Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome.
Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome.
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DOI：
10.3171/spi.2003.99.3.0271
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发表时间：
2003-10
影响因子：
4.1
通讯作者：
P. Gerszten;J. Moossy;J. Flickinger;W. Welch
中科院分区：
文献类型：
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作者：
P. Gerszten;J. Moossy;J. Flickinger;W. Welch
目的临床研究的作者已经证明腰椎间盘摘除术后广泛的硬膜外瘢痕形成与腰背痛和神经根性疼痛的复发之间存在显著的相关性。在动物模型中，围手术期小剂量放疗已被证明可以抑制椎板切除术后的硬膜外纤维化。本研究旨在评价术前放疗对因硬膜外纤维化导致的后背手术失败综合征再次探查和神经根减压术的临床疗效。方法将10例腰椎间盘摘除术后有症状的硬膜外纤维化患者随机分为两组。其中一半患者于有症状神经根再探查减压治疗前24小时接受700cGy外照射至手术部位(治疗组)(S)，另一半患者在未接受术前照射的情况下接受再探查减压治疗(对照组)。所有患者都接受了模拟放射治疗，因此患者和外科医生都不知道患者所在的群体。在所有患者中，抗粘连产品Adcon-L在手术时被放置在受影响的神经根上。在基线、6周、3个月和1年的随访中，使用美国神经外科医生协会/美国神经外科医生大会联合部分腰椎间盘突出症研究问卷评估临床结果。5名男性和5名女性(平均年龄42岁)接受了随机分组和手术。3例患者在L4-5再次探查，4例在L5-S1再次探查，3例在两个平面重新探查。没有与放射相关的并发症，也没有新的神经功能障碍发生。在1年的随访检查中，3名接受放射治疗的患者没有疼痛，2名患者有改善。在对照组中，3名患者的疼痛缓解有所改善，2名患者没有变化。1年后放疗组有改善预后的趋势(p=0.056)。结论术前低剂量外照射可改善因椎板切除术后硬膜外纤维化引起的神经根疼痛而行神经根再探查和减压后的临床结果。对于因大量硬膜外纤维化而再次手术的复发性神经根性疼痛的患者，术前加用放射治疗可能会改善预后，尤其是在目前还没有抗粘连产品可供临床使用的情况下。
OBJECT The authors of clinical studies have demonstrated a significant association between the presence of extensive post-lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed-back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. METHODS Ten patients with symptomatic post-discectomy peridural fibrosis were randomized. Half of the patients underwent 700-cGy external-beam irradiation to the operative site 24 hours prior to reexploration and decompressive treatment of their symptomatic nerve root(s) (treatment group) and the other half underwent reexploration and decompressive treatment without preoperative irradiation (control group). All patients underwent simulated irradiation so neither patient nor surgeon was aware of the patient's group. In all patients the antiadhesion product ADCON-L was placed over the affected nerve root at the time of surgery. Clinical outcome was assessed using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire at baseline, 6 weeks, 3 months, and 1 year follow up. Five men and five women (mean age 42 years) underwent randomization and surgery. Three patients underwent reexploration at L4-5, four at L5-S1, and three at both levels. No complication was associated with irradiation, and no new neurological deficits occurred. At 1-year follow-up examination, three irradiation-treated patients were pain free and two experienced improvement. In the control group, three patients experienced improved pain relief and two were unchanged. There was a trend toward better outcome at 1 year in the radiotherapy-treated group (p = 0.056). CONCLUSIONS Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.