Hirai Takashi, Yoshii Toshitaka, Inose Hiroyuki, Yamada Tsuyoshi, Yuasa Masato, Ushio Shuta, Egawa Satoru, Hirai Keigo, Okawa Atsushi
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Spine Surg Relat Res. 2018 Mar 15;2(3):215-220. doi: 10.22603/ssrr.2017-0048. eCollection 2018.
Patients treated with revision surgery after lumbar decompression with fusion typically have persistent low back pain and lower extremity numbness compared with patients treated with only primary surgery. No well-designed study has investigated the persistence and degree of pain after revision surgery following instrumented operation. The purpose of this study is to compare residual pain among patients who underwent reoperation and those who underwent only primary surgery for lumbar degenerative disorder using patient-based evaluation.
We reviewed 350 consecutive patients (143 men, 207 women, mean age 63 years) treated with primary lumbar instrumented surgery between October 2010 and February 2014 at our institution and followed up for ≥2 years postoperatively. Patients were categorized into three groups based on number of levels fused: 1-segment, 2-segment, and ≥3-segment fusion (1F, 2F, and ≥3F groups, respectively). We used the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analog scales (VASs) for low back pain and lower extremity pain to evaluate pain intensity pre- and postoperatively.
Salvage surgery for late-phase complications was required in 5 cases (2.4%), 6 cases (11.3%), and 11 cases (12.1%) in the 1F, 2F, and ≥3F groups, respectively. In the 1F and 2F groups, patients treated with revision surgery had unsatisfactory improvement in the pain domain of JOABPEQ and VASs for low back pain and lower extremity pain compared with patients with only primary short fusion surgery. The ≥3F group showed no significant differences between patients who underwent reoperation and those who underwent only primary surgery.
Low back pain and lower extremity pain often persist after revision surgery in patients treated with short fusion (≤2-segment) operation. We need to follow pain states in such patients.
与仅接受初次手术的患者相比，腰椎减压融合术后接受翻修手术的患者通常会持续存在下腰痛和下肢麻木。尚无精心设计的研究调查器械辅助手术后翻修手术疼痛的持续情况和程度。本研究的目的是使用基于患者的评估方法，比较接受再次手术的患者与仅接受初次手术治疗腰椎退行性疾病的患者之间的残余疼痛情况。
我们回顾了2010年10月至2014年2月在我院接受初次腰椎器械辅助手术并术后随访≥2年的350例连续患者（143例男性，207例女性，平均年龄63岁）。根据融合节段数量将患者分为三组：单节段、双节段和≥三节段融合（分别为1F、2F和≥3F组）。我们使用日本骨科协会腰痛评估问卷（JOABPEQ）和视觉模拟量表（VAS）评估术前和术后的腰痛及下肢疼痛强度。
1F、2F和≥3F组分别有5例（2.4%）、6例（11.3%）和11例（12.1%）因晚期并发症需要进行挽救性手术。在1F和2F组中，与仅接受初次短节段融合手术的患者相比，接受翻修手术的患者在JOABPEQ疼痛领域以及腰痛和下肢疼痛的VAS评分方面改善不明显。≥3F组中，接受再次手术的患者与仅接受初次手术的患者之间无显著差异。
接受短节段（≤2节段）融合手术的患者翻修术后，下腰痛和下肢疼痛通常会持续存在。我们需要密切关注这类患者的疼痛状态。
