Suri Pradeep, Pearson Adam M, Scherer Emily A, Zhao Wenyan, Lurie Jon D, Morgan Tamara S, Weinstein James N
Seattle Epidemiologic Research and Information Center (ERIC) and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle WA; and Department of Rehabilitation Medicine, University of Washington, Seattle, WA(∗).
Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH(†).
PM R. 2016 May;8(5):405-14. doi: 10.1016/j.pmrj.2015.10.016. Epub 2015 Nov 6.
To determine risks and predictors of recurrent leg and low back pain (LBP) after unstructured, usual nonoperative care for subacute/chronic symptomatic lumbar disk herniation (LDH).
Secondary analysis of data from a concurrent randomized trial and observational cohort study.
Thirteen outpatient spine practices.
A total of 199 participants with resolution of leg pain and 142 participants with resolution of LBP from among 478 participants receiving usual nonoperative care for symptomatic LDH.
Potential predictors of recurrence included time to initial symptom resolution, sociodemographics, clinical characteristics, work-related factors, imaging-detected herniation characteristics, and baseline pain bothersomeness.
Leg pain and LBP bothersomeness were assessed by the use of a 0-6 numerical scale at up to 4 years of follow-up. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of recurrence by using Kaplan-Meier survival plots and examined predictors of recurrence using Cox proportional hazards models. We used similar definitions for LBP recurrence.
One- and 3-year cumulative recurrence risks were 23% and 51% for leg pain, and 28% and 70% for LBP, respectively. Early leg pain resolution did not predict future leg pain recurrence. Complete leg pain resolution (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.31-0.72) and posterolateral herniation location (aHR 0.61; 95% CI 0.39-0.97) predicted a lower risk of leg pain recurrence, and joint problems (aHR 1.89; 95% CI 1.16-3.05) and smoking (aHR 1.81; 95% CI 1.07-3.05) predicted a greater risk of leg pain recurrence. For participants with complete initial resolution of pain, recurrence risks at 1 and 3 years were 16% and 41% for leg pain and 24% and 59% for LBP, respectively.
Recurrence of pain is common after unstructured, usual nonsurgical care for LDH. These risk estimates depend on the specific definitions applied, and the predictors identified require replication in future studies.
确定亚急性/慢性症状性腰椎间盘突出症（LDH）在接受非结构化常规非手术治疗后腿部和下背部疼痛（LBP）复发的风险及预测因素。
对一项同期随机试验和观察性队列研究的数据进行二次分析。
13个门诊脊柱诊疗机构。
在478例接受症状性LDH常规非手术治疗的参与者中，共有199例腿部疼痛缓解的参与者和142例LBP缓解的参与者。
复发的潜在预测因素包括初始症状缓解时间、社会人口统计学特征、临床特征、工作相关因素、影像学检测到的突出特征以及基线疼痛困扰程度。
在长达4年的随访中，使用0 - 6数字量表评估腿部疼痛和LBP困扰程度。对于初始腿部疼痛缓解的个体，我们将复发性腿部疼痛定义为在初始腿部疼痛缓解后出现腿部疼痛、接受腰椎硬膜外类固醇注射或接受腰椎手术。我们使用Kaplan - Meier生存曲线计算复发的累积风险，并使用Cox比例风险模型检查复发的预测因素。我们对LBP复发使用类似的定义。
腿部疼痛的1年和3年累积复发风险分别为23%和51%，LBP的分别为28%和70%。早期腿部疼痛缓解并不能预测未来腿部疼痛复发。腿部疼痛完全缓解（调整后风险比[aHR] 0.47，95%置信区间[CI] 0.31 - 0.72）和后外侧突出位置（aHR 0.61；95% CI 0.39 - 0.97）预测腿部疼痛复发风险较低，而关节问题（aHR 1.89；95% CI 1.16 - 3.05）和吸烟（aHR 1.81；95% CI 1.07 - 3.05）预测腿部疼痛复发风险较高。对于初始疼痛完全缓解的参与者，腿部疼痛的1年和3年复发风险分别为16%和41%，LBP的分别为24%和59%。
LDH接受非结构化常规非手术治疗后疼痛复发很常见。这些风险估计取决于所应用的具体定义，且所确定的预测因素需要在未来研究中进行重复验证。
