ABSTRACT

Objective

Recurrent lumbar disc herniation (rLDH) is a common issue after primary discectomy and can cause severe pain, morbidity, and reoperation. The purpose of this systematic review was to evaluate the surgical management of recurrent lumbar disc herniation.

Methods

A systematic literature search was conducted using Pubmed and Embase databases on 18^thAugust, 2019. The inclusion and exclusion criteria were applied according to study design, surgical approach, language, number of patients; and spinal level. Data extracted included patient demographics, and clinical outcomes (patients with excellent/good outcomes; VAS back and leg score improvement, complication and recurrence rates).

Results

Sixteen studies, (comprising of seven prospective and nine retrospective) met the inclusion criteria. Ten studies evaluated discectomy only; four analysed fusion, and two analysed both discectomy only and fusion approaches. Fusion approaches recorded a superior success rate (8.3 % higher, p>0.05); postoperative VAS back score improvement (5 % higher, p>0.05) than discectomy alone. However, discectomy alone approaches recorded a more favourable postoperative VAS leg score improvement (4.2 % higher p>0.05), and complication rate (3.2% lower, p>0.05) than fusion techniques.

Conclusion

There is significant heterogeneity in clinical outcomes reported for studies after surgical intervention in rLDH patients. Neither discectomy nor fusion’s superiority was statistically significant. Despite fusion yielding longer operative times, and length of stay (adding to the expense), it is superior in minimising mechanical instability and recurrence. Finally, we conclude that both approaches are equally efficacious in rLDH cases, and choice should be based on a case by case basis.

中文翻译：

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融合术是复发性腰椎间盘突出症最合适的治疗选择吗？系统评价。

摘要

客观的

复发性腰椎间盘突出症 (rLDH) 是原发性椎间盘切除术后的常见问题，可导致严重的疼痛、发病率和再次手术。本系统评价的目的是评估复发性腰椎间盘突出症的手术治疗。

方法

2019 年 8 月18^日使用 Pubmed 和 Embase 数据库进行系统文献检索。根据研究设计、手术方法、语言、患者数量应用纳入和排除标准；和脊椎水平。提取的数据包括患者人口统计学和临床​​结果（具有优异/良好结果的患者；VAS 背部和腿部评分改善、并发症和复发率）。

结果

16 项研究（包括 7 项前瞻性研究和 9 项回顾性研究）符合纳入标准。十项研究仅评估了椎间盘切除术；四个分析了融合，两个分析了仅椎间盘切除术和融合方法。融合方法记录了较高的成功率（高 8.3%，p>0.05）；与单纯椎间盘切除术相比，术后 VAS 背部评分改善（高 5%，p>0.05）。然而，与融合技术相比，单独的椎间盘切除术记录了更有利的术后 VAS 腿部评分改善（高 4.2%，p>0.05）和并发症发生率（低 3.2%，p>0.05）。

结论

rLDH 患者手术干预后研究报告的临床结果存在显着异质性。椎间盘切除术和融合术的优越性均无统计学意义。尽管融合产生了更长的手术时间和住院时间（增加了费用），但它在最大限度地减少机械不稳定性和复发方面具有优势。最后，我们得出结论，这两种方法在 rLDH 情况下同样有效，选择应根据具体情况而定。