Javid M J
Department of Neurological Surgery, University of Wisconsin Medical School and Clinical Science Center, Madison, USA.
J Neurosurg. 1996 Aug;85(2):231-8. doi: 10.3171/jns.1996.85.2.0231.
This long-term prospective study evaluates the clinical results of subsequent laminectomy in 103 consecutive patients who initially underwent chemonucleolysis (CNL) or laminectomy for lumbar disc herniation. Between 1981 and 1994, 53 patients who had received CNL initially and then underwent laminectomy and 50 patients treated initially with laminectomy underwent a repeat laminectomy. Clinical assessment at 6 weeks showed a success rate of 80.8% for post-CNL laminectomy and 78% for repeat laminectomy. At 6 months, the success rate for patients treated with CNL was 86% versus 78.7% for laminectomy. At 12 months, the overall success rate for the CNL group was 80.4% versus 83.3% for the laminectomy group, but in patients who had not obtained relief from the first procedure the success rate for the second procedure was higher for the post-CNL patients. A questionnaire was sent to all patients for 1- to 13-year follow-up review. The average follow-up period was 6.6 years for post-CNL laminectomy and 5.2 years for repeat laminectomy. The long-term success rate (81.8%) was higher in the post-CNL group compared to 64.4% in the repeat laminectomy group. Seven patients in the post-CNL group and nine in the repeat laminectomy group had undergone a third operation. When these originally successfully treated patients were reassigned after unsuccessful outcomes, the success rate for the CNL groups was 72.7%, versus 51.1% in the laminectomy group (p = 0.049). Employment rates were 80% for patients with CNL (21.8% changed jobs) and 76.3% for patients undergoing laminectomy (48.3% changed jobs) (p = 0.036). In conclusion, patients who underwent laminectomies after receiving CNL had significantly better long-term results than those who had repeat laminectomies.
这项长期前瞻性研究评估了103例因腰椎间盘突出症最初接受化学髓核溶解术（CNL）或椎板切除术的连续患者随后进行椎板切除术的临床结果。在1981年至1994年期间，53例最初接受CNL然后进行椎板切除术的患者和50例最初接受椎板切除术治疗的患者接受了再次椎板切除术。6周时的临床评估显示，CNL后椎板切除术的成功率为80.8%，再次椎板切除术的成功率为78%。6个月时，接受CNL治疗的患者成功率为86%，而椎板切除术患者为78.7%。12个月时，CNL组的总体成功率为80.4%，而椎板切除术组为83.3%，但在首次手术未缓解的患者中，第二次手术的成功率在CNL后患者中更高。向所有患者发送了一份问卷，进行1至13年的随访复查。CNL后椎板切除术的平均随访期为6.6年，再次椎板切除术为5.2年。CNL组的长期成功率（81.8%）高于再次椎板切除术组的64.4%。CNL组有7例患者和再次椎板切除术组有9例患者接受了第三次手术。当这些最初成功治疗的患者在治疗失败后重新分类时，CNL组的成功率为72.7%，而椎板切除术组为51.1%（p = 0.049）。CNL患者的就业率为80%（21.8%更换了工作），接受椎板切除术的患者为76.3%（48.3%更换了工作）（p = 0.036）。总之，接受CNL后进行椎板切除术的患者长期结果明显优于接受再次椎板切除术的患者。
