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同一节段复发性椎间盘突出症治疗中行重复椎间盘切除术:50例患者的研究

Repeat Discectomy for the Management of Same-Level Recurrent Disc Herniation: A Study of 50 Patients.

作者信息

Musa Gerald, Makirov Serik K, Susin Sergey V, Chmutin Gennady E, Kim Alexandre V, Hovrin Dmitri V, Ndandja Dimitri T K, Otarov Olzhas B, Shaafal Hesham M, Familia Ramirez Karina

机构信息

Neurological Surgery, Peoples' Friendship University of Russia (RUDN University) Named After Patrice Lumumba, Moscow, RUS.

Neurological Surgery, Livingstone Central Hospital, Livingstone, ZMB.

出版信息

Cureus. 2023 Jun 15;15(6):e40469. doi: 10.7759/cureus.40469. eCollection 2023 Jun.

Abstract

Background Same-level recurrent disc herniation remains a challenge in spine surgery. Although most surgeons agree on discectomy as the treatment of choice for primary lumbar disc herniation, the management of recurrent disc herniation remains ambiguous and largely depends on the operating surgeon. Many surgeons recommend repeat discectomy over fusion because it is cheaper and less invasive. In this study, we analyzed 50 patients who underwent a repeat discectomy. Materials and methods The patients in the study had previously been managed for lumbar disc herniation and then presented with either recurrent same-level herniation or symptoms attributed to the same level. The patients were then managed with a repeat discectomy without fusion. We analyzed the preoperative and postoperative Oswestry Disability Index (ODI), duration of surgery, blood loss, duration of hospitalization, and complications. Results Fifty patients were included: 27 females (54%), and 23 males (46%). They were followed up for an average of 2.81 years (range: 1-4). The mean duration of hospitalization was 4.06 ± 1.5 days (range: 2-8). The operative time was 104.60 minutes (range: 50-195), with an intraoperative blood loss of 85.40 mL (range: 50-150 mL). Durotomy occurred as a complication in eight (16%) patients. The recurrence rate was 26%, with 36% progressing to fusion. The change in preoperative ODI and postoperative ODI was 20.94 ± 7.24 (6-37), with a p-value of 0.04. There were no long-term complications recorded. Conclusion Repeat discectomy is a good management option for same-level recurrent disc herniation. The procedure is associated with low intraoperative blood loss and a short operating time, but there is a significant risk of durotomy. The risk of recurrence remains a concern due to the progression of degenerative changes, especially in the presence of Modic-2 changes. These advantages and disadvantages should be discussed with patients.

摘要

背景

同节段复发性椎间盘突出症仍是脊柱外科手术中的一项挑战。尽管大多数外科医生都认同椎间盘切除术是原发性腰椎间盘突出症的首选治疗方法,但复发性椎间盘突出症的治疗仍不明确,且很大程度上取决于手术医生。许多外科医生推荐重复椎间盘切除术而非融合术,因为其费用更低且侵入性更小。在本研究中,我们分析了50例行重复椎间盘切除术的患者。

材料与方法

本研究中的患者此前曾接受过腰椎间盘突出症的治疗,随后出现同节段复发性突出或同节段相关症状。这些患者随后接受了不融合的重复椎间盘切除术。我们分析了术前和术后的奥斯威斯利功能障碍指数(ODI)、手术时长、失血量、住院时长及并发症情况。

结果

纳入50例患者,其中女性27例(54%),男性23例(46%)。平均随访2.81年(范围:1 -

4年)。平均住院时长为4.06±1.5天(范围:2 - 8天)。手术时间为104.60分钟(范围:50 - 195分钟),术中失血量为85.40毫升(范围:50 - 150毫升)。8例(16%)患者出现硬膜切开术并发症。复发率为26%,36%的患者进展为融合术。术前ODI与术后ODI的变化为20.94±7.24(6 - 37),p值为0.04。未记录到长期并发症。

结论

重复椎间盘切除术是同节段复发性椎间盘突出症的一种良好治疗选择。该手术术中失血量少且手术时间短,但存在硬膜切开术的显著风险。由于退变改变的进展,尤其是存在Modic - 2改变时,复发风险仍是一个问题。这些优缺点应与患者进行讨论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52ef/10349588/8d24fb922900/cureus-0015-00000040469-i01.jpg

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