学意义（P > 0.05）。采用Roberts等提出的椎间间隙分级方法评估椎间间隙高度（ISH），术前A组为2.04±0.93，B组为2.18±0.91，C组为2.11±0.90；末次随访时，A组为2.64±0.58，B组为1.05±0.59，C组为1.06±0.42。术前与末次随访时比较，三组ISH差异有统计学意义（P < 0.05）。
三种手术方法治疗RLDP均有效，但传统椎间盘切除术和PLIF比TLIF并发症更多。传统椎间盘切除术可能导致椎间间隙进一步狭窄和节段性不稳定的发生，而TLIF更安全、有效，是治疗RLDP的理想方法之一。
