Cheng Chun-Yu, Cheng Ya-Chung, Wang Ting-Chung, Yang Wei-Hsun
Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
Department of Internal medicine, College of Medicine, Nation Taiwan University, Taiwan.
World Neurosurg. 2018 Sep;117:e660-e668. doi: 10.1016/j.wneu.2018.06.109. Epub 2018 Jun 23.
Lumbar disc herniation (LDH) is a common spinal problem, with reoperation rates of 6%-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in patients with LDH.
This retrospective study used a 5-year nationwide database to analyze reoperation rates in Taiwan. Patient age groups (≥20 and <90 years) treated by index surgery and reoperation for LDH were identified. Four surgical procedures were included in the analysis: discectomy (DC), anterior lumbar fusion with DC (FA + DC), posterior lumbar fusion (FP), and posterior lumbar fusion with DC (FP + DC).
There were 1743 index surgeries between 2008 and 2012, with 184 (10.56%) reoperations. Index surgery DC had the highest reoperation rate (n = 121, 20%). The reoperation risk was significantly lower for patients undergoing fusion procedures (FA + DC vs. DC [hazard ratio (HR), 0.24; 95% confidence interval (CI), 0.12-0.47; P < 0.01], FP versus DC [HR, 0.17; 95% C, 0.09-0.33; P <0.01], FP + DC versus DC [HR, 0.31; 95% CI, 0.22-0.44; P < 0.01]). Fusion procedures had significantly higher treatment costs compared with DC (FA + DC vs. FP vs. FP + DC vs. DC: 5851.74 ± 4808.94 vs. 5116.88 ± 3428.97 vs. 4782.16 ± 2902.19 vs. 3846.79 ± 3584.45 U.S. dollars/patient, respectively; P < 0.0001).
Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared with discectomy, but at the expense of higher medical costs.
腰椎间盘突出症（LDH）是一种常见的脊柱疾病，再次手术率为6%-24%。尽管采用了不同的手术技术进行治疗，但关于融合技术是否能降低LDH患者的再次手术率仍存在争议。
这项回顾性研究使用了一个为期5年的全国性数据库来分析台湾地区的再次手术率。确定了接受初次手术和因LDH进行再次手术的患者年龄组（≥20岁和<90岁）。分析包括四种手术方式：椎间盘切除术（DC）、前路腰椎融合术联合DC（FA + DC）、后路腰椎融合术（FP）以及后路腰椎融合术联合DC（FP + DC）。
2008年至2012年间有1743例初次手术，其中184例（10.56%）进行了再次手术。初次手术采用DC的再次手术率最高（n = 121，20%）。接受融合手术的患者再次手术风险显著更低（FA + DC与DC相比[风险比（HR），0.24；95%置信区间（CI），0.12 - 0.47；P < 0.01]，FP与DC相比[HR，0.17；95% CI，0.09 - 0.33；P < 0.01]，FP + DC与DC相比[HR，0.31；95% CI，0.22 - 0.44；P < 0.01]）。与DC相比，融合手术的治疗成本显著更高（FA + DC与FP与FP + DC与DC相比：分别为5851.74 ± 4808.94美元/患者、5116.88 ± 3428.97美元/患者、4782.16 ± 2902.19美元/患者、3846.79 ± 3584.45美元/患者；P < 0.0001）。
在LDH的手术方式中，与椎间盘切除术相比，融合技术与更低的再次手术率相关，但代价是更高的医疗成本。
