Yakovlev Alexander, Tamimi Mazin Al, Liang Hong, Eristavi Maria
Department of Interventional Pain Management, Marshfield Clinic, Marshfield, WI 54494, USA.
Pain Physician. 2007 Mar;10(2):319-28.
Percutaneous disc decompression utilizing Nucleoplasty has emerged as one of the minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs. Only 1 study to date has examined its effect on functional activity and pain medication use; however, results were not analyzed over time, and recall bias was a limitation.
Evaluation of the effect of Nucleoplasty on pain and opioid use in improving functional activity in patients with radicular or axial low back pain secondary to contained herniated discs.
Retrospective, non-randomized case series.
Twenty-two patients who had undergone Nucleoplasty were included in the analysis. Patients were evaluated at 1, 3, 6, and 12 months postoperatively, and were asked to quantify their pain using a visual analog scale ranging from 0 to 10. Patients were also surveyed in regards to their pain medication use, and functional status was quantified by a physical therapist who also used patient reports of ability to perform activities of daily living to assess status. Data were compared between baseline and at 1, 3, 6, and 12 months post-treatment.
Reported pain and medication use were significantly decreased and functional status was improved at 1, 3, 6, and 12 months following Nucleoplasty (P values < or = 0.0010 for all outcome measures at all time periods). There were no complications associated with the procedure and we found continued improvements over time.
Nucleoplasty appears to be safe and effective. Randomized, controlled studies are required to further evaluate its long-term efficacy.
利用髓核成形术进行经皮椎间盘减压已成为治疗因包容性椎间盘突出所致下腰痛和下肢疼痛的微创技术之一。迄今为止，仅有1项研究考察了其对功能活动和止痛药物使用的影响；然而，研究结果未进行长期分析，且存在回忆偏倚这一局限性。
评估髓核成形术对因包容性椎间盘突出继发的神经根性或轴性下腰痛患者在改善功能活动方面的疼痛及阿片类药物使用的影响。
回顾性、非随机病例系列研究。
22例行髓核成形术的患者纳入分析。在术后1、3、6和12个月对患者进行评估，要求患者使用0至10的视觉模拟量表对疼痛进行量化。还对患者的止痛药物使用情况进行了调查，功能状态由一名物理治疗师进行量化，该治疗师还利用患者对日常生活活动能力的报告来评估状态。对基线数据与治疗后1、3、6和12个月的数据进行比较。
髓核成形术后1、3、6和12个月时，报告的疼痛和药物使用显著减少，功能状态得到改善（所有时间段所有结局指标的P值均≤0.0010）。该手术无相关并发症，且我们发现随着时间推移有持续改善。
髓核成形术似乎安全有效。需要进行随机对照研究以进一步评估其长期疗效。
