Turk J Med Sci. 2019 Feb 11;49(1):249-257. doi: 10.3906/sag-1807-173.
BACKGROUND/AIM: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing treatment protocol. MATERIALS AND METHODS: Eighty-two patients with FBSS symptoms were included. Two groups were composed as group I (stabilized) and group II (nonstabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the patient satisfaction scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. RESULTS: Mean VAS scores were 7.8 and 3.28 points in group I (P < 0.001) and 7.51 and 2.74 points in group II (P < 0.001) at the beginning and at 12 months, respectively. Mean ODI scores were 34.05 and 22.16 points in group I (P < 0.001) and 30.74 and 19.46 points in group II (P < 0.001) at the beginning and at 12 months. VAS and ODI scores decreased significantly in both groups, but were more significant in the nonstabilized group (P < 0.001). Moderate or severe fibrous tissue was observed in 86.58% of the patients and patient satisfaction scores were very good or good in 78.06% of the patients. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the nonstabilization group; however, none of these patients developed a spinal headache and no significant permanent complication arose. CONCLUSION: We suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients
背景/目的:我们旨在比较通过硬膜外镜进行机械松解和类固醇酶注射治疗失败性腰椎手术综合征(FBSS)患者的结果,这些患者的稳定状态不同,并检测病理诊断标志物对预后和现行治疗方案的影响。
材料和方法:共纳入 82 例 FBSS 症状患者。将两组患者分别组成 I 组(稳定)和 II 组(非稳定)。所有患者在治疗前、治疗后 1、3、6 和 12 个月时均使用 Oswestry 残疾指数(ODI)和视觉模拟评分(VAS)进行评估,并在治疗后 12 个月时使用患者满意度量表进行评估。还记录了硬膜外瘢痕组织的视觉和机械迹象。
结果:I 组患者的平均 VAS 评分分别为 7.8 和 3.28 分(P<0.001),II 组患者分别为 7.51 和 2.74 分(P<0.001);I 组患者的平均 ODI 评分分别为 34.05 和 22.16 分(P<0.001),II 组患者分别为 30.74 和 19.46 分(P<0.001)。两组患者的 VAS 和 ODI 评分均显著降低,但非稳定组降低更为显著(P<0.001)。86.58%的患者观察到中度或重度纤维组织,78.06%的患者对治疗非常满意或满意。在手术过程中,稳定组有 4 例患者和非稳定组有 2 例患者发生硬脊膜破裂,但无患者发生脊髓性头痛,也无明显的永久性并发症发生。
结论:我们建议对慢性腰痛和/或根性症状的 FBSS 患者进行硬膜外粘连松解、透明质酸酶和类固醇注射,这可能会提供有关生活质量、诊断准确性以及现有发现的可能过程的可靠信息,并且在非稳定患者中可能更有效。
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