Veterans Affairs Boston Healthcare System, Boston, MA, USA.
Arch Phys Med Rehabil. 2012 Apr;93(4):690-5. doi: 10.1016/j.apmr.2011.11.028.
To determine recurrence rates of lower-extremity radicular pain after nonsurgical treatment of acute symptomatic lumbar disk herniation (LDH), and to identify predictors of recurrence.
Prospective inception cohort.
Outpatient spine clinic.
Patients (N=79) reporting resolution of radicular pain after magnetic resonance imaging confirmation of LDH.
Individualized nonsurgical treatment tailored to the patient. All patients received education, but other treatments varied depending on the individual.
Resolution of radicular pain was defined as a pain-free period of ≥1 month. Patients who reported resolution of radicular pain within 1 year after seeking care for acute LDH were asked whether pain had recurred at 1 year after seeking care and were also reassessed 1 year after the time of resolution of radicular pain and 2 years after seeking care. Patients reported on recurrence and the date of recurrence, if any. We evaluated the 1-year incidence of recurrence, using Kaplan-Meier survival plots. We examined predictors of recurrence using bivariate and multivariate Cox proportional hazards models. We examined the secondary outcome of back pain recurrence using identical methods.
Twenty-five percent (95% confidence interval [CI], 15-35) of individuals with resolution of radicular pain for at least 1 month reported subsequent recurrence of pain within 1 year after resolution. The only factor independently associated with radicular pain recurrence was the number of months prior to resolution of pain (hazard ratio per month=1.24; 95% CI, 1.13-1.37; P<.001). The 1-year incidence of back pain recurrence was 43% (95% CI, 30-56), and older age decreased the hazard of recurrence.
Recurrence of radicular pain is relatively common after nonsurgical treatment of LDH and is predicted by longer time to initial resolution of pain.
确定非手术治疗急性症状性腰椎间盘突出症（LDH）后下肢根性疼痛的复发率，并确定复发的预测因素。
前瞻性发病队列。
门诊脊柱诊所。
报告 MRI 证实 LDH 后根性疼痛缓解的患者（N=79）。
针对患者个体情况定制的个体化非手术治疗。所有患者均接受教育，但其他治疗方法因个体而异。
根性疼痛缓解定义为无疼痛期≥1 个月。报告在寻求急性 LDH 治疗后 1 年内根性疼痛缓解的患者，在寻求治疗后 1 年被问及疼痛是否再次出现，并在根性疼痛缓解后 1 年和寻求治疗后 2 年再次进行评估。患者报告疼痛复发情况和任何复发日期。我们使用 Kaplan-Meier 生存图评估 1 年复发率。我们使用双变量和多变量 Cox 比例风险模型评估复发的预测因素。我们使用相同的方法评估腰痛复发的次要结局。
25%（95%置信区间[CI]，15-35）在至少 1 个月内缓解根性疼痛的个体报告在缓解后 1 年内疼痛再次复发。与根性疼痛复发独立相关的唯一因素是疼痛缓解前的月数（每月风险比=1.24；95%CI，1.13-1.37；P<.001）。1 年背痛复发率为 43%（95%CI，30-56），年龄越大，复发风险越低。
非手术治疗 LDH 后根性疼痛复发较为常见，疼痛初始缓解时间较长是复发的预测因素。
