Yüce İsmail, Kahyaoğlu Okan, Çavuşoğlu Halit, Aydın Yunus
Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Services, Istanbul, Turkey.
Acıbadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.
J Clin Neurosci. 2019 May;63:43-47. doi: 10.1016/j.jocn.2019.02.010. Epub 2019 Mar 1.
The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ± 12,9, 44,1 ± 11,6 years and mean-weight was 73,4 ± 14,4, 77,3 ± 14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p < 0,05). The average operation-time was 70,9 ± 5,2 and 42,3 ± 4,6 min and the average surgical hemorrhage was 91,1 ± 11,3 and 50,3 ± 7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery.
复发性腰椎间盘突出症（LDH）的再次手术存在困难且手术效果不佳。首次手术中所采用的手术技术在复发性LDH的再次手术中变得至关重要。我们研究的目的是评估保留黄韧带（LF）的腰椎显微椎间盘切除术治疗复发性腰椎间盘手术的疗效。在我们的研究中，149例因单节段复发性LDH在我们诊所接受治疗的患者被分为两组。第一组包含86例患者，他们在其他诊所首次手术时接受了未保留LF的腰椎显微椎间盘切除术；第二组包含63例患者，他们在我们诊所首次手术时接受了保留LF的腰椎显微椎间盘切除术。我们调查了年龄、体重、性别、复发时间、复发性LDH的节段侧别、手术结果以及出血情况、并发症、手术时间。两组的平均年龄分别为45.9±12.9岁和44.1±11.6岁，平均体重分别为73.4±14.4千克和77.3±14.2千克。29例患者接受了L3 - 4节段的治疗，63例患者接受了L4 - 5节段的治疗，57例患者接受了L5 - S1节段复发性LDH的治疗。所有患者术前和随访时的腰腿疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分均显著降低（p < 0.05）。第一组和第二组的平均手术时间分别为70.9±5.2分钟和42.3±4.6分钟，平均手术出血量分别为91.1±11.3毫升和50.3±7.4毫升。在首次手术中保留LF对于保护解剖结构的复发性腰椎间盘手术越来越重要。我们的技术在复发性腰椎间盘手术中减少了并发症、手术时间和手术出血量，并提供了良好的手术效果。
