Moore Kathleen R, Pinto Manuel R, Butler Lisa M
Twin Cities Spine Center, Minneapolis, Minnesota 55404, USA.
Spine (Phila Pa 1976). 2002 Aug 1;27(15):1680-6. doi: 10.1097/00007632-200208010-00018.
This study retrospectively reviewed the outcome of 58 patients all diagnosed with severe low back pain secondary to degenerative disc disease and treated with anterior arthrodesis and posterior instrumented arthrodesis.
To evaluate the outcome of a select group of patients with degenerative disc disease treated with this surgical intervention at a minimum of 2 years of follow-up.
Patients with degenerative disc disease who fail nonoperative treatment generally have disappointing outcomes with traditional surgical intervention. The literature analyzing posterior instrumented arthrodesis tends to exhibit the best results, but the numbers of patients with degenerative disc disease in these articles are few, and their outcomes are worse than the other low back conditions. Even patients with solid posterior arthrodesis have been noted to have continued low back pain. No articles have evaluated this specific surgical procedure in a group of patients all with the diagnosis of degenerative disc disease and no previous surgery.
All patients were diagnosed with degenerative disc disease and had failed prolonged nonoperative treatment (average 4.9 years). Fusion levels were delineated by MRI and provocative discography in correlation with history and physical examination. The senior author (M.R.P.) performed the identical operative procedure on all patients, under a single anesthetic. The arthrodesis solidity was evaluated with radiographic studies and operative posterior exploration when necessary. Final outcomes were determined using a functional and satisfaction questionnaire, return to work, narcotic use, and the rate of solid arthrodesis. Charts, radiographs, and questionnaires were reviewed by an independent evaluator at final follow-up (average 35 months).
The solid arthrodesis rate was 95%. The three pseudoarthroses were all in patients with a three-level arthrodesis. Eighty-eight percent of the patients were able to return to work. Nineteen percent of patients required long-term narcotics, whereas 48% of the patient population were on narcotics before surgery. Eighty-six percent of the patients had a "better" rating at final follow-up. This included patients with decreased pain by visual analog scale, improved functional questionnaire, and those who would recommend the procedure to a friend or family member. Ten percent of the patients were "the same," and 3% were "worse." Lumbar lordosis was maintained or improved. Complications did not exceed literature controls.
Selected patients with discography-proven severe low back pain secondary to degenerative disc disease, who failed extensive nonoperative treatment, were treated successfully with anterior-posterior instrumented arthrodesis. The good arthrodesis rate, return to work rate, and patient satisfaction may justify the consideration of this aggressive treatment option in this specific patient population.
本研究回顾性分析了58例均被诊断为继发于椎间盘退变疾病的严重腰痛患者的治疗结果，这些患者均接受了前路融合术和后路器械辅助融合术。
评估经该手术干预治疗且至少随访2年的一组特定椎间盘退变疾病患者的治疗结果。
非手术治疗失败的椎间盘退变疾病患者，采用传统手术干预通常疗效不佳。分析后路器械辅助融合术的文献往往显示出最佳结果，但这些文章中椎间盘退变疾病患者数量较少，且其结果比其他腰痛情况更差。即使是后路融合牢固的患者也被发现仍有持续的腰痛。尚无文章评估这一特定手术方法在一组均诊断为椎间盘退变疾病且既往未接受过手术的患者中的疗效。
所有患者均被诊断为椎间盘退变疾病，且长期非手术治疗失败（平均4.9年）。通过MRI和激发性椎间盘造影，并结合病史和体格检查来确定融合节段。资深作者（M.R.P.）在单次麻醉下对所有患者实施相同的手术操作。必要时，通过影像学检查和手术中后路探查评估融合的牢固程度。使用功能和满意度问卷、重返工作情况、麻醉药物使用情况以及融合牢固率来确定最终结果。在最终随访（平均35个月）时，由一名独立评估者审查病历、X线片和问卷。
融合牢固率为95%。3例假关节形成均发生在接受三节段融合术的患者中。88%的患者能够重返工作岗位。19%的患者需要长期使用麻醉药物，而术前有48%的患者使用麻醉药物。86%的患者在最终随访时评价为“较好”。这包括视觉模拟评分法显示疼痛减轻、功能问卷得到改善以及会向朋友或家人推荐该手术的患者。10%的患者评价为“相同”，3%的患者评价为“较差”。腰椎前凸得以维持或改善。并发症未超过文献对照。
经激发性椎间盘造影证实继发于椎间盘退变疾病的严重腰痛患者，经广泛非手术治疗失败后，采用前后路器械辅助融合术治疗成功。良好的融合率回报率、重返工作率和患者满意度可能证明在这一特定患者群体中考虑这种积极的治疗选择是合理的。
