既往腰椎手术的腰椎间盘突出症患者手术治疗的长期预后较差。
Inferior long-term outcomes after surgery for lumbar disc herniation in patients with prior lumbar spine surgery.
机构信息
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
出版信息
Acta Neurochir (Wien). 2024 Jan 24;166(1):32. doi: 10.1007/s00701-024-05932-3.
BACKGROUND
Previous lumbar spine surgery is a frequent exclusion criterion for studies evaluating lumbar surgery outcomes. In real-life clinical settings, this patient population is important, as a notable proportion of patients evaluated for lumbar spine surgery have undergone prior lumbar surgery already previously. Knowledge about the long-term outcomes after microdiscectomy on patients with previous lumbar surgery and how they compare to those of first-time surgery is lacking.
METHODS
The original patient cohort for screening included 615 consecutive patients who underwent surgery for lumbar disc herniation, with a median follow-up time of 18.1 years. Of these patients, 89 (19%) had undergone lumbar spine surgery prior to the index surgery. Propensity score matching (based on age, sex, and follow-up time) was utilized to match two patients without prior surgery with each patient with a previous surgery. The primary outcome measure was the need for further lumbar spine surgery during the follow-up period, and the secondary outcome measures consisted of present-time patient-reported outcome measures (Oswestry Disability Index, EuroQol-5D) and present-time ability to carry out employment.
RESULTS
Patients who received previous lumbar surgeries had a higher need for further surgery (44% vs. 28%, p = 0.009) and had a shorter time to further surgery than the propensity score-matched cohort (mean Kaplan-Meier estimate, 15.7 years vs. 19.8 years, p = 0.008). Patients with prior surgery reported inferior Oswestry Disability Index scores (13.7 vs. 8.0, p = 0.036). and EQ-5D scores (0.77 vs. 0.86, p = 0.01). In addition, they had a higher frequency of receiving lumbar spine-related disability pensions than the other patients (12% vs. 1.9%, p = 0.01).
CONCLUSIONS
Patients with previous lumbar surgery had inferior long-term outcomes compared to patients without prior surgery. However, the vast majority of these patients improved quickly after the index surgery. Furthermore, the difference in the patients' reported outcomes was small at the long-term follow-up, and they reported high satisfaction with the results of the study surgery. Hence, surgery for these patients should be considered if surgical indications are met, but special care needs must be accounted for when deliberating upon their indications for surgery.
背景
既往腰椎手术是评估腰椎手术结果研究的常见排除标准。在实际临床环境中，这部分患者人群很重要，因为相当一部分接受腰椎手术评估的患者之前已经接受过腰椎手术。对于既往有腰椎手术史的患者行微椎间盘切除术的长期疗效以及与初次手术的疗效对比，目前尚缺乏相关知识。
方法
最初的筛选患者队列包括 615 例连续接受腰椎间盘突出症手术治疗的患者，中位随访时间为 18.1 年。这些患者中有 89 例（19%）在指数手术前已行腰椎手术。采用倾向性评分匹配（基于年龄、性别和随访时间），将每例既往手术患者与 2 例无既往手术史患者相匹配。主要结局指标为随访期间是否需要再次行腰椎手术，次要结局指标包括目前的患者报告结局测量指标（Oswestry 残疾指数、EuroQol-5D）和目前的就业能力。
结果
接受过既往腰椎手术的患者再次手术的需求更高（44%比 28%，p=0.009），且再次手术的时间短于倾向性评分匹配队列（平均 Kaplan-Meier 估计时间，15.7 年比 19.8 年，p=0.008）。既往手术患者的 Oswestry 残疾指数评分（13.7 比 8.0，p=0.036）和 EQ-5D 评分（0.77 比 0.86，p=0.01）较差。此外，与其他患者相比，他们接受腰椎相关残疾抚恤金的频率更高（12%比 1.9%，p=0.01）。
结论
与无既往手术史的患者相比，既往有腰椎手术史的患者的长期预后较差。然而，这些患者中的绝大多数在指数手术后很快得到改善。此外，在长期随访时，患者报告的结局差异较小，他们对研究手术的结果非常满意。因此，如果符合手术指征，应考虑为这些患者行手术治疗，但在考虑其手术指征时，必须特别注意。
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