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| LI Hong,LI Chunde,YI Xiaodong.Clinical characteristics and efficacy of long-term revision surgery for later recurrent lumbar disc herniation after primary lumbar discectomy[J].Chinese Journal of Spine and Spinal Cord,2010,20(12):1018-1022. |
| Clinical characteristics and efficacy of long-term revision surgery for later recurrent lumbar disc herniation after primary lumbar discectomy |
| Received:June 21, 2010 Revised:August 16, 2010 |
| English Keywords:Lumbar discectomy Recurrence Operation Effectiveness |
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| English Abstract: |
| 【Abstract】 Objective：To evaluate the clinical characteristics and efficacy of long-term revision surgery for later recurrent lumbar disc herniation after discectomy.Method：35 cases with recurrent lumbar disc herniation of more than 5 years after primary discectomy who were treated from March 2001 to February 2008 were retrospective reviewed.There were 25 males and 10 females with the average age of 57.7 years old（range，45 to 68 years）.The surgical segments included L3/4 in 3 cases，L4/5 in 22 cases and L5/S1 in 10 cases.The mean period between primary surgery and recurrence was 8.7 years（range，5.5 years to 29 years）.The demographic and imaging data before and after operation were recorded.Prolo lumbar score and patient subjective satisfaction were used to evaluate the effect of reoperation and the related factors of recurrence were analyzed.Result：All 35 patients were followed up for at least 2 years with the mean follow-up of 4.7 years（range，2 years to 8 years）.The surgical approach for primary discectomy included fenestration in 5 cases，semi-laminectomy in 8 cases and laminectomy in 22 cases，and the revision surgical approach was discectomy in 2 cases，PLF in 17 patients，PLIF in 8 patients and TLIF in 8 cases.During follow-up，the spinal sagittal imbalance was evident in 21 cases，30 patients had subsidence of intervertebral height，29 cases developed lumbar kyphosis or decrease of lordosis and 24 patients showed MODIC change.The average JOA score was 11.8 before operation and 20.4 after operation（P<0.05）.Subjective satisfaction was excellent in 14 patients，good in 17，and fair in 4 cases.4 cases were complicated with cerebrospinal leakage and 3 cases with wound hydrops.No neurological deficit was noted.Conclusion：Patients with later recurrent lumbar disc herniation after primary lumbar discectomy are apt to develop lumbar sagittal imbalance.Appropriate surgical approach can ensure a good outcome. |
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