Bednar D A
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
J Bone Joint Surg Am. 2001 Nov;83(11):1656-9. doi: 10.2106/00004623-200111000-00006.
Whether lumbar arthrodesis can relieve isolated low-back pain in the absence of focal neurological findings or instability is unclear. The results of published studies are also inconsistent with regard to whether temporary back-pain relief with external spinal skeletal fixation can predict lasting back-pain relief after arthrodesis. This report presents the results, with regard to clinical benefit and complications, of more than 100 external spinal skeletal fixation procedures undertaken as a prelude to lumbar arthrodesis.
The records of all patients who underwent external spinal skeletal fixation between 1989 and 1999 were reviewed with attention to perioperative complications, pain relief from the test procedure, the clinical benefit from a subsequent arthrodesis, and the functional status after the arthrodesis. Analyzed data included the frequency of neurological complications and infections and the benefit (Prolo score) after staged spinal arthrodesis in patients who underwent arthrodesis after temporarily experiencing pain relief with the test procedure.
A total of 103 external spinal skeletal fixation procedures were undertaken. Neurological complications occurred in two procedures (2%); one resulted in permanent sciatica. Infections occurred in five patients (5%). Sixty patients experienced pain relief during the external fixation test, but only twenty-seven of forty-nine patients who went on to have an arthrodesis and had sufficient follow-up reported that they were doing well at a minimum of one year later. In no case did the external spinal skeletal fixation procedure cause a permanent increase in low-back pain.
On the basis of this analysis, external spinal skeletal fixation should not be used as a predictor of pain relief after lumbar arthrodesis.
在没有局灶性神经学表现或不稳定的情况下，腰椎融合术能否缓解单纯性下腰痛尚不清楚。已发表研究的结果在外部脊柱骨骼固定带来的短暂性腰痛缓解能否预测融合术后的持续性腰痛缓解方面也不一致。本报告介绍了作为腰椎融合术前奏而进行的100多例外部脊柱骨骼固定手术在临床获益和并发症方面的结果。
回顾了1989年至1999年间所有接受外部脊柱骨骼固定的患者的记录，关注围手术期并发症、试验性手术的疼痛缓解情况、后续融合术的临床获益以及融合术后的功能状态。分析的数据包括神经并发症和感染的发生率，以及在试验性手术暂时缓解疼痛后接受融合术的患者分期脊柱融合术后的获益情况（普罗洛评分）。
共进行了103例外部脊柱骨骼固定手术。2例手术（2%）出现神经并发症；1例导致永久性坐骨神经痛。5例患者（5%）发生感染。60例患者在外部固定试验期间疼痛缓解，但在继续接受融合术且有足够随访的49例患者中，只有27例报告至少在一年后情况良好。外部脊柱骨骼固定手术在任何情况下均未导致下腰痛永久性加重。
基于本分析，外部脊柱骨骼固定不应作为腰椎融合术后疼痛缓解的预测指标。
