Segura-Trepichio Manuel, Martin-Benlloch Antonio, Manuel Montoza-Nuñez Jose, Candela-Zaplana David, Nolasco Andreu
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario del Vinalopo, Alicante, Spain.
Departamento de Cirugía Ortopédica y Traumatología, Hospital Univeritario Dr Pesset, Valencia, Spain.
J Clin Neurosci. 2018 May;51:29-34. doi: 10.1016/j.jocn.2018.02.010. Epub 2018 Feb 21.
Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system (IDSS) in association with disc excision to prevent pain and re-operation, remains controversial.
Patients (age 18-50 years) presenting with lumbago/sciatica (ICD-10-CM M54.3, M54.4) due to voluminous lumbar disc herniation were eligible for participation. Patients underwent microdiscectomy plus IDSS. The primary outcome measure was the clinical efficacy using Owestry disability index(ODI) and visual analogue pain scale (VAS). We also evaluated several other outcome parameters including: length of stay and costs during hospital admission, 90-day complication rate, and 1-year re-operation rate. This prospective observational study was carried out from January 2015 to August 2016.
A total of 30 patients whose mean age was 38.6(±9.2) years were included. ODI score dropped from 62.93(±16.45) to 13.50(±16.67), representing 78.54% (95% C.I 68.07-88.66%) improvement of the baseline score after one year (p < 0.001). Patients had 90 day re-admission and 1 year re-operation rates of 4/30(13.3%) and 3/30(10%) respectively. Length of stay was 2.1 ± 1.2 days. In-Hospital cost was 1069.8 ± 288.4 € (not including 1500€ of the implant). Implant related complications were common 12/30(40%), although they did not have any clinical consequences.
Our short-term experience indicates that microdiscectomy plus interspinous device is safe and it shows good clinical results, although the clinical improvement seems to be due to microdiscectomy, without the implant adding any extra benefit. The addition of IDSS did not protect against re-operation, and it increased the surgical expenses.
椎间盘切除术有时与术后椎间盘突出复发及疼痛相关。使用棘突间动态稳定系统（IDSS）联合椎间盘切除术以预防疼痛和再次手术的证据仍存在争议。
因大量腰椎间盘突出导致腰痛/坐骨神经痛（国际疾病分类第十版临床修订本，M54.3，M54.4）的18 - 50岁患者符合参与条件。患者接受显微椎间盘切除术加IDSS。主要结局指标是使用Oswestry功能障碍指数（ODI）和视觉模拟疼痛量表（VAS）评估临床疗效。我们还评估了其他几个结局参数，包括：住院时间和住院费用、90天并发症发生率以及1年再次手术率。这项前瞻性观察性研究于2015年1月至2016年8月进行。
共纳入30例患者，平均年龄38.6（±9.2）岁。ODI评分从62.93（±16.45）降至13.50（±16.67），表明一年后基线评分改善了78.54%（95%可信区间68.07 - 88.66%）（p < 0.001）。患者90天再入院率和1年再次手术率分别为4/30（13.3%）和3/30（10%）。住院时间为2.1 ± 1.2天。住院费用为1069.8 ± 288.4欧元（不包括植入物的1500欧元）。与植入物相关的并发症很常见，为12/30（40%），尽管它们没有任何临床后果。
我们的短期经验表明，显微椎间盘切除术加棘突间装置是安全的，并且显示出良好的临床效果，尽管临床改善似乎归因于显微椎间盘切除术，植入物并未带来额外益处。添加IDSS并不能预防再次手术，且增加了手术费用。
