腰椎间盘突出症手术治疗后疗效的预测因素。

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-09-20 DOI:10.14444/8650
Gregory I Sacks, Vincent Destefano, Susan M Fiore, Raphael P Davis, Samuel Ahknoukh, Harry M Mushlin
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引用次数: 0

摘要

背景:腰椎间盘突出症(LDH)是引起根性疼痛的常见原因,每年的发病率在每 1000 名成年人中有 5 到 20 例。腰椎间盘突出症通常采用显微椎间盘切除术进行治疗,美国每年进行的手术超过 30 万例。尽管如此,仍有 25% 至 33% 的患者报告手术效果不佳。本研究试图对接受显微椎间盘切除手术治疗 LDH 的患者进行回顾性分析,旨在找出可能导致手术效果不佳的人口、历史和手术因素:对石溪医学中心 2017 年至 2022 年的 241 名患者进行了回顾性研究,其中 123 名患者随访 90 天或以上,并纳入最终分析。数据收集包括人口统计学、病史/手术史和手术方法。良好结果的定义是达到数字评分系统(NRS)报告的疼痛绝对点变化阈值(ACT)-3.5点,或根性疼痛或神经症状得到缓解:单变量分析显示,100%曾接受过融合手术的患者(P = 0.039)和73.2%曾接受术前物理治疗(PT;P = 0.032)的患者未能达到ACT标准。此外,79.1%(P = 0.021)和 82.8%(P = 0.026)接受过物理治疗的患者分别有残余根性疼痛和神经症状。多变量逻辑回归证实了术前 PT 与未达到 ACT(P = 0.030,OR = 0.252)、根性疼痛(P = 0.006,OR = 0.196)和神经症状(P = 0.030,OR = 0.177)缓解之间的相关性。在单变量(P = 0.0002)和多变量(P = 0.002,OR = 1.554)分析中,ACT 与术前较高的 NRS 评分直接相关:我们的研究结果表明,术前较高的 NRS 评分、PT 和既往融合手术与较差的预后有关。虽然PT被认为是治疗LDH的一种可行的非手术疗法,但我们的研究结果表明,在手术前进行PT会产生不利影响,这表明有必要对PT对高级别LDH患者的影响进行更多研究。
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Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation.

Background: Lumbar disc herniation (LDH) is a common cause of radicular pain with an annual incidence between 5 and 20 cases per 1000 adults. LDH is typically treated by microdiscectomy, of which more than 300,000 are performed in the United States each year. Despite this frequency, 25% to 33% of patients report poor surgical outcomes. This study sought to present a retrospective analysis of patients who underwent microdiscectomy surgery for the treatment of LDH with the aim of identifying demographic, historical, and surgical factors that may contribute to inadequate surgical results.

Methods: A retrospective study of 241 patients at Stony Brook Medicine from 2017 to 2022 was performed, 123 of whom had follow-up of 90 days or more and were included for final analysis. Data collection included demographics, medical/surgical history, and surgical methodology. Good outcomes were defined as meeting the absolute point change threshold (ACT)-3.5pt reduction in pain reported by the Numerical Rating System (NRS) or the resolution of either radicular pain or neurological symptoms.

Results: Univariate analysis revealed that 100% of patients with prior fusion surgery (P = 0.039) and 73.2% who underwent preoperative physical therapy (PT; P = 0.032) failed to meet the ACT. Additionally, 79.1% (P = 0.021) and 82.8% (P = 0.026) of patients who had PT had residual radicular pain and neurological symptoms, respectively. Multivariate logistic regression confirmed correlations between preoperative PT and failure to meet the ACT (P = 0.030, OR = 0.252) and resolution of radicular (P = 0.006, OR = 0.196) and neurological (P = 0.030, OR = 0.177) complaints. ACT directly correlated with higher preoperative NRS scores in univariate (P = 0.0002) and multivariate (P = 0.002, OR = 1.554) analyses.

Conclusion: Our results show that higher preoperative NRS scores, PT, and prior fusion surgery are associated with poorer outcomes. While PT is considered a viable nonoperative treatment for LDH, our findings suggest detrimental effects when preceding surgery, indicating the need for additional research into the effects of PT on patients with high grade LDH.

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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