Spine Center, Schön Klinik München Harlaching, Harlachinger Strasse 51, 81547, Munich, Germany.
Academic Teaching Hospital and Spine Research Institute, Paracelsus Private Medical University, Salzburg, Austria.
Eur Spine J. 2020 Feb;29(Suppl 1):14-21. doi: 10.1007/s00586-019-06194-9. Epub 2019 Oct 29.
Recurrent lumbar disc herniation is the most common complication after discectomy. Due to the altered anatomy with the presence of scar tissue, the surgical revision of already operated patients could be a surgical challenge.
We describe the microsurgical revision technique step by step with the evaluation of our own clinical results in comparison with primary lumbar disc surgeries. The clinical data are based on a clinical register with 2576 recorded primary surgeries (PD) and 592 cases of revisions (RD) with 12- and 24-month follow-up (FU). The intraoperative dura lesion rates of the surgeries between 2016 and 2018 were recorded retrospectively. Data from 894 primary disc surgeries and 117 revisions were evaluated.
The ODI and the VAS for leg and back pain improved in both groups significantly with slightly inferior outcome of the revision group. The ODI improved from 46.3 (PD) and 45.9 (RD), respectively, to 12.6 (PD) and 22.9 (RD) at the 24-month FU. The VAS dropped down as well in both group [VAS back: 47.8 (PD) and 43.9 (RD) to 19.9 and 32.2 at the 24-month FU; VAS leg: 62.9 (PD) and 65.5 (RD) to 15.6 and 26.8 at the 24-month FU]. During the primary interventions, we observed 1.5% (11/894) and during revisions 7.7% (9/117) of dura lesions.
There is no clear guideline for the surgical treatment of recurrent disc herniations. In most cases, a pure re-discectomy is sufficient and can be performed safely and effectively with the help of a microscope. These slides can be retrieved under Electronic Supplementary Material.
腰椎间盘切除术后复发是最常见的并发症。由于存在疤痕组织，解剖结构发生改变，因此对已手术患者进行再次手术可能具有挑战性。
我们逐步描述了显微外科翻修技术，并将其与原发性腰椎间盘手术的临床结果进行了比较。临床数据基于一个临床登记处，其中记录了 2576 例原发性手术（PD）和 592 例翻修手术（RD），随访时间为 12 个月和 24 个月。回顾性记录了 2016 年至 2018 年手术过程中硬脑膜损伤的发生率。评估了 894 例原发性椎间盘手术和 117 例翻修手术的数据。
两组患者的 ODI 和腿部及背部疼痛的 VAS 均显著改善，翻修组的结果略差。ODI 从 PD 的 46.3（45.9）分别改善到 RD 的 12.6（22.9）在 24 个月的 FU 中。两组患者的 VAS 评分也都有所下降[VAS 背部：47.8（43.9）至 RD 的 19.9（32.2）和 24 个月的 FU；VAS 腿部：62.9（65.5）至 RD 的 15.6（26.8）和 24 个月的 FU]。在原发性手术中，我们观察到 1.5%（11/894）发生硬脑膜损伤，在翻修手术中，观察到 7.7%（9/117）发生硬脑膜损伤。
对于复发性椎间盘突出症的手术治疗尚无明确的指南。在大多数情况下，单纯的再椎间盘切除术是足够的，并且可以在显微镜的帮助下安全有效地进行。这些幻灯片可以在电子补充材料中找到。
