Okoro Tosan, Sell Phillip
Department of Orthopaedics and Trauma, University Hospitals Leicester, Leicester UK.
J Spinal Disord Tech. 2010 Feb;23(1):40-2. doi: 10.1097/BSD.0b013e3181b38537.
Prospective cohort study.
To assess whether there is a difference in outcome between single-level discectomy at L4/L5 and L5/S1.
There is sound biomechanical reasoning to suspect a difference between spinal levels. The L4/L5 disc is more susceptible to axial torsion and is the most common site of lumbar instability. The L5/S1 motion segment is protected from torsional strain by extensive iliolumbar ligaments but is more exposed to axial compressive forces. The available literature does not include studies with preoperative standard outcome measures.
Prospectively gathered data from a single center. The outcome measures were the Oswestry disability index, subjective walking distance, modified somatic perception, modified Zung depression index, low back outcome score, and visual analog score. Comparisons between L4/L5 and L5/S1 levels were made with these outcome measures using the Student t test.
Seventy-seven L5/S1 and 53 L4/L5 discectomies were performed. There were no clinically significant differences. Preoperative walking distance for L5/S1 patients was longer than at L4/L5 (455 m vs. 278 m; P=0.027). At 6 months a difference also exists with the low back outcome score [47.11 (L4/L5) vs. 39.47 (L5/S1); P=0.0229]. After 12 months at L5/S1, men had a better Oswestry disability index score than women (17% vs. 32%; P=0.038). Across all other parameters, no significant difference was found to exist between the 2 groups. There was no difference in the recurrence rate or reoperation rate.
This is the first study comparing a discectomy outcome at L4/L5 and L5/S1 with complete preoperative data. No significant difference exists between the 2 levels in terms of postoperative outcome. Surgical procedures such as fusion or arthroplasty should not be carried out synchronous with primary discectomy for radiculopathy. The lack of a difference between L4/L5 and L5/S1 reinforces the fact that the mechanical environment does not affect outcome and should not influence treatment.
前瞻性队列研究。
评估L4/L5和L5/S1单节段椎间盘切除术的预后是否存在差异。
有合理的生物力学依据怀疑不同脊柱节段之间存在差异。L4/L5椎间盘更容易受到轴向扭转影响，是腰椎不稳最常见的部位。L5/S1运动节段受到广泛的髂腰韧带保护免受扭转应变，但更易受到轴向压缩力影响。现有文献中没有术前采用标准预后指标的研究。
前瞻性收集来自单一中心的数据。预后指标包括Oswestry功能障碍指数、主观步行距离、改良躯体感觉、改良zung抑郁指数、下腰痛预后评分和视觉模拟评分。使用Student t检验对L4/L5和L5/S1节段这些预后指标进行比较。
共进行了77例L5/S1和53例L4/L5椎间盘切除术。无临床显著差异。L5/S1患者术前步行距离长于L4/L5患者（455米对278米；P = 0.027）。6个月时，下腰痛预后评分也存在差异[47.11（L4/L5）对39.47（L5/S1）；P = 0.0229]。L5/S1术后12个月时，男性的Oswestry功能障碍指数评分优于女性（17%对32%；P = 0.038）。在所有其他参数方面，两组之间未发现显著差异。复发率和再次手术率无差异。
这是第一项比较L�/5和L5/S1椎间盘切除术预后并具备完整术前数据的研究。在术后预后方面，这两个节段之间无显著差异。对于神经根病，不应在初次椎间盘切除术的同时进行融合或关节成形术等手术。L4/L5和L5/S1之间缺乏差异进一步证明了机械环境不影响预后且不应影响治疗这一事实。
