Cinotti G, Roysam G S, Eisenstein S M, Postacchini F
Department of Orthopaedics and Traumatology, University of Rome La Sapienza, Italy.
J Bone Joint Surg Br. 1998 Sep;80(5):825-32. doi: 10.1302/0301-620x.80b5.8540.
We analysed prospectively 26 patients who had revision operations for ipsilateral recurrent radicular pain after a period of pain relief of more than six months following primary discectomy. They were assessed before the initial operation, between the two procedures and at a minimum of two years after reoperation. MRI was performed before primary discectomy and reoperation. Fifty consecutive patients who had a disc excision during the study period but did not have recurrent radicular pain, were analysed as a control group. Of the study group 42% related the onset of recurrent radicular pain to an isolated injury or a precipitating event, but none of the control group did so (p < 0.001). T2-weighted MRI performed before primary discectomy showed that patients in the study group had significantly more severe disc degeneration compared with the control group (p=0.02). Intraoperative findings revealed recurrent disc herniation in 24 patients and bulging of the disc in two, one of whom also had lateral stenosis. Epidural scarring was found to be abundant, intraoperatively and on MRI, in eight and in nine patients, respectively. At the last follow-up, the clinical outcome was satisfactory in 85% of patients in the study group and in 88% of the control group (p > 0.05). Work or daily activities had been resumed at the same level as before the onset of symptoms by 81% of the patients in the study group and 84% of the control group. No correlation was found between the amount of epidural fibrosis, as seen intraoperatively and on MRI, and the result of surgery. The recurrence of radicular pain caused no significant changes in the psychological profile compared with the assessment before the primary discectomy.
我们对26例患者进行了前瞻性分析，这些患者在初次椎间盘切除术后疼痛缓解超过6个月后，因同侧复发性神经根性疼痛接受了翻修手术。在初次手术前、两次手术之间以及再次手术后至少两年对他们进行了评估。在初次椎间盘切除术和再次手术前均进行了MRI检查。将研究期间连续50例接受椎间盘切除术但无复发性神经根性疼痛的患者作为对照组进行分析。研究组中42%的患者将复发性神经根性疼痛的发作归因于孤立性损伤或诱发事件，而对照组中无一例如此（p<0.001）。初次椎间盘切除术前行T2加权MRI检查显示，研究组患者的椎间盘退变明显比对照组严重（p=0.02）。术中发现24例患者存在复发性椎间盘突出，2例患者存在椎间盘膨出，其中1例还伴有侧隐窝狭窄。术中及MRI检查发现分别有8例和9例患者存在大量硬膜外瘢痕形成。在最后一次随访时，研究组85%的患者和对照组88%的患者临床结果满意（p>0.05）。研究组81%的患者和对照组84%的患者已恢复到症状发作前的相同工作或日常活动水平。术中及MRI所见的硬膜外纤维化程度与手术结果之间未发现相关性。与初次椎间盘切除术之前的评估相比，神经根性疼痛的复发在心理状况方面未引起显著变化。
