Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France.
Centre Des Massues, Croix Rouge, 92 Rue Dr Ed Locard, 69005, Lyon, France.
Eur Spine J. 2020 Feb;29(Suppl 1):22-38. doi: 10.1007/s00586-020-06314-w. Epub 2020 Jan 29.
To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication.
We conducted two separate PUBMED searches to evaluate the revision post-stenosis and degenerative scoliosis surgery using the terms: lumbar vertebrae/surgery, spinal stenosis, spine, scoliosis and reoperation. The resulting papers were categorized into three groups: (1) those that evaluated reoperation post-simple decompression; (2) those that evaluated spinal decompression and fusion for short (3 levels or less) or long (more than 3 levels) segment spinal fusion; and (3) those diagnosing the stenosis during the surgery.
(1) We found 11 relevant papers that only looked at revision spine surgery post-laminectomy for spinal stenosis. (2) We found 20 papers looked at reoperation post-laminectomy and fusion amongst which there were two papers specifically comparing long-segment (> 3 level) and short-segment (3 or less levels) fusions. (3) In the unspecified group, we found only one article. Fifteen articles were excluded as they were not specifically looking at our objective criteria for revision surgery. In regard to revision post-adult deformity surgery, we found 18 relevant articles.
After this literature review and analysis of post-operative stenosis, it seems important to provide some advice to avoid revision surgeries more or less induced by the surgery. It looks interesting when performing simple decompression without fusion in the lumbar spine to analyse the risk of instability induced by the decompression and facet resection but also by a global balance analysis. Regarding pre-operative stenosis in a previously operated area, different causes may be evocated, like screw or cage malpositionning but also insufficient decompression which is a common cause. Intraoperatively, the use of neuromonitoring and intraoperative CT scan with navigation are useful tool in complex cases to avoid persisting stenosis. Pre-op analysis and planning are key parameters to decrease post-op problems. These slides can be retrieved under Electronic Supplementary Material.
对初次手术后脊柱狭窄症复发的文献进行综述，并制定避免该并发症的规则。
我们进行了两次独立的 PubMed 检索，使用以下术语评估狭窄症术后翻修和退行性脊柱侧凸手术：腰椎/手术、脊柱狭窄症、脊柱、脊柱侧凸和再次手术。将得到的论文分为三组：(1) 评估单纯减压术后再次手术的论文；(2) 评估短节段(3 个节段或以下)或长节段(超过 3 个节段)脊柱减压融合的论文；(3) 术中诊断狭窄症的论文。
(1) 我们发现了 11 篇仅研究单纯减压术后脊柱狭窄症翻修手术的相关论文。(2) 我们发现了 20 篇研究减压融合术后再次手术的论文，其中有 2 篇论文专门比较了长节段(>3 个节段)和短节段(3 个节段或以下)融合。(3) 在未特指组中，我们只发现了一篇文章。15 篇文章被排除在外，因为它们不是专门针对我们的翻修手术的客观标准。关于成人畸形术后翻修手术，我们发现了 18 篇相关文章。
通过对术后狭窄症的文献回顾和分析，似乎有必要提供一些建议，以避免或多或少因手术而导致的翻修手术。在腰椎单纯减压而不融合的情况下，分析减压和小关节切除引起的不稳定风险以及整体平衡分析是很有趣的。对于先前手术区域的术前狭窄，可能会出现不同的原因，如螺钉或 cage 错位，也可能是减压不充分，这是一个常见的原因。术中使用神经监测和术中 CT 扫描导航是复杂病例中避免持续狭窄的有用工具。术前分析和规划是减少术后问题的关键参数。这些幻灯片可在电子补充材料中检索。
