Hanley E N, Shapiro D E
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania.
J Bone Joint Surg Am. 1989 Jun;71(5):719-21.
One hundred and twenty consecutive patients who had primary excision of a lumbar disc at a single level for predominantly radicular symptoms were studied. Of these patients, eighty-seven (72 per cent) were available for comprehensive review. The duration of follow-up ranged from twenty-four to eighty-seven months (average, thirty-eight months). Radiculopathy was initially relieved in eighty-six (99 per cent) of the patients, although six patients (7 per cent) had recurrent herniation, which was successfully treated by reoperation. In an additional twelve patients (14 per cent), the operation was deemed a failure due to subsequent disabling low-back pain. Narrowing of the disc space was present radiographically in 98 per cent of the patients, but the amount of narrowing did not correlate with the degree of low-back pain, the age of the patient, or the length of time after operation. Factors predisposing to failure of the operation due to disabling low-back pain included coverage under Workmen's Compensation (p less than 0.00001), a history of more than fifteen pack-years of cigarette-smoking (average, one pack a day for fifteen years) (p less than 0.01), and an age of more than forty years (p less than 0.05).
对连续120例因主要为神经根症状而接受单节段腰椎间盘初次切除的患者进行了研究。其中87例（72%）患者可供全面复查。随访时间为24至87个月（平均38个月）。86例（99%）患者的神经根病最初得到缓解，尽管有6例（7%）患者出现复发性疝，经再次手术成功治疗。另有12例（14%）患者，由于随后出现致残性腰痛，手术被认为失败。98%的患者影像学上存在椎间盘间隙变窄，但变窄程度与腰痛程度、患者年龄或术后时间长短无关。因致残性腰痛导致手术失败的易感因素包括获得工伤赔偿（p<0.00001）、吸烟史超过15包年（平均每天一包，共15年）（p<0.01）以及年龄超过40岁（p<0.05）。
