Abrishamkar Saied, Mahmoudkhani Mehdi, Aminmansour Bahram, Mahabadi Amir, Jafari Shohreh
Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2014 Nov 20;3:220. doi: 10.4103/2277-9175.145125. eCollection 2014.
After single disk herniation operation, about 5-20% recurrences may occur. Different etiology may affect the prevalence of recurrence. Disk degeneration according to Modic and Los Angles scales could affect recurrence rate. This study wants to show the relationship between disk space degeneration according to these scales on severity, time, and prevalence of disk herniation recurrence.
Thirty-four patients presented with radicular pain (with or without back pain) and history of lumbar disk surgery was included in this prospective study. Pre- and postoperative T2-weighted sagittal magnetic resonance imaging (MRI) compared for Modic and Los Angeles disk degeneration grading, then, data analysis on SPSS (version 20) software, paired t-test, and others.
The result of study shows for first operation that grade (II) Los Angeles is the most common, but, for second procedure grade (IV) was less common and the mostly decreased (from 14.7 to 9.2%). In addition, Wilcoxon test shows no change of Los Angeles grading for both first and second surgery (P = 0.06). Whereas; based on Modic criteria grading was different from first operation, in other words, grade (I) (41.2%) in first operation was changed to 20.6% in second operation (P = 0.007).
Our study showed that the Los Angeles criterion is more practical and useful for prediction of recurrence and in the patients with Los Angles grade III and IV and grade II and III on Modic scale, the chance of recurrence is less than patients with lower grades.
单节段椎间盘突出症手术后，可能会出现5%-20%的复发率。不同的病因可能会影响复发的发生率。根据莫迪克（Modic）和洛杉矶（Los Angles）分级标准的椎间盘退变可能会影响复发率。本研究旨在揭示根据这些分级标准的椎间盘间隙退变与椎间盘突出症复发的严重程度、时间及发生率之间的关系。
本前瞻性研究纳入了34例有神经根性疼痛（伴或不伴背痛）且有腰椎手术史的患者。对术前和术后的T2加权矢状面磁共振成像（MRI）进行莫迪克和洛杉矶椎间盘退变分级比较，然后在SPSS（20版）软件上进行数据分析、配对t检验等。
研究结果显示，首次手术时洛杉矶分级（II）级最为常见，但二次手术时（IV）级较少见且大多降低（从14.7%降至9.2%）。此外，威尔科克森检验显示首次和二次手术的洛杉矶分级均无变化（P = 0.06）。然而，根据莫迪克标准，分级与首次手术不同，也就是说，首次手术时（I）级（41.2%）在二次手术时变为20.6%（P = 0.007）。
我们的研究表明，洛杉矶标准在预测复发方面更实用，对于莫迪克分级为III级和IV级以及II级和III级的患者，复发几率低于分级较低的患者。
