Bodiu A
Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova.
J Med Life. 2014 Oct-Dec;7(4):533-7.
THE OBJECT OF STUDY: Analysis of surgical treatment results in patients with recurrent lumbar disc herniation by transforaminal lumbar interbody fusion (TLIF) and repeated laminotomy and discectomy for the improvement of pain and disability.
Data analysis was performed on a complex diagnosis and treatment of 56 patients with recurrent lumbar disc herniation who had previously underwent 1-3 lumbar disc surgeries. An MRI investigation with paramagnetic contrast agent (gadolinium) was used for the diagnosis and differentiation of epidural fibrosis, and a dynamic lateral X-ray investigation was carried out for the identification of segmental instability. The evolution period after the previous surgery was between 1 and 3 years after the index surgery. Pain expression degree and dynamics were assessed with the pain visual analog scale (VAS) in early and late postoperative periods. Postoperative success was assessed by using a modified MacNab scale. The follow-up recording period after the last operation was of at least 1 year, ranging from 1 to 4 years.
The surgical treatment was effective in most cases, recording a reduction in pain expression level from 7.2-7.7 points on the VAS scale to 1.7-2.1 in the early period and 2.2-2.6 in the late period (1 year). Repeated surgery was effective in 21 of 30 (70%) cases who underwent decompression surgery without fusion and in 20 of 26 (76.9%) cases who underwent repeated surgery with transforaminal lumbar interbody fusion (TLIF). Overall, postoperative success was assessed by using a modified MacNab scale.
Repeated surgery is a viable option for patients who have clinical manifestations of recurrent disc herniation. Investigation with contrast agent by MRI allows differentiating disk herniation recurrences from epidural fibrosis. Supplementing repeated discectomies and decompression with intervertebral transforaminal fusion provide superior clinical outcomes, especially in patients with clinical and radiological signs of lumbar segment instability.
研究目的：分析经椎间孔腰椎椎体间融合术（TLIF）及重复椎板切开髓核摘除术治疗复发性腰椎间盘突出症患者的手术治疗效果，以改善疼痛和功能障碍。
对56例曾接受1 - 3次腰椎间盘手术的复发性腰椎间盘突出症患者的综合诊断和治疗进行数据分析。使用顺磁性造影剂（钆）的MRI检查用于诊断和鉴别硬膜外纤维化，进行动态侧位X线检查以确定节段性不稳定。上次手术后的演变期为初次手术后1至3年。在术后早期和晚期使用疼痛视觉模拟量表（VAS）评估疼痛表达程度和动态变化。使用改良的MacNab量表评估术后成功率。最后一次手术后的随访记录期至少为1年，范围为1至4年。
大多数情况下手术治疗有效，VAS量表上的疼痛表达水平从7.2 - 7.7分在早期降至1.7 - 2.1分，在晚期（1年）降至2.2 - 2.6分。在30例未进行融合的减压手术患者中，21例（70%）重复手术有效；在26例接受经椎间孔腰椎椎体间融合术（TLIF）重复手术的患者中，20例（76.9%）有效。总体而言，使用改良的MacNab量表评估术后成功率。
对于有复发性椎间盘突出症临床表现的患者，重复手术是一种可行的选择。通过MRI使用造影剂进行检查可将椎间盘突出复发与硬膜外纤维化区分开来。用椎间孔间融合术补充重复的髓核摘除术和减压术可提供更好的临床效果，特别是对于有腰椎节段不稳定临床和放射学体征的患者。
