The Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
J Bone Joint Surg Am. 2011 Oct 19;93(20):1906-14. doi: 10.2106/JBJS.J.00878.
The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.
An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up intervals up to four years. The treatment effect for each outcome measure was determined at each follow-up period for the duration of symptoms for both groups.
At all follow-up intervals, the primary outcome measures were significantly worse in patients who had had symptoms for more than six months prior to treatment, regardless of whether the treatment was operative or nonoperative. When the values at the time of the four-year follow-up were compared with the baseline values, patients in the operative treatment group who had had symptoms for six months or less had a greater increase in the bodily pain domain of the Short Form-36 (SF-36) (mean change, 48.3 compared with 41.9; p < 0.001), a greater increase in the physical function domain of the SF-36 (mean change, 47.7 compared with 41.2; p < 0.001), and a greater decrease in the Oswestry Disability Index score (mean change, -41.1 compared with -34.6; p < 0.001) as compared with those who had had symptoms for more than six months (with higher scores indicating less severe symptoms on the SF-36 and indicating more severe symptoms on the Oswestry Disability Index). When the values at the time of the four-year follow-up were compared with the baseline values, patients in the nonoperative treatment group who had had symptoms for six months or less had a greater increase in the bodily pain domain of the SF-36 (mean change, 31.8 compared with 21.4; p < 0.001), a greater increase in the physical function domain of the SF-36 (mean change, 29.5 compared with 22.6; p = 0.015), and a greater decrease in the Oswestry Disability Index score (mean change, -24.9 compared with -18.5; p = 0.006) as compared with those who had had symptoms for more than six months. Differences in treatment effect between the two groups related to the duration of symptoms were not significant.
Increased symptom duration due to lumbar disc herniation is related to worse outcomes following both operative and nonoperative treatment. The relative increased benefit of surgery compared with nonoperative treatment was not dependent on the duration of the symptoms.
本研究旨在确定症状持续时间是否会影响腰椎间盘突出症治疗后的结果。
对接受脊柱患者结局研究试验（SPORT）治疗腰椎间盘突出症的患者进行了按治疗分析。合并了随机和观察队列。比较了症状持续时间为 6 个月或更短（n=927）和症状持续时间超过 6 个月（n=265）的患者。主要和次要结局在基线和 4 年的定期随访间隔进行测量。确定了两组每个随访期症状持续时间的每个结局测量的治疗效果。
在所有随访间隔，与手术或非手术治疗相比，症状持续时间超过 6 个月的患者的主要结局测量指标明显更差。当将四年随访时的数值与基线值进行比较时，症状持续时间为 6 个月或更短的手术治疗组患者在简明健康状况量表-36 （SF-36）的身体疼痛域（平均变化，48.3 比 41.9；p<0.001）、SF-36 的身体功能域（平均变化，47.7 比 41.2；p<0.001）有更大的增加，Oswestry 残疾指数评分（平均变化，-41.1 比-34.6；p<0.001）有更大的降低，与症状持续时间超过 6 个月的患者相比（SF-36 评分越高表示症状越轻，Oswestry 残疾指数评分越高表示症状越重）。当将四年随访时的数值与基线值进行比较时，症状持续时间为 6 个月或更短的非手术治疗组患者在 SF-36 的身体疼痛域（平均变化，31.8 比 21.4；p<0.001）、SF-36 的身体功能域（平均变化，29.5 比 22.6；p=0.015）有更大的增加，Oswestry 残疾指数评分（平均变化，-24.9 比-18.5；p=0.006）有更大的降低，与症状持续时间超过 6 个月的患者相比。与症状持续时间相关的两组间治疗效果差异无统计学意义。
由于腰椎间盘突出症导致的症状持续时间增加与手术和非手术治疗后的结果较差有关。与非手术治疗相比，手术的相对获益增加并不取决于症状的持续时间。
