Himchan UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah, United Arab Emirates.
Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon, Korea.
J Neurol Surg A Cent Eur Neurosurg. 2020 Sep;81(5):392-398. doi: 10.1055/s-0040-1709164. Epub 2020 May 3.
Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes.
This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries.
Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression.
The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.
腰椎管狭窄症（LSS）的再次手术具有一定的技术难度。目前有关比较脊柱融合术与脊柱减压术的术前风险因素和再次手术结果的研究有限。因此，本研究比较了这两种术式的再手术率、与再次手术相关的术前因素以及临床结果。
本回顾性队列研究纳入了 2001 年 5 月至 2015 年 3 月间因退行性 LSS 而接受翻修手术的患者前瞻性采集的数据。分析并比较了融合术与减压术的再手术率、手术类型、主要翻修原因、最终临床结果（疼痛、生活质量改善、患者满意度和并发症发生率）。
在 13 年间的 987 例患者中，我们发现融合术后有 25 例、减压术后有 23 例需要再次手术，融合术和减压术的再手术率分别为 5.88%和 4.00%。合并并存疾病（融合术：危险比[HR]为 1.98；多节段受累[融合术：HR 为 2.92；减压术：HR 为 1.95]）与每种术式的术前人口统计学危险因素密切相关。融合术后再次手术的主要原因是近端交界性后凸（40%）和内植物失败（20%），减压术后再次手术的主要原因是复发病变（48.8%）和手术不彻底（17.4%）。初次融合后再次融合而初次减压后不融合是最常见的手术方式。与减压术相比，融合术后腰痛和患者满意度更好。
初次融合与初次减压的再手术率、术前风险因素、翻修原因、再次手术类型、临床结果、患者满意度以及初次手术与再次手术之间的时间间隔不同。更好地了解疾病的病理生理学和手术程序特点将有助于改善疾病管理和治疗策略的制定。
