Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea.
Spine (Phila Pa 1976). 2013 Apr 1;38(7):581-90. doi: 10.1097/BRS.0b013e318274f9a7.
Retrospective cohort study using national health insurance data.
To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods.
Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted.
A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method.
Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates.
The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the reoperation rates of the other procedures were not different from that of open discectomy.
使用国家健康保险数据的回顾性队列研究。
提供腰椎间盘突出症（HIVD）手术后的纵向再次手术率，并比较手术方法的再次手术率。
椎间盘突出症是最常见的腰椎脊柱手术原因。尽管手术技术和器械有所改进，但仍无法避免再次手术。既往研究中再次手术率在 6%至 24%之间。基于人群的研究受到的偏倚较小；因此，需要进行全国性的纵向分析。
使用国家健康保险数据库确定 2003 年接受首次椎间盘突出症手术的患者队列，共选择了 18590 名患者。通过加密的唯一居民登记号，对每个患者进行至少 5 年的随访。主要终点是任何类型的第二次腰椎手术。在调整混杂因素后，比较了 5 种手术方法（融合、椎板切除术、开放椎间盘切除术、内镜椎间盘切除术和核溶解术[包括机械核减压术]）。以开放椎间盘切除术为参考方法。
开放椎间盘切除术是最常见的手术方法（68.9%），其次是内镜椎间盘切除术（16.1%）、椎板切除术（7.9%）、融合术（3.9%）和核溶解术（3.2%）。术后 3 个月的累积再手术率为 5.4%，1 年时为 7.4%，2 年时为 9%，3 年时为 10.5%，4 年时为 12.1%，5 年时为 13.4%。椎板切除术、核溶解术、开放椎间盘切除术、内镜椎间盘切除术和融合术后的再手术率分别为 18.6%、14.7%、13.8%、12.4%和 11.8%。与开放椎间盘切除术相比，术后 3 个月椎板切除术的再手术率更高，而其他手术方法的再手术率相似。
5 年后的累积再手术率为 13.4%，一半的再手术发生在术后第一年。除椎板切除术外，其他手术方法的再手术率与开放椎间盘切除术无差异。
