腰部脊柱管狭窄症に対する再手術例の検討

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OBJECTIVE; The results in patients with lumbar spinal canal stenosis (LCS) who undergo re-operation for failed back surgery syndrome are usually unsatisfactory. We will report our results in a series of 54 patients with recurrent LCS who were re-operated. PATIENTS AND METHOD; We reviewed 54 patients who underwent posterior re-decompression without fusion to treat recurrent LCS. All were operated at our institution during the last 5 years. At the initial operation, all patients underwent posterior decompression and 8 of them were also subjected to posterior fusion. RESULT; The most common reason for the re-operation was stenosis of the lateral recess. Further treatment after the initial operation was required in 3 patients with iatrogenic spondylolisthesis. The symptom recovery rate, assessed on the JOA score, was 68.6%. The surgical outcome was better in patients whose symptoms were present for less than 1 year before re-operation. Instability of the lumbar spine before the 2nd operation was not significantly correlated with poor outcomes. CONCLUSION; Re-operation consisting of posterior re-decompression without fusion did not worsen the clinical condition of our 54 patients. There was no significant correlation between instability of the lumbar spine before reoperation and poor outcomes. Our findings stress the importance of carefully considering the indication for fusion in patients undergoing re-operation for LCS. As we found a significant correlation between poor results and the duration of symptoms in re-operated patients, the observation period after the first operation must be limited to avoid poor outcomes.
日本脊髄外科学会の論文

腰部脊柱管狭窄症に対する再手術例の検討

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