The Analysis Of Clinical Results And Imaging Of Recurrent Lumbar Disc Herniation And The Choice Of Different Methods Of Reoperation

Objective: A retrospective analysis of the data of clinical results and imagingof patients diagnosed with RLDH was undertaken to investigate its risk factors.Byanalyzing the preoperative and postoperative clinical data、 imaging andcomplications, recommend the choice method for managing RLDH through theevaluating and comparing the merit and demerit of its different methods.Methods: Between January,1990and June,2013,3017patients with LDH,who underwent nucleus pulpose discectomy(range from L2to S1),1455patientswere followed up and enrolled in this study.Among them, there were844males and611females.The patients were divided into a non-recurrent group (N group) and a recurrent group (R group). By reviewing all patients’medical records、nursing records、operation notes and imaging data, compare the General information and operative data of the two groups:age,gender,occupation,smoking,course of the disease,body-mass index (BMI),operating time,intraoperative blood losses,the type of LDH,operative segment;imaging data:DHI,SROM; omorbidity:hypertension,diabetes and so on;complications in operation and after operation.The postoperative3months’JOA score、VAS and imaging of patients were recorded through telephone and outpatient time.Among R group,98patientswho underwent reoperation were followed up.Patients were divided by different operative methods:Interlaminar larger vertebral plate fenestration and nucleuspulpose discectomy group、laminectomy and nucleus pulpose discectomy group and PLIF group.Comparative analysis:the degree of ASD、DHI、SROM andcomplications and general information, comparing the JOA score of reoperation、postoperative time(in3months、1year) and the last follow-up,evaluate thepostoperative effects of different methods.Results: The mean recurrent time was29.8±22.5months (range from6to120months). Patients in R group were divided by the type of LDH:Among them,42patients were II type(protrusion);61were III type(extrusion);30were Ⅳtype(sequestered).They underwent reoperation for a recurrent ipsilateral (n=94) andcontralateral (n=39).The mean DHI in the two groups were (0.38±0.07),(0.30±0.08),respectively.The mean SROM in the two groups were (10.8±2.3°),(5.8±1.4°),respectively.The smoking percent was significantly higher in R group (69.9vs. 29.9%, p<0.001).The hypertension percent was significantly higher in R group (12.8vs.7.2%, P=0.00). The obesity (BMI≥25) percent was significantly higher in Rgroup (34.6vs.22.5%, P=0.002).The mean operating time was significantly longerin R group(102.6±12.4vs.51.5±13.8minutes, p<0.001). The preoperative historywas significantly longer in R group (65vs.141minutes, p<0.001). The meanintraoperative blood losses was significantly more in R group (282.6±172.9vs.124.1±76.2ml，P=0.00).According to the operative segment,L2-L3/L3-L4（4.5vs.2.6%）、L4-L5（66.9vs.49.9%）、L5-S1（28.6vs.47.5%），chi-square testshowed:there was a significant difference in terms of different operative segment bychi-square test（χ2=31.57，p=0.00）.And we found that L4-5was the most frequentlyrecurrent segment,which was significantly higher than that of the other twosegments.Multiple logistic regression analysis showed that hypertension、age(40-54)、operative segment（L4-5）、obesity、smoking were significantly relatedwith recurrent LDH. DHI、SROM in group R was significantly higher than the Ngroup (p <0.05).According to the Macnab classification,results of98patients were excellent in54, good in6, fair in12, and poor in5,and excellent and good outcome was achievedin82.7%of the cases.The mean operation time in the three groupswere(51.5±13.8),(101.0±10.7),(132.6±14.4)minutes(F=363.38,P=0.00）,respectively.The mean intraoperative blood losses in the three groups were (92.0±85.7),(397.5±219.3),(446.9±224.0) ml (F=46.11， p=0.00）,respectively.LSD-t testshowed：there was a significant difference in the three groups in terms of the meanoperating time and intraoperative blood losses.At the last follow-up,JOA score in thethree groups were11.82±1.87、8.72±2.67、12.36±2.04（F=19.27，P=0.00）.The JOAscore of group B was the lowest.LSD-t test showed：There was significant differencein the three groups（P=0.00）.The mean preoperative DHI in the two groups were(0.362±0.071),(0.361±0.085), respectively,and the mean SROM in the two groupswere (9.00±0.30),(9.12±0.26), respectively.At the last follow-up,The mean DHI inthe two groups were (0.360±0.140),(0.30±0.226)（P=0.00）, respectively,and themean SROM in the two groups were (9.96±1.67),(11.67±1.92), respectively.Therewas significant difference in the three groups in terms of complications (chi-squaretest and Fisher’s exact test).Conclusion Hypertension、age(40-54)、operative segment(L4-L5)、obesity、smoking are associated with the development of RLDH. DHI、SROM in group R was significantly higher than the N group (p <0.05).Interlaminar larger vertebralplate fenestration and nucleus pulpose discectomy、PLIF are better than laminectomyand nucleus pulpose discectomy in terms of the effects of operation andpostoperative complications.And Interlaminar larger vertebral plate fenestration andnucleus pulpose discectomy surpasses PLIF in terms of operation time、intraopertiveblood losses and postoperative complications.Through the careful examination andanalysis before surgery and the attentive procedure,the effects of surgery treatmentfor RLDH will turn out to be excellent.