Cause and clinical analysis of lumbar reoperation / 中国矫形外科杂志

ABSTRACT

[Objective] To investigate the causes,indications,operative methods and clinical results of lumbar reoperation.[Methods]Twenty-eight failure lumbar procedure cases were received reoperation from May 2003 to May 2005.There were 16 males and 12 females.These cases were from 31 to 70 years old(mean 47).It took a mean 1 year and 8 month(from 1 month to 8 year)from last operation to this registry.The causes of reoperation included rehemiated disc nucleus pulpous,degeneration of adjacent segment and instability and insufficiency of canal decompression.Some cases of discogenic back pain were operated by mistaken procedure.Some cases involved severe complications including infection in disc space or vertebral itself,pedicle screws misposition,aneurysm formation and CSF leakage.The operative methods included rediscectomy,lumbar canal decompression,and lumbar reconstruction by implant and fusion.[Results]The operative time and blood lose were from 50 to 350 minutes(mean 213)and from 100 to 3 000 ml(mean 760 ml)respectively.One patient died because of severe abdominal cavity infection.The other cases were recovered and clinical complaint became less.The VAS and Oswestry Disability Index decreased from(7.9?1.6)and(52.4?7.2)to(2.8?1.0)and(8.3?3.6)respectively(the decrease rate64.3% and 66.5%)after 24 to 48 months follow-up(mean 32.8 months).[Conclusion]The causes of failure lumbar procedure must be analyzed as soon as possible.The risks and benefits of reoperation must be balanced although it may make patients get more chance to recovery.It is very difficult for these procedures and the risks are also high.The dura sac rupture is the most common complication.It is the most important to deal with the adhesion and bleeding control in canal.The use of the magnification and lighting equipment can reduce the complications.