Frymoyer J W, Matteri R E, Hanley E N, Kuhlmann D, Howe J
Spine (Phila Pa 1976). 1978 Mar;3(1):7-11. doi: 10.1097/00007632-197803000-00002.
Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.
对45例10年或更早之前接受过腰椎间盘手术且需要二次手术的患者进行了评估。首次手术后长达16年出现了手术失败情况，最常见的原因是最初接受脊柱融合术的患者发生了假关节形成，而未进行融合术的患者则是在与之前手术相同的节段出现了椎间盘复发病变。需要二次手术的第二组患者的临床和功能结果与仅需一次手术的患者相当。相比之下，接受过脊柱融合术且需要二次手术的患者，与未接受融合术的患者以及仅进行了一次融合手术的患者相比，其临床和功能结果明显更差。唯一可预测、可证实的失败原因是获得性椎弓根峡部裂。通常，假关节修复并不能缓解症状。这些数据表明，在腰椎间盘疾病的治疗中，脊柱融合术失败后的预后明显比单纯椎间盘切除术更差。
