Department of Orthopaedics, Huddersfield Royal Infirmary, Huddersfield, UK.
Eur Spine J. 1992 Sep;1(2):89-95. doi: 10.1007/BF00300933.
In the 11-year period from 1978 and 1988, myelography was performed on 624 patients with suspected herniated lumbar discs. Positive findings, defined as an indentation of the contrast-filled dural sac and/or lack of contrast filling of the nerve roots, were found in 508 (81.4%) patients. Patients with suspected spinal stenosis were excluded from the study. The choice of treatment was determined by the preference of the consultant in charge. In all, 146 patients were treated by chemonucleolysis, 152 patients underwent surgical excision of the disc via laminectomy/fenestration, while 210 patients were listed for further treatment (albeit chemonucleolysis or laminectomy) but sustained relief of symptoms whilst waiting for admission or refused further intervention and consequently continued conservative treatments (such as physiotherapy, manipulations under anaesthetic, epidural or local injections). Following a repetitive questionnaire and clinical review, 78% of those patients that had undergone chemonucleolysis were satisfied with their treatment (i.e. symptoms were either 'gone', 'much better' or 'better'). Significantly fewer patients were satisfied after surgical disc excision or conservative treatments (71% and 61%, respectively; P <0.001). Whereas patients with a short duration of symptoms (less than 1 year) achieved the best outcome after chemonucleolysis and laminectomy, patients with a prolonged history (greater than 2 years) benefitted most from conservative methods. Of those patients in whom symptoms were considered to be worse or the same following treatment, 46%, 51% and 42% were still working following chemonucleolysis, surgery and conservative treatment, respectively. The outcome did not depend upon the size of the disc involved. Although this is a retrospective study, it is the first report to compare the outcome following chemonucleolysis, surgery and conservative methods in patients with disc prolapse confirmed by myelography.
在 1978 年至 1988 年的 11 年期间，对 624 例疑似腰椎间盘突出症的患者进行了脊髓造影检查。在 508 例（81.4%）患者中发现阳性发现，定义为硬膜囊充盈对比剂的凹陷和/或神经根充盈对比剂的缺失。本研究排除了疑似脊柱狭窄症的患者。治疗选择由负责的顾问决定。共有 146 例患者接受了化学髓核溶解术治疗，152 例患者通过椎板切除术/开窗术切除了椎间盘，而 210 例患者被列为进一步治疗（尽管是化学髓核溶解术或椎板切除术），但在等待入院期间症状缓解，或拒绝进一步干预，因此继续保守治疗（如物理治疗、麻醉下推拿、硬膜外或局部注射）。通过重复的问卷调查和临床复查，接受化学髓核溶解术的患者中有 78%对治疗满意（即症状“消失”、“明显改善”或“改善”）。接受手术切除椎间盘或保守治疗的患者满意度明显较低（分别为 71%和 61%；P<0.001）。尽管接受化学髓核溶解术和椎板切除术的患者症状持续时间较短（<1 年）的治疗效果最好，但病史较长（>2 年）的患者最受益于保守方法。在治疗后症状被认为更糟或相同的患者中，接受化学髓核溶解术、手术和保守治疗的患者中，分别有 46%、51%和 42%仍在工作。结果与椎间盘大小无关。尽管这是一项回顾性研究，但它是第一项比较化学髓核溶解术、手术和保守方法治疗经脊髓造影证实的椎间盘突出症患者的预后的报告。
