Kim Jin-Sung, Oh Hyeong Seok, Lee Sang-Ho
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
Photomed Laser Surg. 2012 Oct;30(10):568-72. doi: 10.1089/pho.2012.3288. Epub 2012 Aug 13.
During revision microdiscectomy for recurrent lumbar disc herniation (rLDH), the major concerns are approach-related complications, including dural tear and nerve root injury, because of adhesion scars and granulation tissue along the previous laminotomy site. In revision microdiscectomy of rLDH, carbon dioxide (CO2) laser can enable precise dissection and removal of adhesion scar. The purpose of this study was to evaluate the clinical usefulness of CO2 laser dissection in patients who had undergone revision microdisectomy of rLDH.
Clinical and radiologic data were reviewed from 21 patients who underwent single lumbar level CO2 laser dissection followed by removal of rLDH between October 2006 and July 2010. They were followed up with plain radiographs, and their mean follow-up period was 30 months.
Patients' mean hospital stay after operation was 5.1 days. Pain scores on a visual analogue scale (VAS) for back and leg pain were improved from a preoperative mean of 4.7 and 7.6 to a postoperative mean of 3.5 and 3.0, respectively (p<0.001). Clinical outcomes based on the Oswestry Disability Index (ODI) were improved from a preoperative mean of 57.4-22.2% postoperatively (p<0.001).
Our results demonstrate that CO2 laser could be a useful surgical tool during revision microdisectomy of rLDH.
在复发性腰椎间盘突出症（rLDH）的翻修显微椎间盘切除术期间，主要关注点是与手术入路相关的并发症，包括硬膜撕裂和神经根损伤，这是由于先前椎板切开部位存在粘连瘢痕和肉芽组织。在rLDH的翻修显微椎间盘切除术中，二氧化碳（CO2）激光能够实现精确的粘连瘢痕分离和切除。本研究的目的是评估CO2激光分离术在接受rLDH翻修显微椎间盘切除术患者中的临床实用性。
回顾性分析2006年10月至2010年7月期间接受单节段腰椎CO2激光分离术并随后切除rLDH的21例患者的临床和影像学资料。对他们进行X线平片随访，平均随访时间为30个月。
患者术后平均住院时间为5.1天。视觉模拟量表（VAS）评估的背痛和腿痛评分分别从术前平均4.7和7.6改善至术后平均3.5和3.0（p<0.001）。基于Oswestry功能障碍指数（ODI）的临床结果从术前平均57.4改善至术后的22.2%（p<0.001）。
我们的结果表明，CO2激光可能是rLDH翻修显微椎间盘切除术中一种有用的手术工具。
