症状持续时间是否会影响接受显微椎间盘切除术和减压术的坐骨神经痛患者的预后？

Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions?

作者信息

Pitsika Marina, Thomas Eleanor, Shaheen Sabeena, Sharma Himanshu

机构信息

Plymouth Spine Services, South West Neurosurgical Department, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom.

出版信息

Spine J. 2016 Apr;16(4 Suppl):S21-5. doi: 10.1016/j.spinee.2015.12.097. Epub 2016 Mar 3.

DOI:10.1016/j.spinee.2015.12.097

PMID:26940192

Abstract

BACKGROUND

Early surgical treatment for back and leg pain secondary to disc herniation has been associated with very good outcomes. However, there are conflicting data on the role of surgical treatment in case of prolonged radicular symptomatology.

PURPOSE

We aimed to evaluate whether the duration of symptoms at presentation affects the subjective outcome.

STUDY DESIGN/SETTING: This is a retrospective review of prospectively collected data from a single surgeon including micro-discectomies and lateral recess decompressions in patients younger than 60 years old using patient medical notes, radiology imaging, operation notes, and Patient Reported Outcome Measures (PROMS) including Oswestry Disability Index (ODI), visual analogue scale for back pain and leg pain (VAS-BP and VAS-LP). The final follow-up was carried out through postal questionnaire or telephone consultation.

METHODS

Demographic information, duration of symptoms, type and incidence of complications, length of hospital stay, and follow-up were analyzed. Data were categorized into four subgroups: symptoms 0≥6 months, 6 months≥1 year, 1 year≥2 years, and >2 years. A clinically significant result was an average improvement of 2 or more points in the VAS and of 20% and over in the ODI. The level of statistical significance was <0.05%.

RESULTS

A total number of 107 patients who underwent 109 operations were included. The level of surgery was L5/S1 (50), L4/L5 (43), L3/L4 (3), L2/L3 (2), and two levels (11). The mean improvement was from 0 to ≤6 months (VAS-LP 5.21±2.81, VAS-BP 3.04±3.15, ODI 35.26±19.25), 6 months to ≤1 year (VAS-LP 4.73±2.61, VAS-BP 3.30±3.05, ODI 26.92±19.49), 1 year to ≤2 years (VAS-LP 3.78±3.68, VAS-BP 3.00±2.78, ODI 19.03±20.24), and >2 years (VAS-LP 4.77±3.61, VAS-BP 3.54±3.43, ODI 28.36±20.93). The length of hospital stay and complication rate was comparable between groups. Average follow-up was 15.69 months.

CONCLUSIONS

Our study showed significant improvement in patients with symptoms beyond 1 as well as 2 years since onset, and surgery is a viable option in selected patients.

摘要

背景

椎间盘突出继发腰腿痛的早期手术治疗已取得了非常好的效果。然而，对于长期神经根症状的手术治疗作用，数据存在矛盾。

目的

我们旨在评估就诊时症状持续时间是否会影响主观疗效。

研究设计/研究地点：这是一项对前瞻性收集数据的回顾性研究，数据来自一位外科医生，包括对60岁以下患者进行的显微椎间盘切除术和侧隐窝减压术，使用患者病历、放射影像、手术记录以及患者报告结局量表（PROMS），包括奥斯威斯残疾指数（ODI）、背痛和腿痛视觉模拟量表（VAS-BP和VAS-LP）。最终随访通过邮寄问卷或电话咨询进行。

方法

分析人口统计学信息、症状持续时间、并发症类型和发生率、住院时间以及随访情况。数据分为四个亚组：症状持续时间0≥6个月、6个月≥1年、1年≥2年和>2年。临床显著结果为VAS平均改善2分或更多，ODI改善20%及以上。统计学显著性水平为<0.05%。

结果

共纳入107例患者，进行了109次手术。手术节段为L5/S1（50例）、L4/L5（43例）、L3/L4（3例）、L2/L3（2例）以及两个节段（11例）。平均改善情况为：症状持续时间0至≤6个月（VAS-LP 5.21±2.81，VAS-BP 3.04±3.15，ODI 35.26±19.25）、6个月至≤1年（VAS-LP 4.73±2.61，VAS-BP 3.30±3.05，ODI 26.92±19.49）、1年至≤2年（VAS-LP 3.78±3.68，VAS-BP 3.00±2.78，ODI 19.03±20.24）以及>2年（VAS-LP 4.77±3.61，VAS-BP 3.54±3.43，ODI 28.36±20.93）。各亚组间住院时间和并发症发生率相当。平均随访时间为15.69个月。