脊柱患者疗效研究试验中复发性椎间盘突出症的再次手术：发生率、危险因素及疗效分析
Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome.
作者信息
Abdu Robert W, Abdu William A, Pearson Adam M, Zhao Wenyan, Lurie Jon D, Weinstein James N
机构信息
The University of New England College of Osteopathic Medicine, Biddeford, ME.
Department of Orthopedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
出版信息
Spine (Phila Pa 1976). 2017 Jul 15;42(14):1106-1114. doi: 10.1097/BRS.0000000000002088.
STUDY DESIGN
This study was a post-hoc subgroup analysis of prospectively collected data in the Spine Patient Outcomes Research Trial (SPORT).
OBJECTIVE
The aim of this study was to determine the risk factors for and to compare the outcomes of patients undergoing revision disc excision surgery in SPORT.
SUMMARY OF BACKGROUND DATA
Risk factors for reherniation and outcomes after revision surgery have not been well-studied. This information is critical for proper patient counseling and decision-making.
METHODS
Patients who underwent primary discectomy in the SPORT intervertebral disc herniation cohort were analyzed to determine risk factors for undergoing revision surgery. Risk factors for undergoing revision surgery for reherniation were evaluated using univariate and multivariate analysis. Primary outcome measures consisted of Oswestry Disability Index (ODI), the Sciatica Bothersomeness index (SBI), and the Short Form 36 (SF-36) at 6 weeks, 3 months, 6 months, and yearly to 4 years.
RESULTS
Of 810 surgical patients, 74 (9.1%) received revision surgery for reherniation. Risk factors for reherniation included: younger age (hazard ratio [HR] 0.96 [0.94-0.99]), lack of a sensory deficit (HR 0.61 [0.37-0.99]) lack of motor deficit (HR 0.54 [0.32-0.91]), and higher baseline ODI score (HR 1.02 [1.01-1.03]). The time-adjusted mean improvement from baseline to 4 years was less for the reherniation group on all outcome measures (Bodily Pain Index [BP] 39.5 vs. 44.9, P = 0.001; Physical Function Index [PF] 37.1 vs. 44.5, P < 0.001; ODI 33.9 vs. 38.3, P < 0.001; SBI 8.7 vs. 10.5, P < 0.001). At 4 years, only SBI (-9 vs. -11.4, P = 0.002) was significantly lower in the reherniation group.
CONCLUSION
Younger patients with higher baseline disability without neurological deficit are at increased risk of undergoing revision surgery for reherniation. Those considering revision surgery for reherniation will likely improve significantly following surgery, but possibly not as much as with primary discectomy.
LEVEL OF EVIDENCE
研究设计
本研究是对脊柱患者预后研究试验（SPORT）中前瞻性收集的数据进行的事后亚组分析。
目的
本研究的目的是确定SPORT中接受翻修椎间盘切除术患者的风险因素，并比较其预后。
背景数据总结
复发疝的风险因素以及翻修手术后的预后尚未得到充分研究。这些信息对于为患者提供恰当的咨询和决策至关重要。
方法
对SPORT椎间盘突出症队列中接受初次椎间盘切除术的患者进行分析，以确定接受翻修手术的风险因素。使用单因素和多因素分析评估因复发疝接受翻修手术的风险因素。主要结局指标包括6周、3个月、6个月以及每年至4年时的Oswestry功能障碍指数（ODI）、坐骨神经痛困扰指数（SBI）和简明健康状况调查量表（SF-36）。
结果
在810例手术患者中，74例（9.1%）因复发疝接受了翻修手术。复发疝的风险因素包括：年龄较小（风险比[HR]0.96[0.94 - 0.99]）、无感觉障碍（HR 0.61[0.37 - 0.99]）、无运动障碍（HR 0.54[0.32 - 0.91]）以及较高的基线ODI评分（HR 1.02[1.01 - 1.03]）。在所有结局指标上，复发疝组从基线到4年的时间调整平均改善程度均低于初次手术组（身体疼痛指数[BP]39.5对44.9，P = 0.001；身体功能指数[PF]37.1对44.5，P < 0.001；ODI 33.9对38.3，P < 0.001；SBI 8.7对10.5，P < 0.001）。在4年时，复发疝组仅SBI（-9对-11.4，P = 0.002）显著更低。
结论
基线残疾程度较高且无神经功能缺损的年轻患者因复发疝接受翻修手术的风险增加。考虑因复发疝进行翻修手术的患者术后可能会有显著改善，但可能不如初次椎间盘切除术的患者改善明显。
证据级别
3级。
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