Abdallah Anas, Güler Abdallah Betül
Department of Neurosurgery, Istanbul Training and Research Hospital, Samatya-Istanbul, Turkey.
Department of Psychiatry - AMATEM Unit, University of Health Sciences, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Bakırköy-Istanbul, Turkey.
Neurol Res. 2023 Jan;45(1):11-27. doi: 10.1080/01616412.2022.2116525. Epub 2022 Sep 1.
Recurrent lumbar disk herniation (RLDH) is one of the most undesirable complications following lumbar discectomy (LD). This study aimed to prospectively investigate the non-biomechanical-radiological and intraoperative factors affecting the recurrence after discectomy.
Data of 988 consecutive patients with Lumbar disk herniation (LDH) who underwent LD at our department for over 2 years (2014-2015) were prospectively collected. Patients who met our study criteria were included (n = 816). Patients were divided into the following groups; group 1 included patients with symptomatic RLDH within the first postoperative 2 years (PO24M), group 2 included patients with symptomatic RLDH after PO24M, and group 3 included patients without symptomatic RLDH/LDH. The preoperative non-biomechanical-radiological, surgical, and intraoperative characteristics were compared among the groups.
A total of 842 LDHs in 816 (386 men and 430 women) patients received LD. The mean age was 46.9 years. The mean follow-up period was 72.8 months. The first recurrence rates within the first PO24M and after PO24M were 7.1% and 3.2%, respectively. Disks with Modic changes type-II and contained disks without fragments were associated with the short- and long-term RLDH [(p = 0.004; HR = 0.6); (p < 0.0001; HR = 0.14)] and [(p = 0.041; HR = 0.6); (p < 0.0001; HR = 0.16)], respectively.
Several radiological, surgical, and intraoperative factors can play a critical role in RLDH; therefore, the selection criteria of patients with LDH should be carefully considered for surgical treatment to obtain acceptable outcomes.
ANOVA: A one-way analysis of variance, CIs: 95% confidence intervals, HR: Hazard ratio, LD: Lumbar discectomy, LDH: Lumbar disc herniation, LF: ligamentum flavum, MRI: Magnetic resonance imaging, MC-I: Modic changes type I, MC-II: Modic changes type II, MC-III: Modic changes type III, n: Number, ODI: Oswestry Disability Index, OR: Odds ratio, p-value: Probability value, PO: Postoperative, Pre: Preoperative, Pts: Patients, RLDH: Recurrent lumbar disc herniation, RR: Relative/risk ratio, SPSS: Statistical package for the social science, T1WIs: T1-weighted images, T2WIs: T2-weighted images, VAS: Visual analog scale.
复发性腰椎间盘突出症（RLDH）是腰椎间盘切除术（LD）后最不良的并发症之一。本研究旨在前瞻性调查影响椎间盘切除术后复发的非生物力学 - 放射学及术中因素。
前瞻性收集了在我院接受LD治疗超过2年（2014 - 2015年）的988例连续性腰椎间盘突出症（LDH）患者的数据。符合研究标准的患者被纳入（n = 816）。患者被分为以下几组：第1组包括术后2年内（PO24M）出现症状性RLDH的患者，第2组包括PO24M后出现症状性RLDH的患者，第3组包括无症状性RLDH/LDH的患者。比较各组术前的非生物力学 - 放射学、手术及术中特征。
816例（386例男性和430例女性）患者共842处LDH接受了LD治疗。平均年龄为46.9岁。平均随访期为72.8个月。PO24M内及PO24M后的首次复发率分别为7.1%和3.2%。Modic改变II型椎间盘及无碎片的包容性椎间盘分别与短期和长期RLDH相关[（p = 0.004；HR = 0.6）；（p < 0.0001；HR = 0.14）]及[（p = 0.041；HR = 0.6）；（p < 0.0001；HR = 0.16）]。
一些放射学、手术及术中因素在RLDH中起关键作用；因此，对于LDH患者进行手术治疗时，应仔细考虑患者选择标准以获得可接受的结果。
ANOVA：单因素方差分析，CIs：95%置信区间，HR：风险比，LD：腰椎间盘切除术，LDH：腰椎间盘突出症，LF：黄韧带，MRI：磁共振成像，MC - I：Modic改变I型，MC - II：Modic改变II型，MC - III：Modic改变III型，n：数量，ODI：Oswestry功能障碍指数，OR：比值比，p值：概率值，PO：术后，Pre：术前，Pts：患者，RLDH：复发性腰椎间盘突出症，RR：相对风险比，SPSS：社会科学统计软件包，T1WIs：T1加权图像，T2WIs：T2加权图像，VAS：视觉模拟评分
