Lehmann T R, LaRocca H S
Spine (Phila Pa 1976). 1981 Nov-Dec;6(6):615-9.
Thirty-six patients with chronic back and/or leg pain following previous lumbar surgery who underwent both spinal canal exploration and spinal fusion were subjected to retrospective review. The purpose was to determine the probability of success for this surgical approach. Twenty (56%) of the 36 patients had a satisfactory result. In 15 patients with multiple objective findings of an ongoing radiculopathy, 11 (73%) improved. Only nine (43%) of 21 patients improved if these preoperative criteria were absent. Analysis according to the type of surgery performed in the spinal canal demonstrated improvement in (a) 17 (74%) of 23 patients who had wide bony decompression, (b) eight (61%) of 12 patients who had discectomy, and (c) seven (47%) of 15 patients who had an extensive neurolysis. In 17 patients whose time interval between the previous operation and present reconstruction was greater than 18 months, 13 (76%) improved. Only seven (36%) of 19 patients with a shorter time interval improved. The presence of pseudarthrosis was a poor indication for repeat lumbar surgery. The number of previous lumbar surgeries may not necessarily preclude a satisfactory outcome. Solid fusion correlated highly with a satisfactory outcome. Best results are obtained when objective preoperative findings indicate the presence of a surgically correctable abnormality.
对36例既往接受过腰椎手术且患有慢性背痛和/或腿痛的患者进行了回顾性研究，这些患者均接受了椎管探查和脊柱融合手术。目的是确定这种手术方法的成功概率。36例患者中有20例（56%）取得了满意的结果。在15例存在持续性神经根病多项客观表现的患者中，11例（73%）病情改善。如果不存在这些术前标准，21例患者中只有9例（43%）病情改善。根据椎管内所进行的手术类型分析，结果显示：（a）23例行广泛骨性减压的患者中有17例（74%）病情改善；（b）12例行椎间盘切除术的患者中有8例（61%）病情改善；（c）15例行广泛神经松解术的患者中有7例（47%）病情改善。在17例上次手术与本次重建间隔时间大于18个月的患者中，13例（76%）病情改善。间隔时间较短的19例患者中只有7例（36%）病情改善。假关节的存在对再次腰椎手术来说是一个不良指征。既往腰椎手术的次数不一定会妨碍取得满意的结果。坚固融合与满意的结果高度相关。当术前客观检查结果表明存在可通过手术矫正的异常时，可获得最佳效果。
