Departamento de Cirugía Ortopédica y Traumatología, Hospital IMED, Alicante, Spain.
Departamento de Medicina Familiar y Comunitaria, Hospital del Vinalopó, Alicante, Spain.
J Clin Neurosci. 2021 Apr;86:193-201. doi: 10.1016/j.jocn.2021.01.035. Epub 2021 Feb 9.
Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone.
Patients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated.
A total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.
椎间盘切除术有时会与手术后椎间盘突出和疼痛的复发有关。使用棘突间动态稳定系统或器械融合与椎间盘切除联合使用以预防疼痛和再次手术的证据仍然存在争议。在这项研究中，我们分析了单独使用微椎间盘切除术（MD）与单独使用微椎间盘切除术（MD）相比，添加棘突间间隔物或融合是否具有优势。
将腰椎间盘突出症患者分为 3 组；单纯微椎间盘切除术（MD）、微椎间盘切除术加棘突间间隔物（IS）和后路腰椎椎间融合术（PLIF）。使用 Oswestry 功能障碍指数（ODI）测量临床疗效。其他观察指标包括视觉模拟评分法（VAS）背部和腿部疼痛、住院时间、直接住院费用、90 天并发症发生率和 1 年再手术率。
共纳入 103 例患者，平均年龄为 39.1（±8.5）岁。3 组患者的 ODI 和 VAS 背部和腿部疼痛基线评分均显著改善。1 年后，3 组间 ODI、VAS 背部和腿部疼痛无显著差异。IS 组总直接住院费用增加 169%，PLIF 组增加 287%，与 MD 相比（p<0.001）。IS 组住院时间增加 86%，PLIF 组增加 384%，与 MD 相比（p<0.001）。1 年再手术率分别为 5.6%、10%和 16.2%（p=0.33）。椎间盘切除术似乎是临床改善的主要原因，而棘突间间隔物或融合并没有带来任何益处。添加棘突间间隔物或融合增加了直接住院费用和住院时间，并且不能防止再次手术。
