Klessinger Stephan
Department of Neurosurgery, Nova Clinic Biberach, Eichendorffweg 5, 88400 Biberach, Germany.
Department of Neurosurgery, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Minim Invasive Surg. 2018 Oct 9;2018:5286760. doi: 10.1155/2018/5286760. eCollection 2018.
To prevent open surgical procedures, minimally invasive techniques, like Dekompressor (PLDD), have been developed. The absence of reherniation is an important factor correlating with clinical success after lumbar surgery. In this retrospective, observational study, the frequency of additional open surgery after PLDD in a long time retrospective was examined. The correlation between clinical symptoms and outcome was assessed, and the time between PLDD and open surgery was analyzed. Consecutive patients after PLDD between 2005 and 2007 were included. MacNab's outcome criteria were used to evaluate patient satisfaction. The need for additional open surgery of the lumbar spine, the period between Dekompressor and resurgery, and the treated levels were analyzed. In total, 73 patients were included in this study. The patients were seen one month after PLDD. The majority of patients (76.7%) had additional radicular pain. The most common level treated was L4-5 (58.9%). The follow-up time was longer than 5 years in 30.1% of the patients and longer than 10 years in 6.82%. The short-term success rate was 67.1%. Additional surgery was performed in 26.0% of patients, with 78.9% of the reoperations undertaken during the first year after PLDD. These patients had a statistically significant worse outcome (P = 0.025). Radicular pain was present in all patients with an early subsequent surgery, but only in 50% of patients with late surgery (P = 0.035). Significantly more patients with poor pain relief had radicular pain (P = 0.04). The short-term success rate was worsened by a resurgery rate of 26.0%. Subsequent surgery, a short time after PLDD, suggests that PLDD is not a replacement for open discectomy. Because patients with radicular pain had a worse outcome and more frequent resurgeries, whether radicular pain is an ideal indication for PLDD should be discussed.
为避免开放性手术，人们研发了诸如减压仪（经皮激光椎间盘减压术）之类的微创技术。无复发疝是腰椎手术后临床成功的一个重要相关因素。在这项回顾性观察研究中，对经皮激光椎间盘减压术（PLDD）后长期随访中再次进行开放性手术的频率进行了检查。评估了临床症状与治疗结果之间的相关性，并分析了PLDD与再次手术之间的时间间隔。纳入了2005年至2007年间接受PLDD治疗的连续患者。采用MacNab的结果标准来评估患者满意度。分析了腰椎再次开放性手术的必要性、减压仪治疗与再次手术之间的时间段以及治疗节段。本研究共纳入73例患者。在PLDD术后1个月对患者进行了检查。大多数患者（76.7%）有额外的神经根性疼痛。最常治疗的节段是L4 - 5（58.9%）。30.1%的患者随访时间超过5年，6.82%的患者随访时间超过10年。短期成功率为67.1%。26.0%的患者进行了再次手术，其中78.9%的再次手术是在PLDD后的第一年进行的。这些患者的治疗结果在统计学上显著更差（P = 0.025）。所有早期进行后续手术的患者均有神经根性疼痛，但晚期手术患者中只有50%有神经根性疼痛（P = 0.035）。疼痛缓解不佳的患者中神经根性疼痛的比例明显更高（P = 0.04）。26.0%的再次手术率使短期成功率降低。PLDD术后短时间内进行后续手术表明，PLDD不能替代开放性椎间盘切除术。由于有神经根性疼痛的患者治疗结果更差且再次手术更频繁，因此应讨论神经根性疼痛是否是PLDD的理想适应证。
