Mekhail Nagy, Kapural Leonardo
Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Pain Pract. 2004 Jun;4(2):84-90. doi: 10.1111/j.1533-2500.2004.04203.x.
Published studies of intradiscal thermal annuloplasty (IDTA) have shown at most 50% pain relief as an improved outcome with little focus on functional improvement in the treatment of discogenic pain. Previous studies have used a number of criteria for patient selection including low back pain unresponsive to conservative care, no compressive radiculopathy, positive provocative discography and absence of previous surgery at the same symptomatic level. The purpose of present study is to examine the hypothesis that additional inclusion criteria for patient selection such as disc height, absence of degenerative disc disease (DDD) in untreated discs, absence of herniated nucleus pulposus or lumbar canal stenosis may improve the outcome of treatment.
In this prospective case-series study additional criteria of patient selection were introduced, namely disc height of at least 50%, no lumbar canal stenosis, one or two levels of DDD, no evidence of nucleus pulposus herniation on magnetic resonance image. Thirty-four patients were enrolled in the study and 32 of them were followed over a period of 12 months. The visual analog scale (VAS) pain score and seven activities of daily living (ADLs) were followed and reported on a scale from 0 to 10.
Sustained decrease of the VAS pain scores was observed from 3 to 12 months following IDTA. ADLs improved in all patients between 3 and 12 months post-treatment. Patients in the Bureau of Workers Compensation (BWC) group had a higher VAS score but showed the same level of improvement in ADLs as compared to commercial insurance or self-pay patients. In the non-BWC patient group an average VAS pain score decrease of more than 6 points on a 10-point scale was reported at 6 to 12 months following IDTA.
We found dramatic improvement of pain scores and ADLs following IDTA when strict patient selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in properly selected patients.
已发表的关于椎间盘内热环成形术（IDTA）的研究表明，作为一种改善的结果，最多有50%的疼痛缓解，且很少关注盘源性疼痛治疗中的功能改善。先前的研究使用了多种患者选择标准，包括对保守治疗无反应的下腰痛、无压迫性神经根病、激发性椎间盘造影阳性以及在相同症状水平上无既往手术史。本研究的目的是检验这样一种假设，即诸如椎间盘高度、未治疗椎间盘无退行性椎间盘疾病（DDD）、无髓核突出或腰椎管狭窄等额外的患者选择纳入标准可能会改善治疗结果。
在这项前瞻性病例系列研究中，引入了额外的患者选择标准，即椎间盘高度至少为50%、无腰椎管狭窄、一或两个节段的DDD、磁共振成像上无髓核突出证据。34名患者纳入研究，其中32名患者随访12个月。采用视觉模拟量表（VAS）疼痛评分，并对7项日常生活活动（ADL）进行评分，范围为0至10分。
IDTA术后3至12个月观察到VAS疼痛评分持续下降。所有患者在治疗后3至12个月ADL均有改善。工人赔偿局（BWC）组的患者VAS评分较高，但与商业保险或自费患者相比，ADL的改善水平相同。在非BWC患者组中，IDTA术后6至12个月报告VAS疼痛评分平均在10分制上下降超过6分。
当应用严格的患者选择标准时，我们发现IDTA术后疼痛评分和ADL有显著改善。我们认为，IDTA是一种针对适当选择的患者治疗盘源性疼痛的有效、微创治疗方法。
