Schneider C, Krayenbühl N, Landolt H
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Acta Neurochir (Wien). 2007 Aug;149(8):783-91; discussion 791. doi: 10.1007/s00701-007-1114-4. Epub 2007 Jul 12.
Lumbar disc disease is a very common condition with a substantial socioeconomic impact. Studies have shown the importance of a multilevel assessment of this disease, as its course is influenced by many factors. Most follow-up studies use the degree of physical impairment to measure the outcome of a certain treatment. This remains unsatisfactory, as physical impairment itself seems to be influenced by the social, psychological and personal condition of a patient. We believe that an overall quality of life assessment is required to evaluate success of treatment. The SF-36 questionnaire seemed appropriate, as it provides consistent data of a patient's overall health status. To ensure measurement of disability due to back pain we combined the SF-36 with the NASS (North American Spine Society) questionnaire, an instrument specific for lumbar spine disorders.
One year after the last outpatient consultation in our neurosurgical clinic, a SF-36 questionnaire was sent to 636 patients with conservatively treated lumbar disc disease. We used the Mann Whitney Test to compare patient's data with a standard group. The demographics of the standard group were matched with the study cohort.
A total of 486 patients (66.5% males and 33.5% females), mean age 49 years (range 21-82 years), returned the questionnaire. The SF-36 data was usable in 76.4% of the patients. Statistical testing reported a significant impact of the disease on all 8 items of the SF-36 questionnaire. The "Role Functioning - Physical (RF)" item was the most, the "Mental Health (MH)" item the less affected. No statistical difference was found between males and females regarding the impact on single items. The NASS scores were also affected suggesting that lumbar back disorder was the influencing factor for the low SF-36 scores.
Besides impairment in the execution of daily physical tasks, patients with lumbar disc disease also showed a significant impact on the "Mental Health (MH)" item. Early SF-36 assessment could identify subjects with high probability of prolonged recovery and development of chronic pain syndromes. In these patients, an early rheumatologic, rehabilitative and psychiatric treatment might be the key to improve their coping abilities and should become an integral part of the treatment strategy.
腰椎间盘疾病非常常见，具有重大的社会经济影响。研究表明对该疾病进行多层次评估很重要，因为其病程受多种因素影响。大多数随访研究使用身体损伤程度来衡量某种治疗的结果。这仍不尽人意，因为身体损伤本身似乎受患者的社会、心理和个人状况影响。我们认为需要进行总体生活质量评估来评估治疗的成功与否。SF - 36问卷似乎合适，因为它能提供患者总体健康状况的一致数据。为确保测量背痛导致的残疾情况，我们将SF - 36与北美脊柱协会（NASS）问卷相结合，后者是一种专门针对腰椎疾病的工具。
在我们神经外科门诊最后一次门诊咨询一年后，向636例接受保守治疗的腰椎间盘疾病患者发送了SF - 36问卷。我们使用曼 - 惠特尼检验将患者数据与一个标准组进行比较。标准组的人口统计学特征与研究队列相匹配。
共有486例患者（66.5%为男性，33.5%为女性）回复了问卷，平均年龄49岁（范围21 - 82岁）。76.4%的患者的SF - 36数据可用。统计测试表明该疾病对SF - 36问卷的所有8个项目均有显著影响。“角色功能 - 身体（RF）”项目受影响最大，“心理健康（MH）”项目受影响较小。在单个项目的影响方面，男性和女性之间未发现统计学差异。NASS评分也受到影响，表明腰椎疾病是SF - 36低分的影响因素。
除了日常身体任务执行方面的损伤外，腰椎间盘疾病患者的“心理健康（MH）”项目也受到显著影响。早期SF - 36评估可以识别出恢复时间长和慢性疼痛综合征发生可能性高的患者。对于这些患者，早期的风湿病学、康复和精神治疗可能是提高其应对能力的关键，应成为治疗策略的一个组成部分。
