Факторы риска возникновения рецидива грыжи диска после поясничной микродискэктомии у взрослых. Обзор литературы.

Поясничная микродискэктомия – одна из самых распространенных операций на позвоночнике во всем мире. Проблема рецидивов болевых и неврологических синдромов после таких операций остается актуальной. Рецидивы болевых синдромов могут быть обусловлены возникновением повторной грыжи оперированного диска.

ЦЕЛЬ: Определить факторы риска развития рецидива грыжи диска в поясничном отделе после выполнения микродискэктомии.

МЕТОДЫ: Для достижения поставленной цели проведен обзор литературы с использованием баз данных PubMed и MEDLINE. В качестве запрашиваемого материала были – «рецидивирующая грыжа поясничного диска» и «факторы риска». Полученные результаты: Существуют доказательства (промежуточного уровня от II до IV), детализирующие периоперационные факторы риска рецидива грыжи поясничного диска. Были выделены факторы риска (такие как тип грыжи, вид оперативного вмешательства, курение, образ жизни пациента, его физическая активность в послеоперационном периоде, возраст, пол, наличие ожирения, сахарного диабета, биомеханические факторы, изменения типа Modic), которые могут быть причиной возникновения рецидива грыжи диска в поясничном отделе.

ВЫВОДЫ: Множественные факторы риска, включающие тип грыжи, вид оперативного вмешательства, курение, образ жизни пациента, его физическая активность в послеоперационном периоде, возраст, пол, наличие ожирения, сахарного диабета, биомеханические факторы позвоночника, изменения типа Modic могут способствовать рецидиву грыжи диска. Уровень доказательности ни одного из исследованных факторов риска рецидива грыжи диска после микродискэктомии не достигает I класса. Необходимы дополнительные исследования, которые смогут позволить получить окончательный ответ о влиянии различных факторов на рецидивирование грыжи диска.

1. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015; 372:1240– 1248.

2. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 2006; 296:2451–2459.

3. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 2008; 33:2789–2800.

4. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. New Engl J Med 2007; 356:2245–2256.

5. Risk Factors for Recurrent Lumbar Disc Herniations Byung-Joon Shin Asian Spine J. 2014 Apr; 8(2): 211–215. Published online 2014 Apr 8. doi: 10.4184/asj.2014.8.2.211

6. Gasiński P. et al. Peridural fibrosis in lumbar disc surgery– pathogenesis, clinical problems and prophylactic attempts // Neurologia i neurochirurgia polska.– 2000. – Т. 34.– № . 5. – С. 983–993.

7. Asch H. L. et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80 % success rates be the norm? // Journal of Neurosurgery: Spine.– 2002. – Т. 96.– № . 1. – С. 34–44.

8. Fountas K.N. et al. Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome // Spine.– 2004. – Т. 29.– № . 22. – С. 2521–2524

9. Крылов В.В. и др. Состояние нейрохирургической службы Российской Федерации // Нейрохирургия.– 2016.– № . 3. – С. 3–44

10. Kim K-T, Park S-W, Kim Y-B (2009) Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine 34:2674–2678

11. Papadopoulos EC, Girardi FP, Sandhu HS et al (2006) Outcome of revision discectomies following recurrent lumbar disc herniation. Spine 31:1473–1476

12. Suk K-S, Lee HM, Moon SH, Kim N-H (2001) Recurrent lumbar disc herniation: results of operative management. Spine 26:672–676

13. McGirt MJ, Eustacchio S, Varga P et al (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 34:2044–2051

14. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F (1998) Ipsilateral recurrent lumbar disc herniation. J Bone Joint Surg Br 80:825–832

15. Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85:102–108

16. Kim JM, Lee SH, Ahn Y et al (2007) Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50:82–85. doi:10.1055/s2007–982504

17. Miwa S, Yokogawa A, Kobayashi T et al (2012) Risk factors of recurrent lumbar disc herniation: a single center study and review of the literature. J Spinal Disord Tech 28: E 265–E 269. doi:10.1097/BSD.0b013e31828215b3

18. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–108.

19. Dewing CB, Provencher MT, Riffenburgh RH, Kerr S, Manos RE. The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine (Phila Pa 1976) 2008;33:33–38.

20. Miwa S, Yokogawa A, Kobayashi T, et al. Risk factors of recurrent lumbar disc herniation: a single center study and review of the literature. J Spinal Disord Tech. 2013 Nov 08; [Epub]. http://dx.doi.org/10.1097/BSD.0b013e31828215b3.

21. O’Connell JE. Protrusions of the lumbar intervertebral discs, a clinical review based on five hundred cases treated by excision of the protrusion. J Bone Joint Surg Br. 1951;33:8–30.

22. Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine (Phila Pa 1976) 1978;3:175–182.

23. Spengler DM. Lumbar discectomy. Results with limited disc excision and selective foraminotomy. Spine (Phila Pa 1976) 1982;7:604–607.

24. Ebeling U, Kalbarcyk H, Reulen HJ. Microsurgical reoperation following lumbar disc surgery. Timing, surgical findings, and outcome in 92 patients. J Neurosurg. 1989;70:397–404.

25. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976) 2006;31:653–657.

26. Barth M, Weiss C, Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine (Phila Pa 1976) 2008;33:265– 272.

27. Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien) 1995;133:107–111.

28. McGirt MJ, Ambrossi GL, Datoo G, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 2009;64:338–344.

29. An HS, Silveri CP, Simpson JM, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord. 1994;7:369–373.

30. Kelsey JL, Githens PB, O’Conner T, et al. Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine (Phila Pa 1976) 1984;9:608–613.

31. Wera GD, Marcus RE, Ghanayem AJ, Bohlman HH. Failure within one year following subtotal lumbar discectomy. J Bone Joint Surg Am. 2008;90:10–15.

32. Shimia M, Babaei-Ghazani A, Sadat BE, Habibi B, Habibzadeh A. Risk factors of recurrent lumbar disk herniation. Asian J Neurosurg. 2013;8:93–96.

33. Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc. Spine (Phila Pa 1976) 2004;29:2700–2709.

34. Grunhagen T, Wilde G, Soukane DM, Shirazi-Adl SA, Urban JP. Nutrient supply and intervertebral disc metabolism. J Bone Joint Surg Am. 2006;88(Suppl 2):30–35.

35. Holm S, Nachemson A. Nutrition of the intervertebral disc: acute effects of cigarette smoking. An experimental animal study. Ups J Med Sci. 1988;93:91–99.

36. Akmal M, Kesani A, Anand B, Singh A, Wiseman M, Goodship A. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine (Phila Pa 1976) 2004;29:568–575.

37. Kuri M, Nakagawa M, Tanaka H, Hasuo S, Kishi Y. Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery. Anesthesiology. 2005;102:892– 896.

38. Little CP, Burston BJ, Hopkinson-Woolley J, Burge P. Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg Br. 2006;31:252–255.

39. Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003;238:1–5.

40. Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res. 1999;(365):184–200.

41. Moller AM, Pedersen T, Villebro N, Munksgaard A. Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br. 2003;85:178–181.

42. Cinotti G, Roysam GS, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br. 1998;80:825–832.

43. Carragee EJ, Han MY, Yang B, Kim DH, Kraemer H, Billys J. Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions. Spine (Phila Pa 1976) 1999;24:2346–2351.

44. Shimia M, Babaei-Ghazani A, Sadat BE, Habibi B, Habibzadeh A. Risk factors of recurrent lumbar disk herniation. Asian J Neurosurg. 2013;8:93–6.

45. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010;10:575–80.

46. Miwa S, Yokogawa A, Kobayashi T, et al. Risk factors of recurrent lumbar disk herniation: a single center study and review of the literature. J Spinal Disord Tech. 2015;28: E 265–9.

47. Keskimaki I, Seitsalo S, Osterman H, et al. Reoperations after lumbar disc surgery. Spine 2000; 25:1500–1508.

48. Jansson KA, Nemeth G, Granath F, et al. Surgery for herniation of a lumbar disc in Sweden between 1987 and 1999: an analysis of 27,576 operations. J Bone Joint Surg Br 2004; 86:841–847.

49. Yurac R, Zamorano JJ, Lira F, Valiente D, Ballesteros V, Urzua A. Risk factors for the need of surgical treatment of a first recurrent lumbar disc herniation. Eur Spine J. 2016;25:1403–8.

50. Yao Y, Liu H, Zhang H, et al. Risk factors for the recurrent herniation after microendoscopic discectomy. World Neurosurg. 2016; 95:451–5.

51. Shimia M, Babaei-Ghazani A, Sadat BE, Habibi B, Habibzadeh A. Risk factors of recurrent lumbar disk herniation. Asian J Neurosurg. 2013;8:93–6.

52. Kim KT, Lee DH, Cho DC, Sung JK, Kim YB. Preoperative risk factors for recurrent lumbar disk herniation in L5-S1. J Spinal Disord Tech. 2015;28: E 571–7.

53. Meredith DS, Huang, RC, Nguyen, J, Lymas, S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010;10:575–580.

54. Rihn, JA, Kurd, M, Hilibrand, AS. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95:1–8.

55. Quah, C, Sye, G, Swamy, GN, Nanjayan, S, Fowler, A, Calthorpe, D. Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy. Ann R Coll Surg Engl. 2014; 96:140–143.

56. Moliterno, JA, Knopman, J, Parikh, K. Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. J Neurosurg Spine. 2010;12:680–686.

57. Mobbs, RJ, Newcombe, RL, Chandran, KN. Lumbar discectomy and the diabetic patient: incidence and outcome. J Clin Neurosci. 2001;8:10–13.

58. Robinson, D, Mirovsky, Y, Halperin, N, Evron, Z, Nevo, Z. Changes in proteoglycans of intervertebral disc in diabetic patients. A possible cause of increased back pain. Spine (Phila Pa 1976). 1998;23:849–856.

59. Shimia, M, Babaei-Ghazani, A, Sadat, BE, Habibi, B, Habibzadeh, A. Risk factors of recurrent lumbar disk herniation. Asian J Neurosurg. 2013;8:93–96.

60. Kim, KT, Park, SW, Kim, YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2009;34:2674–2678.

61. Yao Y, Liu H, Zhang H, et al. Risk factors for the recurrent herniation after microendoscopic discectomy. World Neurosurg. 2016; 95:451–5.

62. Yaman ME, Kazanci A, Yaman ND, Bas F, Ayberk G. Factors that influence recurrent lumbar disc herniation. Hong Kong Med J. 2017;23:258–63.

63. Contralateral recurrent lumbar disc herniation. Results of discectomy compared with those in primary herniation. Cinotti G, Gumina S, Giannicola G, Postacchini F. Spine (Phila Pa 1976). 1999 Apr 15; 24(8):800–6.

64. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–08.

65. Mobbs RJ, Newcombe RL, Chandran KN. Lumbar discectomy and the diabetic patient: Incidence and outcome. J Clin Neurosci. 2001;8:10–3.

66. Suk KS, Lee HM, Moon SH, Kim NH. Recurrent lumbar disc herniation: Results of operative management. Spine (Phila Pa 1976) 2001;26:672–76.

67. Cinotti G, Roysam S, Eisenstein SM, Postacchini F. Ipsilateral recurrent lumbar disc herniation: A prospective, controlled study. J Bone Joint Surg Br. 1998;80:825–32.

68. Graver V, Haaland AK, Magnaes B, Loeb M. Seven-year clinical follow-up after lumbar disc surgery: Results and predictors of outcome. Br J Neurosurg. 1999;13:178–84.

69. Palma L, Carangelo B, Muzii VF, Mariottini A, Zalaffi A, Capitani S. Microsurgery for recurrent lumbar disk herniation at the same level and side: Do patients fare worse? Experience with 95 consecutive cases. Surg Neurol. 2008;70:619–21.

70. Meredith DS, Huang RC, Nguyen J, Lymas S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010;10:575–80.

71. Moliterno JA, Knopman J, Parikh K, Cohan JA, Huang QD, Aaker GD, et al. Results and risk factors for recurrence following singlelevel tubular lumbar microdiscectomy Clinical article. J Neurosurg Spine. 2010;12:680–6.

72. Quah C, Syme G, Swamy G, Nanjayan S, Fowler A, Calthorpe D. Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy. Ann R Coll Surg Engl. 2014;96:140–143. DOI: 10.1308/003588414X13814021676873

73. Moliterno, J. A., Knopman, J., Parikh, K., Cohan, J. N., Huang, Q. D., Aaker, G. D., Grivoyannis, A. D., Patel, A. R., Härtl, R., & Boockvar, J. A. (2010). Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy, Journal of Neurosurgery: Spine SPI, 12(6), 680–686. Retrieved Feb 21, 2021, from https://thejns.org/spine/view/journals/j-neurosurg-spine/12/6/articlep680.xml