Clinical outcome and relative factors of revision surgery for lumbar disc herniation

English Keywords:Lumbar disc herniation  Revision  Clinical outcome  Relative factors

English Abstract:

  【Abstract】　Objectives:　To investigate the clinical outcome and relative factors of revision surgery for lumbar disc herniation. Methods: From January 2005 to November 2009, 94 patients who underwent revision surgery for lumbar disc herniation were reviewed retrospectively. According to natural history, clinical signs, physical examination and imaging findings, the causes of revision surgery included 49(52.1%) disc recurrence, 17(18.1%) lumbar canal stenosis,　16(17.0%) inadequate decompression at primary surgery, 7(7.4%) adjacent segment disease, 5(5.3%) lumbar disc herniation at new level. Before revision surgery, the lumbar JOA score was 15.5±5.6, the VAS score for back pain and leg pain was 4.5±1.6 and 7.1±1.9 respectively. Posterior decompression, discectomy, pedicle screw fixation, and transverse process or interbody bone graft and fusion were performed in all cases. 94 patients were followed up, and the surgical results were evaluated by VAS,　JOA and patients satisfactory degree. Relative factors including sex,　age, smoking, previous operation times, previous operation methods, period of pain-free interval after the last surgery, disease course of this time, neurologic deficit, number of fusion segments were investigated. Data were analyzed by multivariate nonconditiona1 Logistic regression analysis. Results: The revision surgical time ranged from 1.6h to 4.5h, with a mean of 2.4h, and the blood loss ranged from 200ml to 1500ml, with a mean of 538ml. No case was complicated with nerve injury in revision surgery. 7 cases were complicated with cerebrospinal fluid leakage and 1 case was complicated with wound infection after operation, and all resolved after responsive management. All cases were followed up for 2-6.5 years, with a mean of 4.2 years. At final follow-up, the functional results showed excellent to good rate of 78.7%, the lumbar JOA score was 24.0±6.2, the VAS score for back and leg pain was 1.3±0.9 and 0.9±1.8 respectively, which showed significant differences（P<0．001). Neurologic deficit, disease course of this time were the most relative factors of prognosis（P<0.05）, while gender, age, smoking, previous operation times, previous operation methods, period of pain-free interval after the last surgery, number of fusion segments were not the relative factors（P＞0．05）. Conclusions: Revision surgery for lumbar disc herniation is reliable, and neurologic deficit, disease course of this times are the relative factors of prognosis.