Nüks lomber disk hernilerinde tedavi yaklaşımları

Abstract

ntroduction: The main aim of recurrent disc herniation is to provide neural decompression, to fuse the levels if there are signs of instability, to eliminate the other reasons responsible for back pain or to mobilize the patient as soon as possible so as to have a normal life. Material and Method: 24 patients with recurrent disc herniation were retrospectively reviewed in Ankara Numune Education and Research Hospital Neurosurgery Department between March 2006 and December 2009. The Visual Analog Pain Scale (VAS), clinical findings and imaging technics were the main diagnostic methods. Result: In patients whose mean improvement in quality of life (QOL) time was 62,96 (1-350) months were admitted to our clinic with same complaints. 17 of 24 patients (70.9%) were treated by applying discectomy, 5 of 24 patients (%20.8) by discectomy and granulation tissue excision and 2 of 24 patients (8.3%) by stabilization with pedicle screws. VAS were obtained from the time of presentation, from the time of hospital discharge, and from the most recent follow-up visit. The mean VAS was 9,08 (6-10) at presentation and 2,33 (0- 5) at final follow-up (P<.001). Discussion: As we examined the lordosis angle in the postoperative period, we found statistically not significant incline in the lumbar lordosis angle. Rediscectomy must be the first step, fusion surgery has to be performed when instability has been diagnosed. Conclusion: We found that there was a marked and statistically significant decline in the disc height and statistically significant increase in signs of degeneration after lumbar disc surgery. In the management of recurent lumbar disc herniation, good assesment should be made in terms of lumbar segmental instability because of increasing in signs of degeneration. We stated that majority of the patients benefited from the repeated discectomy surgery