Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28232, USA.
J Bone Joint Surg Am. 2010 May;92(5):1293-304. doi: 10.2106/JBJS.I.01439.
Lumbar arthrodesis is a commonly performed operative procedure for the treatment of low back pain. Recently, total disc arthroplasty has gained some acceptance among surgeons and patients. However, the indications for and results of back pain surgery remain controversial and confusing. Available information suggests that meaningful functional improvement from these procedures is debatable and that the cost of such elective operations is high. Currently, lumbar disc replacement has gained minimal support from governmental and private payers. Among those attending this symposium at the 2009 Annual Meeting of the AOA, the vast majority concurred that Medicare and private insurance should not necessarily pay for disc replacement surgery. Interestingly, among this skeptical group of orthopaedic surgeons, only 23% believed that degeneration of the intervertebral disc is the major cause of low back pain. When asked the hypothetical question, "If you experienced chronic low back pain with degenerative changes at one level, what course of treatment would you opt for?" 61% responded that they would choose nonoperative treatment and 38%, that they would choose no treatment. Of more than 100 respondents, only one responded that he or she would undergo fusion and one admitted a willingness to undergo disc replacement in this hypothetical scenario.
腰椎融合术是一种常用于治疗腰痛的手术。最近，全椎间盘置换术在外科医生和患者中得到了一定的认可。然而，腰痛手术的适应证和结果仍然存在争议和混淆。现有资料表明，这些手术的功能改善意义值得商榷，而且这种选择性手术的费用很高。目前，腰椎间盘置换术很少得到政府和私人支付方的支持。在参加本次 2009 年 AOA 年会研讨会的人中，绝大多数人认为医疗保险和私人保险不一定应该支付椎间盘置换手术的费用。有趣的是，在这群持怀疑态度的骨科医生中，只有 23%的人认为椎间盘退化是腰痛的主要原因。当被问及一个假设性问题，“如果您在一个水平上经历了慢性腰痛和退行性变化，您会选择哪种治疗方法？”61%的人表示他们会选择非手术治疗，而 38%的人表示他们会选择不治疗。在 100 多名回答者中，只有一名回答说他或她会接受融合手术，一名承认在这种假设情况下愿意接受椎间盘置换手术。
