요추 척추관 협착증 환자에서 단순 감압적 후궁절제술 후 재수술에 대한 위험인자

Abstract

Background and Objectives : Microdecompression is popular surgical treatment option for lumbar spinal stenosis. However, this procedure have several limitations and it need reoperation for persistent symptoms. The risk factors of reoperation after simple decompression for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation.

Materials and Methods : This study is performed retrospectively by reviewing of the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used VAS and the Japanese Orthopedic Association (JOA) scoring system for radiating leg pain, Charlson comorbidity index and body mass index. We analyzed the Modic change and Pfirrmann grade for degeneration in the endplate for fradiologic evaluation. also the height of disc space, angulation of facet joint, and sagittal rotation angle in decompression level site were measured.

Results : Total Sixty-five patients aged 63 ± 4 years at index surgery were studied for 36 ± 15 months. The average preoperative JOA score was 6.4 ± 1.3 points. The score improved to 10.1 ± 1.9 points at the latest follow-up (p<0.001). Reoperation was performed in eleven patients (17%). Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value > 0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation.

Conclusion : Degree of the degeneration of intervertebral disc (Pfirrmann IV) in lower lumbar spine is a risk factor of disc herniation or foraminal stenosis requiring reoperation after MD in LSS.