同一高位腰椎再手術例の成績と合併症

Outcome of Revision Surgery for Lumbar Degenerative Diseases

　腰椎後方手術後の同一高位再狭窄に対し後方より再手術を行った41例(男28，女13，63.7歳)の成績を調査した．JOAスコア改善率は53.1％で，ヘルニア群では61.4％，狭窄群45.8％，不安定群45.0％であり，ヘルニア群のなかでも初回再脱出ヘルニアは74.6％と他と比べて有意に良好な成績であった．前回手術から今回手術までの期間や罹病期間と改善率に相関関係はなかった．合併症は41.5％で認められ，特に髄液漏は31.7％に認められた．手術回数が増えるほど合併症発生率は高かった．

　We retrospectively investigated the clinical outcome and perioperative complications of lumbar revision surgery.　The subjects were limited to patients who underwent posterior surgery at the same level as in the previous surgery and consisted of 41 patients, 28 men and 13 women, whose mean age was 63.7 years.　The average JOA score recovery rate was 53.1%.　The recovery rate was a high 74.6% among patients who had experienced their first recurrent disc herniation, but was relatively low among patients with multiple recurrent disc herniation, disc herniation after lumbar decompression surgery for canal stenosis, or canal re-stenosis with or without instability.　No significant correlations were found between the recovery rate and inter-surgery period or duration of symptoms.　Perioperative complications occurred in 17 patients (41.5%), and liquorrhea was the most common complication (31.7%).　Having undergone more than twice revision surgeries was a significant risk factor for perioperative complications.