Department of Neurosurgery, Neurospine Section, Chamran Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran.
Department of Neurosurgery, Neurospine Section, Chamran Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran ; Department of Trauma Research Center (TRC), Rajaee Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran.
Global Spine J. 2014 Dec;4(4):233-44. doi: 10.1055/s-0034-1390010. Epub 2014 Sep 26.
Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire-Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power.
回顾性队列研究。目的：确定三种不同腰椎间盘突出症手术方法的结果和临床结果差异，并评估可能预测手术结果的因素的影响。方法：我们使用日本矫形协会（JOA）腰痛评估问卷、日常生活活动量表和视觉模拟量表（VAS）评估了 2006 年 3 月至 2011 年 3 月间因三种不同手术方法（椎板切除术、显微镜辅助经皮髓核切除术和棘突截骨术）进行腰椎间盘突出症手术的 148 例患者，评估内容包括下腰痛和神经根痛的恢复情况。我们的研究问卷涵盖了患者对手术的主观满意度、残留症状和恢复工作情况。使用 SPSS 版本 16.0（SPSS，Inc.，芝加哥，伊利诺伊州，美国）进行数据分析。统计显著性设置为 0.05。进行了卡方检验、Mann-Whitney U 检验、Kruskal-Wallis 检验和重复测量分析等统计学分析。为了确定混杂因素，使用卡方检验进行单因素分析，然后进行逻辑回归分析。结果：我们的 94%的患者对手术结果满意。VAS 记录神经根痛减轻的总成功率为 93.3%。在 JOA 腰痛评估问卷方面，椎板切除术的结果更好。手术结果不因年龄、性别、教育程度、术前腰痛 VAS、术前神经根痛 VAS、恢复以前的工作或疝出程度而显著不同。结论：腰椎间盘突出症手术在减轻神经根痛方面是有效的（93.4%）。三种手术方法均显著降低术前神经根痛和腰痛，但组间疗效无差异。根据 JOA 腰痛评估问卷-腰痛（JOABPQ-LBP）和腰椎功能评分，椎板切除术的结果明显优于其他方法。值得注意的是，在我们的研究人群中，神经根痛的缓解与手术的主观满意度相关。腰椎间盘突出症手术治疗无效的预测因素是女性和术前直腿抬高试验阴性。年龄、教育程度和术前腰痛 VAS 也是具有预测能力的因素。
