Abstract
A total of 51 patients who underwent the second open discectomy by fenestration from January 1988 through December 1994, were followed for an average of 146.8 months. The long-term follow-up results were evaluated through direct examinations and questionnaires. At the final follow-up, according to the Macnab classification an excellent and good outcome was achieved in 70.6% of the cases, and 78.4% were satisfied with their results. The failure rate was 15.7% (8 patients). Excluding those 8 failed cases who needed another reoperation, the average improvement calculated by Japanese Orthopaedic Association (JOA) scores was 64.6%. Factors that were associated with a fair and bad outcome included smoking, isolated trauma or injury, fibrosis and the duration of the remaining or recurrent primary postoperative symptoms. We noted that psychosociological signs were probably negative predictors of lumbar disc surgery outcome. Because the revision operation is typically associated with a higher complexity, selection of suitable surgical candidates and determination of valid indications for operative treatment are very important.
Résumé
51 patients ont bénéficié d'une réintervention (deuxième intervention pour discectomie) entre janvier 1988 et décembre 1994 et ont été suivis en moyenne 146,8 mois. Les résultats à long terme ont été évalués après un questionnaire et un examen. Au suivi final 70,6% présentaient un excellent ou bon résultat suivant la classification de MacNab, 78,4% étant satisfaits de leur résultat. Le taux d'échec est de 15,7% (8 patients). Si l'on exclut ces huit patients qui ont nécessité une nouvelle réintervention, l'amélioration moyenne calculée selon le score de la JOA a été de 64,6%. Ces facteurs associés avec un mauvais résultat ou un résultat médiocre sont les patients fumeurs, les lésions post-traumatiques, les phénomènes de fibroses, un long délai entre la réintervention et l'intervention primaire. Les facteurs sociologiques sont souvent perçus comme des facteurs négatifs compte tenu du fait que la révision est souvent complexe, il est donc nécessaire de bien sélectionner les patients à réopérer avec des indications bien solides.
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Guo, J.J., Yang, H. & Tang, T. Long-term outcomes of the revision open lumbar discectomy by fenestration: A follow-up study of more than 10 years. International Orthopaedics (SICOT) 33, 1341–1345 (2009). https://doi.org/10.1007/s00264-008-0648-2
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DOI: https://doi.org/10.1007/s00264-008-0648-2