Author/Editor		Fokter, Samo K; Vengust, Vilibald
Title		Zatrditev po herniaciji ledvenega diska L4-L5 s poprejšnjo operacijo in brez nje
Translated title		Fusion in disc herniation at L4-L5 level with or without previous surgery
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 295-8
Language		slo
Abstract		Background. The results of treatment in patients with transpedicular instrumented or interbody cage fusion for lumbar disc extrusions at L4-L5 level were retrospectively analyzed. The goal was to determine whether comparable clinical outcome can be achieved in cases with and without previous surgery. Methods. Ten patients who had first symptomatic acute massive disc herniation underwent herniotomy, posterior decompression as necessary, and fusion (Group A). Nine patients with recurrent disc herniation treated 6 years (mean, range 4 months to 14 years) earlier for the same disease were reoperated and fused because of worsening of the symptoms (Group B). At final follow-up of at least 2 years the patients were asked to estimate their low back and leg pain as well as their activity level on a visual scale, and to fill-in the Oswestry questionnaire. Clinical and radiological evaluation was performed using modified scoring system of the Japanese Orthopaedic Association (JOA) and score after Tria. Overall clinical results were assessed using the modified Stauffer-Coventry's evaluating criteria. Results. Patients in Group A were doing better than those in Group B according to low back pain (p < 0.01), leg pain (p = 0.01), and Oswestry questionnaire (p < 0.05). However, the results were not significantly different if measured by the score of Tria, JOA and activity level (p > 0.05; two group t-test). 8 patients of Group A and 3 patients in Group B achieved an overall satisfactory result. Conclusions. Despite the groups were small for statistical analysis, the results of the study suggest that patients undergoing fusion for massive disc herniation atL4-LS level may do better if being fused at the time of primary procedure.
Summary		Izhodišča. Retrospektivno smo analizirali rezultate zdravljenja bolnikov s hernijo medvretenčnega diska L4-L5, ki smo jim napravili posterolateralno transpedikularno zatrditev z instrumentacijo ali medvretenčno zatrditev s kletkama. Želeli smo ugotoviti, ali so rezultati zdravljenja bolnikov po primarni operaciji oziroma reviziji medsebojno primerljivi. Metode. Deset bolnikov s prvo simptomatsko masivno akutno hernijo diska smo zdravili s herniotomijo, sprostitvijo nevralnega tkiva in zatrditvijo (skupina A). Devet bolnikov smo zaradi recidivne hernije s poslabšanjem stanja povprečno 6 let po primarni operaciji (razpon štiri mesece do 14 let) zdravili s ponovno herniotomijo in zatrditvijo (skupina B). Ob zaključni kontroli z opazovalno dobo najmanj dve leti so bolniki ocenili svojo bolečino v križu in spodnjem udu ter raven svoje aktivnosti na vizualni lestvici in odgovorili na Oswestrijev vprašalnik. Opravili smo jim klinični pregled in rentgenološke preiskave ter rezultate ovrednotili po modificiranem merilu Japonskega ortopedskega združenja (JOA) in merilu po Triaju. Zbirno smo rezultate ocenili po modificiranem merilu Staufferja in Coventrija. Rezultati. Bolniki skupine A so dosegli bo jše rezultate zdravjenja v primerjavi z bolniki skupine B po kriterijih jakosti bolečine v križu (p < 0, 01), spodnjem udu (p = 0, 01) in odgovorih na Oswestrijev vprašalnik (p < 0,05). Razlika med skupinama ni bila statistično značilna po merilu Triaja, JOA in ravni aktivnosti (p > 0,05; dvosmerni t-test). Zbirno je osem bolnikov skupine A doseglo zadovoljiv (odličen ali dober) rezultat zdravljenja, medtem ko so tak rezultat dosegli le trije bolniki skupine B. Zaključki. Skupini sta bili majhni za statistično analizo, vendar bolniki s primarno zatrditvijo L4-L5 zaradi masivne hernije medvretenčnega diska dosegajo boljše rezultate zdravljenja.
Descriptors		LUMBAR VERTEBRAE INTERVERTEBRAL DISK DISPLACEMENT SPINAL FUSION LOW BACK PAIN TREATMENT OUTCOME RETROSPECTIVE STUDIES