Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy

요추 추간판 탈출증의 관혈적 수핵 제거술에 따른 재발률과 생존율

Yang, Bo-Kyu;Ha, Jeong-Hyun;Hahn, Sung-Ho;Yi, Seung-Rim;Chung, Shun-Wook;Ahn, Young-Joon;Kim, Min-Seok
양보규;하정현;한성호;이승림;정선욱;안영준;김민석

  • Published : 20040000
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Abstract

Purpose: The aim of this study was to estimate the true recurrence rate of lumbar disc herniation after open discectomy, and to compare these results with those from other studies. Materials and Methods: From January 1992 to June 2002, the medical records and radiological findings, including a telephone survey were studied retrospectively. This study examined 306 cases, who had been operated by an open discectomy on a single level and had no other spinal lesions such as spondylolisthesis, spondylolysis, or spinal stenosis. MRI was used to confirm the diagnosis of a lumbar disc herniation in all cases. The recurrence of lumbar disc hemiation was diagnosed only in those cases who had the same pattern of symptoms and was confirmed by MRI. The cases who had undergone additional surgery at another hospital at the same spinal level were also included as ecurrence. In order to make up for weak points such the losses to a long term follow-up, statistical survival analysis was carried out using a life table method. In the life table method, the assumption is that all patients undergo surgery simultaneously. The longest follow-up duration was 11 years. Results: In 252 of the 306 cases (82%), follow-up study was possible. The average duration of the follow-up was 5.9 years (from 1 to 11 years). The average age of the patients was 27.1 years (17 to 75), and the male to female ratio was 11.6:1. The most common lesion of lumbar disc herniation was L4-5 (74%) at the initial diagnosis. The simple recurrence rate was 8.3% (21 cases) using the conventional method, in which the cases lost to follow-up were excluded. Survival analysis showed that, the annual recurrence rate was highest at the first year postoperatively as 3.4%, but decreased with time. At the last follow-up of 11 years, the cumulative survival rate was 88.9% and the recurrence rate was estimated to be 11.1% at final stage. Conclusion: Using survival analysis, the true rate of a recurrence of lumbar disc herniation after an open discectomy calculated. Even though the annual recurrence rate decreased with time, the true recurrence rate using the conventional method may be higher than the results obtained suggest.

목 적: 요추 추간판 탈출증의 관혈적 수핵 제거술에 따른 진성 재발률(true recurrence rate)을 추정하고, 추시 가능한 증례 만을 포함하는 기존의 단순 재발률과 비교하고자 하였다. 대상 및 방법: 1992년 1월부터 2002년 6월까지 척추 전방 전위증, 척추 분리증, 척추관 협착증 등의 척추 기타 병변이 동반되지 아니하고, 단일 병소에만 발생한 요추 추간판 탈출증에 대하여 관혈적 수핵 제거술을 시행 받은 306예를 대상으로 하였다. 의무기록과 방사선학적 결과 및 전화 조사를 병행하여 후향적 방법으로 연구하였다. 전례에서 추간판 탈출증의 진단은 MRI를 통하여 확진하였다. 재발의 판정은 증상의 재발 및 MRI의 확진이 동반된 경우로 한정하였으며, 타 병원 에서 같은 부위의 재발로 진단받고, 재수술 받은 경우도 포함하였다. 장기추시에 따른 증례 탈락의 단점을 보완하고자 통계학적 생존분석(survival analysis)을 사용하였다. 생존분석은 해당 증례의 모든 환자가 동시에 수술 받았다고 가정하고 최종 추시기간이 11년까지 포함하는 생명표(life table) 방법을 이용하여 시행하였다. 결과: 평균 5.9년(1-11년)의 장기 추시 중 18%의 추시 소실이 있었다. 추시 관찰이 가능하였던 252명(82%)의 경우, 남녀비는 11.6:1로 남자가 많았으며, 평균 연령은 27.1세(17-75세)였고, 가장 많은 발생 부위는 요추 제 4-5번간(74%)이었다. 추시 가능한 환자만을 대상으로 한 단순 재발률은 8.3% (21예)였으며, 이 중 요추 제 4-5번에서(16예; 76%) 가장 많이 발생하였다. 추시 중 소실된 증례를 포함하는 생존 분석의 경우, 연간 재발률(annual recurrence rate)이 수술 첫해에 가장 높은 3.4%를 나타났으며, 시간이 지남에 따라 점차 감소하였다. 추시 9년에 누적 생존율(cumulative survival rate)은 88.9%로 나타났으며, 이후 최종 추시 11년까지 변화를 보이지 않았고, 이에 따른 장기 추시 재발률은 11.1%로 추정되었다. 결론: 생존 분석을 이용하여, 장기 추시에 따른 증례 소실을 고려한 진성 재발률을 추정하였다. 분석 결과, 수술 후 재발률은 추시 기간에 따라 다르게 나타나고, 연간 재발률은 추시 기간의 증가에 따라 점차 감소하였으나, 전체적인 진성 재발률은 추시 가능한 증례만을 이용한 단순 재발률에 비해 높게 나타났다.

Keywords

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