Herno A, Airaksinen O, Saari T, Sihvonen T
Department of Physical Medicine, Kuopio University Hospital, Finland.
Spine (Phila Pa 1976). 1995 Apr 15;20(8):964-9. doi: 10.1097/00007632-199504150-00015.
This retrospective study was designed to investigate the effects of previous back surgery in patients undergoing surgical procedure for lumbar spinal stenosis.
The authors evaluated the results of singly operated and repeat surgery patients operated on for lumbar spinal stenosis, and compared prognostic factors correlated with the results for these two groups.
Repeat back surgery is generally not as successful as a first operation, but few studies evaluate the effects of previous back surgery on the surgical outcome of patients with lumbar spinal stenosis.
The subjective disability of singly operated and repeat surgery patients as assessed by the Oswestry questionnaire was compared with clinical data and myelographic findings to identify factors predictive of outcome.
The mean Oswestry score was 31.0 for singly operated patients and 40.9 for repeat surgery patients (P = 0.0001). The outcome was excellent-to-good in 67% of singly operated patients and in 46% of repeat surgery ones (P < 0.0017). Severe myelographic findings correlated significantly with good outcome in the singly operated group but not in the repeat surgery group. Coexisting disease contributed significantly to poor outcome in the repeat surgery group, but not in the singly operated group. The optimum time interval for achieving successful results from subsequent surgery is at least 18 months after previous surgery. In the regression analysis, the prognostic preoperative variables for good outcome was block stenosis on myelography in the singly operated patients and age over 50 years and no coexisting disease in the repeat surgery patients.
Previous back surgery had a highly significant worsening effect on the outcome of patients reoperated on for lumbar spinal stenosis. Not even a very well-established diagnosis of lumbar spinal stenosis, as confirmed by myelography and during surgery, could guarantee as successful a surgical outcome in the repeat surgery patients as that in the singly operated patients.
本回顾性研究旨在调查既往接受过背部手术的患者在接受腰椎管狭窄症手术时的影响。
作者评估了接受单次手术和再次手术的腰椎管狭窄症患者的手术结果，并比较了与这两组结果相关的预后因素。
再次背部手术通常不如首次手术成功，但很少有研究评估既往背部手术对腰椎管狭窄症患者手术结果的影响。
通过Oswestry问卷评估单次手术和再次手术患者的主观残疾情况，并与临床数据和脊髓造影结果进行比较，以确定预测结果的因素。
单次手术患者的Oswestry平均评分为31.0，再次手术患者为40.9（P = 0.0001）。单次手术患者中67%的结果为优至良，再次手术患者中为46%（P < 0.0017）。严重的脊髓造影结果在单次手术组中与良好结果显著相关，但在再次手术组中并非如此。并存疾病在再次手术组中对不良结果有显著影响，但在单次手术组中并非如此。后续手术取得成功结果的最佳时间间隔是在前次手术至少18个月后。在回归分析中，单次手术患者预后良好的术前预测变量是脊髓造影显示的节段性狭窄，再次手术患者是年龄超过50岁且无并存疾病。
既往背部手术对接受腰椎管狭窄症再次手术患者的结果有非常显著的恶化影响。即使通过脊髓造影和手术证实了非常明确的腰椎管狭窄诊断，也不能保证再次手术患者的手术结果与单次手术患者一样成功。
