Jensen Tue S, Albert Hanne B, Soerensen Joan S, Manniche Claus, Leboeuf-Yde Charlotte
The Back Research Center, Clinical Locomotion Science, University of Southern Denmark, Ringe, Denmark.
Spine (Phila Pa 1976). 2006 Jun 15;31(14):1605-12; discussion 1613. doi: 10.1097/01.brs.0000221992.77779.37.
A prospective observational study of patients with sciatica.
To describe the 14-month development of disc-related MRI findings in patients with sciatica receiving active conservative treatment.
Previous studies of disc changes over time have reported reduction of herniations in 35% to 100% of cases. This wide range may be explained by differences in patient populations and classifications used to describe disc herniations.
Data were obtained from patients with radicular pain (n = 181) who were randomly allocated into one of two active conservative treatment regimens lasting 8 weeks. All patients were scanned at baseline and at 14 months of follow-up. Variables of interest in the present study were disc contour and nerve root compromise at the presumed symptomatic disc level. Disc contour was assessed using the recommendations from the Combined Task Forces of NASS, ASSR, and ASNR.
In all, 154 patients were included in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45 years). It was possible to identify the symptomatic disc level in 90% of patients. Extrusions or sequestrations were more common in individuals younger than 45 years and in men. Men were also more likely to have nerve root compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 0.0001). Nerve root compromise improved in 21% to 80% depending on the disc contour. Neither type of treatment nor age had any effect on the development of MRI findings over time. However, nerve root compromise was more likely to improve in men.
This classification system could be used to identify the majority of symptomatic disc levels. At 14 months, the MRI outcome was generally good for disc herniations and nerve root compromise. Nerve root compromise had the best MRI prognosis if the disc was extruded at baseline. There were significant differences between men and women in relation to baseline findings as well as in relation to development of MRI findings over time.
一项对坐骨神经痛患者的前瞻性观察研究。
描述接受积极保守治疗的坐骨神经痛患者椎间盘相关MRI表现的14个月发展情况。
既往关于椎间盘随时间变化的研究报告称，35%至100%的病例中椎间盘突出有所减轻。这一广泛范围可能是由于患者群体和用于描述椎间盘突出的分类存在差异所致。
数据来自患有神经根性疼痛的患者（n = 181），这些患者被随机分配到两种持续8周的积极保守治疗方案之一。所有患者在基线和随访14个月时均接受扫描。本研究感兴趣的变量是假定有症状的椎间盘水平处的椎间盘轮廓和神经根受压情况。使用北美脊柱协会（NASS）、美国脊柱放射学会（ASSR）和美国神经放射学会（ASNR）联合特别工作组的建议评估椎间盘轮廓。
本研究共纳入154例患者（70例女性和84例男性；年龄范围18 - 65岁；平均年龄和中位数年龄均为(45)岁）。90%的患者能够确定有症状的椎间盘水平。突出或游离在45岁以下个体和男性中更为常见。男性也更有可能出现神经根受压。只有3%的膨出和38%的局灶性突出有所改善，而75%至100%的基底较宽的突出、突出和游离有所改善（P < 0.0001）。根据椎间盘轮廓，神经根受压改善率在21%至80%之间。两种治疗方式和年龄对MRI表现随时间的发展均无任何影响。然而，男性的神经根受压更有可能改善。
该分类系统可用于识别大多数有症状的椎间盘水平。在14个月时，对于椎间盘突出和神经根受压，MRI结果总体良好。如果基线时椎间盘为游离型，神经根受压的MRI预后最佳。男性和女性在基线表现以及MRI表现随时间的发展方面存在显著差异。
