Material and Method
This study is a prospective randomized study. Between 2011 and 2016, it was carried out in different
clinics but by the same team. Fifty patients who had previously undergone surgery due to lumbar disc
herniation were reoperated at the same level and on the same side due to relapse. The criteria for inclusion
in this study were: 1) at least 6 months of relaxation time from primary lumbar disc surgery; 2) recurrent
disc pain that does not respond to conserved treatment for at least 6 Weeks; 3) magnetic resonance (MRI)
examination of lumbosacral region to show that the recurrence disc is on the same level and the same side.
Exclusion criteria were; multisegment spinal canal stenosis, spinal deformity, spondylolisthesis, adjacent
segment disease, instability in dynamic spinal graphics, the presence of granulation tissue in MRI disk
instead of disk and absence of actual recurrence disk. The study consisted of 28 women (56%) and 22 men
(44%) with a mean age of 40.62 years. All patients underwent neurological examinations and X-rays,
computed tomography and MRI were taken. The clinical symptoms and symptoms were evaluated directly
through the question and by examining the Japanese Orthopedic Association's evaluation system (JOA
score) for Low Back Pain Syndrome. Table 1
Patients were divided into three groups according to the surgical procedure. Group OD was composed of
16 patients with only discectomy and laminectomy; group DSTFO diskectomy and laminectomy were
comprised of 16 patients with posterior transpedicular screw system and fusion, and group DDS was
composed of 17 patients with transpedicular screw system and dynamic rod.
After all medications and general anesthesia for group OD, all patients were brought to the prone position
by placing roller pads under them to reduce venous drainage and lower abdominal pressure. All revision
surgeries were performed on the first operation side and level. After opening the anatomic structure in the
appropriate procedure, the scar tissue developed in the previous laminectomy region was separated from
the remaining lamina. After reaching the normal epidural area, the remaining lamina was removed, and
epidural scar tissue was exfoliated as much as possible. Nerve root was obtained from lateral dissection.
The Root was gently mobilized to medial, and the disk fragment was reached. Acute dissection was
performed when the nerve root was attached to the disc fragment and ligamentous structures in the
extrude. After extraction of the extracted fragment, the disc space was evacuated.
The beginning stage of the surgery for group DSTFO was the same as group OD. Facetectomy was
performed after laminectomy, before nerve root dissection, until pedicle appears. This approach made it
easier to reach the fragment disc and root without excessive rule out of neural tissue. After disc dissection
and discectomy, transpedicular screws were inserted and posterolateral fusion was applied.
The beginning part of the surgery for group DDS was carried out in the same way. A unilateral
facetectomy was performed after laminectomy, before nerve root dissection, until pedicle was seen. After
dissecting the fragmented disc and performing a discectomy, transpedicular screws were placed. Dynamic
routes have been deployed without fusion. After the surgery was completed in all groups, drainage was put
in the surgical area, and the layers were closed in the appropriate anatomic position.
Perioperative prophylaxis was applied to all patients. The following postoperative day, patients were taken
to walk, and the lumbar corset was used for two months. Patients were monitored for at least two years at
regular intervals. Clinical symptoms and results were evaluated using the JOA score. Postoperative
outcomes were assessed according to the recovery rate defined by Hirabayashi and his colleagues.
All results were evaluated after surgery. Preoperative symptoms and differences in postoperative outcomes
between the groups were analyzed statistically. Statistical analysis was performed using SPSS 16.0 for
Windows statistical software. Statistical significance was calculated using the p-value less than 0.05.
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