Saal J A, Saal J S
SOAR, Physiatry Medical Group, Menlo Park, CA 94025, USA.
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2622-7. doi: 10.1097/00007632-200010150-00013.
Prospective case series.
To determine the outcome of patients with chronic low back pain whose symptoms did not improve with aggressive nonoperative care and who chose (intradiscal electrothermal anuloplasty) IDET as an alternative to chronic pain management or interbody fusion surgery.
Patients with unremitting chronic discogenic low back pain are faced with the choice of long-term pain management or fusion surgery. Intradiscal electrothermal anuloplasty (IDET) was developed as an alternative minimally invasive treatment.
Sixty-two patients from the author's practice who had chronic low back pain unresponsive to nonoperative care, no evidence of compressive radiculopathy, and concordant pain reproduction at one or more disc levels on provocative discography were enrolled in the study. Visual analog scale (VAS) pain scores and Short Form (SF)-36 Health Status Questionnaire Physical Function subscale and SF-36 Bodily Pain subscale scores were assessed at baseline and at least 1 year later.
Mean follow-up was 16 months, and mean preoperative duration of symptoms was 60 months. Baseline and follow-up outcome measures demonstrated a mean change in VAS score of 3.0 (P < 0.001), mean change in SF-36 physical function of 20 (P < 0.001), and mean change in SF-36 bodily pain of 17 (P < 0.001). Symptoms improved in 44 (71%) of 62 of the study group on the SF-36 physical function subscale, in 46 (74%) of 62 on the SF-36 Bodily Pain subscale, and in 44 (71%) of 62 on the VAS scores. Twelve (19%) of 62 of the patients did not show improvement on any scale.
A cohort of patients with chronic unremitting low back pain of discogenic origin whose symptoms had failed to improve with aggressive nonoperative care demonstrated a statistically significant and clinically meaningful improvement on the SF-36 and the VAS scores at a minimum follow-up of 1 year after IDET. The positive results should be validated with placebo-controlled randomized trials and studies that compare IDET with alternative treatments.-
前瞻性病例系列研究。
确定慢性下腰痛患者的治疗结果，这些患者的症状在积极的非手术治疗后未改善，且选择椎间盘内电热环成形术（IDET）作为慢性疼痛管理或椎间融合手术的替代方法。
慢性椎间盘源性下腰痛患者面临长期疼痛管理或融合手术的选择。椎间盘内电热环成形术（IDET）是作为一种替代性的微创治疗方法而开发的。
选取作者诊所中62例慢性下腰痛患者，这些患者对非手术治疗无反应，无压迫性神经根病证据，且在激发性椎间盘造影时一个或多个椎间盘水平有一致性疼痛再现，将其纳入研究。在基线时以及至少1年后评估视觉模拟量表（VAS）疼痛评分、简短健康调查问卷（SF）-36健康状况问卷身体功能子量表和SF-36身体疼痛子量表评分。
平均随访16个月，术前平均症状持续时间为60个月。基线和随访结果测量显示，VAS评分平均变化3.0（P<0.001），SF-36身体功能平均变化20（P<0.001），SF-36身体疼痛平均变化17（P<0.001）。在SF-36身体功能子量表上，研究组62例中有44例（71%）症状改善；在SF-36身体疼痛子量表上，62例中有46例（74%）症状改善；在VAS评分上，62例中有44例（71%）症状改善。62例患者中有12例（19%）在任何量表上均未显示改善。
一组椎间盘源性慢性持续性下腰痛患者，其症状在积极的非手术治疗后未改善，在接受IDET治疗至少1年后，SF-36和VAS评分显示出统计学上显著且具有临床意义的改善。这些阳性结果应通过安慰剂对照随机试验以及将IDET与其他治疗方法进行比较的研究来验证。
