徳島大学 教育・研究者情報データベース(EDB)

1. (英) Yagi Kiyoshi / (日) 八木 清

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2. (英) Kishima Kazuya / (日) 木島 和也

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3. 手束 文威([徳島大学.大学院医歯薬学研究部.医学域.先端医学教育研究プロジェクト]/[徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.運動機能外科学])

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4. 森本 雅俊([徳島大学.大学院医歯薬学研究部.医学域.連携研究部門(医学域).寄附講座系(医学域).地域運動器・スポーツ医学])

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5. 山下 一太([徳島大学.大学院医歯薬学研究部.医学域.連携研究部門(医学域).寄附講座系(医学域).地域運動器・スポーツ医学])

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6. 髙田 洋一郎

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7. 酒井 紀典([徳島大学.病院.中央診療施設等.高度先進整形外科診療部])

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8. 前田 徹

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9. 西良 浩一([徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.運動機能外科学])

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(英) Advantages of revision transforaminal full-endoscopic spine surgery in patients who have previously undergone posterior spine surgery.

(英) Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability postoperatively; therefore, fusion surgery is often selected. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. To assess the clinical outcomes of revision TF-FES and outline its advantages. Forty-eight consecutive patients who underwent revision TF-FES (at 60 levels) under local anesthesia. Clinical outcomes of TF-FES performed as revision surgery in patients with a history of posterior lumbar spine surgery. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. Mean operating time was 70.5±14.4 (52-106) min. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair in 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0±2.6 for back pain, 6.8±2.4 for leg pain, and 6.3±2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for were 4.3±2.5, 3.8±2.6, and 4.6±3.2, respectively. VAS scores for all three parameters were significantly improved (p<0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.

1. (英) PublicationType: Journal Article