Shin Joon-Shik, Lee Jinho, Lee Yoon Jae, Kim Me-Riong, Ahn Yong-Jun, Park Ki Byung, Shin Byung-Cheul, Lee Myeong Soo, Ha In-Hyuk
Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea.
Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.
Spine (Phila Pa 1976). 2016 Aug 15;41(16):E955-E963. doi: 10.1097/BRS.0000000000001494.
STUDY DESIGN: Prospective observational 5-year study. OBJECTIVE: To assess pain, functional disability, surgical status, and health care use of patients who actively selected complementary and alternative medicine treatment and risk factors for lumbar surgery. SUMMARY OF BACKGROUND DATA: Controversy continues regarding difference in long-term outcomes of conservative and surgical treatment. METHODS: We recruited 150 consecutive lumbar disc herniation patients with radiating pain (numeric rating scale ≥5) from November, 2006 at a Korean medicine hospital outpatient department, of which 128 patients completed 6 months of complementary and alternative medicine treatment (herbal medicine, acupuncture, bee-venom pharmacopuncture, and Chuna manipulation). Follow-up data was collected every year for 5 years. RESULTS: We assessed surgical status in 105 patients (82%), of which 8 replied that they had received surgery. Ninety-two patients (72%) attended the 5-year follow-up. Visual analog scale of back pain which was 4.19 ± 2.60 at baseline improved after treatment, decreasing to 0.94 ± 1.13 at 6 months, and was maintained at 1.25 ± 1.81 at 5 years. Visual analog scale of leg pain decreased from 7.50 ± 1.32 to 0.94 ± 1.29 and was sustained at 0.98 ± 1.73. Participants reported less disability with Oswestry Disability Index scores decreasing from 41.50 ± 15.07 at baseline to 11.24 ± 10.44 at 6 months, which then declined further to 7.61 ± 9.82 at 5 years. SF-36 quality-of-life health survey scores also improved, increasing from 33.41 ± 12.67 at baseline to 66.04 ± 15.77 at 6 months, and reaching 75.43 ± 15.79 at 5 years. In assessment of satisfaction with current state, 20% replied "highly satisfied," 67% "satisfied," 10% "fairly satisfied," and 2% "dissatisfied." Patients with younger age, previous treatment for current pain episode, and higher levels of sensory impairment and pain in the lower extremities were at higher risk of lumbar surgery. CONCLUSION: The long-term results of lumbar disc herniation patients receiving nonsurgical complementary and alternative medicine treatment were favorable and satisfaction rates were high. LEVEL OF EVIDENCE: 2.
研究设计：前瞻性观察性5年研究。 目的：评估积极选择补充和替代医学治疗的患者的疼痛、功能障碍、手术状况及医疗保健利用情况，以及腰椎手术的风险因素。 背景数据总结：关于保守治疗和手术治疗的长期疗效差异仍存在争议。 方法：2006年11月，我们在一家韩医医院门诊部连续招募了150例伴有放射性疼痛（数字评分量表≥5）的腰椎间盘突出症患者，其中128例患者完成了6个月的补充和替代医学治疗（草药、针灸、蜂毒药针和脊柱推拿）。连续5年每年收集随访数据。 结果：我们对105例患者（82%）进行了手术状况评估，其中8例表示接受了手术。92例患者（72%）参加了5年随访。治疗后，背痛的视觉模拟量表评分从基线时的4.19±2.60改善至6个月时的0.94±1.13，并在5年时维持在1.25±1.81。腿痛的视觉模拟量表评分从7.50±1.32降至0.94±1.29，并维持在0.98±1.73。参与者报告的功能障碍减少，Oswestry功能障碍指数评分从基线时的41.50±15.07降至6个月时的11.24±10.44，然后在5年时进一步降至7.61±9.82。SF-36生活质量健康调查评分也有所改善，从基线时的33.41±12.67增至6个月时的66.04±15.77，并在5年时达到75.43±15.79。在对当前状态的满意度评估中，20%回答“非常满意”，67%回答“满意”，10%回答“比较满意”，2%回答“不满意”。年龄较小、当前疼痛发作曾接受过治疗、感觉障碍程度较高以及下肢疼痛程度较高的患者接受腰椎手术的风险较高。 结论：接受非手术补充和替代医学治疗的腰椎间盘突出症患者的长期结果良好，满意度较高。 证据级别：2级。
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