Recurrence factors of spinal implant fixation for the treatment of lumbar disc herniation

doi:10.3969/j.issn.2095-4344.2013.30.019

Abstract

Abstract:

BACKGROUND: The correct method selected according to the specific type and characteristics of lumbar disc herniation can achieve satisfactory effect, but in clinic, there still some patients have recurrence symptoms after treatment.
OBJECTIVE: To investigate the recurrence factors of spinal implant internal fixation for the treatment of lumbar disc herniation, as well as the intervention measures.
METHODS: Fifty-two patients with recurrence symptoms of lumbar disc herniation after internal fixation from January 2002 to December 2007 in the Department of Orthopedics, the 306th Hospital of PLA were retrospectively analyzed, including 28 male cases and 24 female cases, the average age was 43.2 years, ranged from 25-52 years. The time form first internal fixation to the recurrence was 3-192 months, average 38 months. The patients had the symptoms of lumbar and bilateral/unilateral leg pain and numbness. All the patients underwent the anteroposterior radiographs of lumbar spine and the hyperextension and flexion lateral X-ray films to evaluate the stability of the lumbar spine. Lumbar magnetic resonance imaging was used to observe the intervertebral disc situation of the segment treated with lumbar internal fixation as well as the spinal stenosis and disc degeneration.
RESUTLS AND CONCLUSION: Among the 52 patients, 22 cases had recurrence lumbar disc herniation on the same segment after first internal fixation; four cases had recurrence symptoms caused by the spondylodiscitis after implant internal fixation; five cases had scar adhesions caused nerve compression on the site treated with internal fixation; 10 cases had the symptoms of lateral recess and nerve root canal stenosis on the site treated with internal fixation; 11 cases had recurrence symptoms caused by lumbar instability after internal fixation. It has reality clinical significance to analyze the reasons of recurrence of lumbar disc herniation after internal fixation.

Key words: bone and joint implants, academic discussion of bone and joint, spinal implants, internal fixation, lumbar disc herniation, recurrence, relevant factors, pedicle screw fixation, bony fusion, intervertebral disc displacement, discectomy, free, pathological anatomy, biomechanics, complications

CLC Number:

R318

Chen Xiao-ming, Ma Hua-song, Wang Meng, Tan Rong, Yang Bin. Recurrence factors of spinal implant fixation for the treatment of lumbar disc herniation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(30): 5539-5544.

Figures/Tables 1

2.1 相关研究资料的获取检索CNKI数据库和SCI数据库的方法获取相关研究文献[11-12]。检索时间范围1990至2012年，检索词为“腰椎间盘突出症（lumbar disc herniation）；复发（recurrence）；相关因素(related factors)；内固定(fixation)；椎弓根螺钉固定(pedicle screw fixation)；骨性融合(osseous fusion)；椎间盘移位(intervertebral disk displacement)；椎间盘切除(discectomy)；游离(free)”，检索出相关研究文献27篇，其中CNKI数据库文献11篇，学术期刊9篇，学位论文1篇，会议论文1篇。SCI数据库文献16篇。按设定的主题要求，纳入研究的文献共12篇[13-24]。 2.2 入选标准 ①研究的主题包括腰椎间盘突出症内固定后复发原因、二次治疗方式的选择及防治措施等。检索的文献中排除与研究主题无关的文献9篇。②研究所撰写的文章类型包括原著、实验分析及病例分析等。检索文献中排除综述类文章3篇。③文献内容筛选如下，检索的文献中比较不同方式治疗复发性单节段腰椎间盘突出症效果的研究文献共2篇，2篇文献为同一实验项目，且为同一组实验人员进行的研究，定为重复研究文献，选取其中1篇进行深入分析。同样对腰椎间盘突出症术后复发的临床研究的3篇文献也为重复文献，选取其中1篇进行深入分析。在腰椎间盘突出症病例回顾分析及中长期随访研究中，同样检索出重复的2篇研究文献，选取其中1篇进行深入分析。 2.3 质量评估符合纳入标准的12篇研究中，对腰椎间盘突出症复发治疗选择内固定与非内固定方式进行了比较[13-16]；并分析了腰椎间盘突出症复发治疗指征[17-21]；探讨了腰椎间盘突出症内固定治疗后复发的预防措施[22-24]。 2.4 腰椎间盘突出症复发治疗选择内固定与非内固定方式的比较内固定是治疗腰椎间盘突出症的有效方法，但由于坐骨神经痛复发需要再治疗的病例时有发生，髓核再次突出是再治疗的主要原因之一，再次治疗方法的选择目前尚无统一的标准[13-14]。孟宪中等[15]比较了内固定与非内固定对单节段腰椎间盘突出症内固定治疗后复发患者的远期疗效。对复发性腰椎间盘突出患者99例,平均复发时间为治疗后69个月(8-130个月)，再次治疗时55例采用单纯扩大切除椎板髓核摘除或双侧开窗髓核摘除(非内固定组),44采用全椎板切除减压髓核摘除360°融合内固定治疗(内固定组)。治疗后平均随访66个月(36-96个月)，比较两组患者的临床效果，见表1。复发性腰椎间盘突出症再治疗的目的是解除症状，恢复功能，重建脊柱稳定性。但具体的治疗方法，应该视具体情况而定，原则是尽可能减少创伤，有效的解除症状。郭钧等[16]认为腰椎间盘突出症内固定后同节段复发的确切原因仍不清楚，对诊断明确并伴有神经根损伤表现的患者可行二次治疗，是否采用内固定加植骨融合视患者不同情况而定。"

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