Mashhadinezhad Hossein, Sarabi Ebrahim, Mashhadinezhad Sara, Ganjeifar Babak
Research performed at Ghaem Hospital, Mashhad, Iran.
Department of Neurological Surgery, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
Arch Bone Jt Surg. 2018 Sep;6(5):397-401.
Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinical outcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In this study, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed.
We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analogue scale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvement of symptoms and functional outcomes.
Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%) obtained fair or poor results (group 2). There was no significant difference between the groups regarding age (), gender (), body mass index (), diabetes mellitus (), smoking (), interval between primary and revision surgeries (), and surgical outcomes (). However, significant improvements were achieved in VAS scores for back () and radicular pain (), as well as ODI scores (). Based on the findings, only ODI scores showed a significant inter-group difference in the 12-month follow-up ().
Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDH without overt instabilities.
翻修椎间盘切除术是复发性腰椎间盘突出症（RLDH）的主要手术方式。该手术后的临床效果与初次椎间盘切除术相当或略差。本研究分析了接受显微外科椎间盘切除术治疗RLDH患者的临床效果。
我们检查了179例行腰椎显微椎间盘切除术治疗RLDH的患者。采用视觉模拟量表（VAS）、普罗洛评分系统和奥斯维斯特里残疾指数（ODI）评估症状改善情况和功能结局。
179例患者中，101例（56%）获得了良好和优秀的普罗洛评分（第1组），而78例（44%）获得了一般或较差的结果（第2组）。两组在年龄、性别、体重指数、糖尿病、吸烟、初次手术与翻修手术间隔时间以及手术结局方面无显著差异。然而，背部和根性疼痛的VAS评分以及ODI评分均有显著改善。根据研究结果，仅ODI评分在12个月随访时显示出显著的组间差异。
对于无明显不稳定的RLDH患者，有限的显微外科椎间盘切除术可被视为主要的手术方法。
