Beack Joo Yul, Chun Hyoung Joon, Bak Koang Hum, Choi Kyu-Sun, Bae In-Suk, Kim Kee D
Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
Department of Neurological Surgery, University of California, Davis, CA, USA.
J Korean Neurosurg Soc. 2019 Sep;62(5):586-593. doi: 10.3340/jkns.2019.0085. Epub 2019 Aug 30.
To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.
Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.
The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4-5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).
Patients with high BMI or severe disc degeneration should be informed of HLD revision.
研究复发性腰椎间盘突出症（HLD）二次腰椎间盘切除术（LD）的危险因素，并确定降低复发率的方法。
回顾性收集160例行初次LD患者的数据。分析人口统计学特征、包括Pfirrmann椎间盘退变在内的影像学表现以及手术信息，以比较翻修患者和非翻修患者的风险。
翻修率为15%（24例患者），平均随访时间为28.3个月。HLD复发与任何人口统计学特征均无关。初次和二次LD最常见于L4-5节段，但手术节段与翻修无显著相关性。初次LD最常见的Pfirrmann椎间盘退变分级为3级，其次为4级。对于复发性HLD，Pfirrmann 4级最常见且具有统计学意义（p<0.05）。体重指数（BMI）超过30被视为肥胖，且与HLD翻修显著相关（p<0.05）。
对于BMI高或椎间盘退变严重的患者，应告知其HLD翻修的情况。
