O'Donnell Jeffrey A, Anderson Joshua T, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Department of Orthopedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Ohio Bureau of Workers' Compensation, Columbus, OH.
Spine (Phila Pa 1976). 2017 Jul 15;42(14):E864-E870. doi: 10.1097/BRS.0000000000002057.
Retrospective cohort study.
To determine outcomes after reoperation discectomy with or without fusion surgery for recurrent lumbar disc herniation (RLDH) in the workers' compensation (WC) population.
RLDH is estimated to occur in 7% to 24% of patients after discectomy. There are two main surgical options after reherniation: a revision discectomy (RD), or an RD combined with fusion (RDF).
A total of 10,592 patients received lost-work compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with lumbar spine comorbidities, a smoking history, or multilevel surgery were excluded. One hundred two patients had RD alone for RLDH and 196 had RDF procedures. The primary outcome was whether subjects returned to work (RTW).
A total of 298 WC patients met our study criteria, including 230 (77.2%) men and 68 (22.8%) women with an average age of 39.4 years (range 19-66). The RDF group had lower rates of RTW than the RD group (27.0% vs 40.2%; P = 0.03). Multivariate regression analysis showed that reoperation with discectomy and fusion (P = 0.04; odds ratio [OR] = 0.56), psychiatric illness (P < 0.01; OR = 0.19), and opioid analgesic use within 1 month of reoperation (P < 0.01; OR = 0.44) were independent negative predictors of RTW. RDF patients were supplied with opioids for 252.3 days longer (P < 0.01) and incurred $34,914 (31.8%) higher medical costs (P < 0.01) than the RD alone group.
We analyzed outcomes after operative management of RLDH in the WC population. WC patients receiving RDF had lower RTW rates, higher costs, and a longer duration of postoperative opioid use than those receiving RD alone. This information allows for informed patient management decisions and suggests that fusion should be reserved for patients with clear indications for its use. We are unable to conclude what treatment method is best, but rather we provide a baseline for future studies.
回顾性队列研究。
确定在工人赔偿（WC）人群中，复发性腰椎间盘突出症（RLDH）行再次椎间盘切除术联合或不联合融合手术的术后结果。
据估计，椎间盘切除术后7%至24%的患者会发生RLDH。再次突出后主要有两种手术选择：翻修椎间盘切除术（RD）或RD联合融合术（RDF）。
2005年至2012年期间，共有10592名因腰椎间盘突出症从俄亥俄州工人赔偿局获得误工赔偿的患者。排除有腰椎合并症、吸烟史或多节段手术史的患者。102例患者因RLDH单独接受了RD手术，196例接受了RDF手术。主要结局是受试者是否重返工作岗位（RTW）。
共有298名WC患者符合我们的研究标准，其中男性230例（77.2%），女性68例（22.8%），平均年龄39.4岁（范围19 - 66岁）。RDF组的RTW率低于RD组（27.0%对40.2%；P = 0.03）。多因素回归分析显示，椎间盘切除联合融合术再次手术（P = 0.04；比值比[OR]=[0.56]）、精神疾病（P < 0.01；OR =[0.19]）以及再次手术后1个月内使用阿片类镇痛药（P < 0.01；OR =[0.44]）是RTW的独立负性预测因素。RDF患者使用阿片类药物的时间比单纯RD组延长252.3天（P < 0.01），医疗费用高出34914美元（31.8%）（P < 0.01）。
我们分析了WC人群中RLDH手术治疗后的结果。接受RDF的WC患者比单纯接受RD的患者RTW率更低、费用更高且术后使用阿片类药物的时间更长。这些信息有助于做出明智的患者管理决策，并表明融合术应仅用于有明确使用指征的患者。我们无法得出哪种治疗方法最佳的结论，而是为未来的研究提供了一个基线。
3级。
