Ebenbichler Gerold R, Leitgeb Jürgen, Amtmann Gabriele, König Franz, Schernthaner Melanie, Resch Karl-Ludwig, Kainberger Franz
From the Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria (GRE); Vienna Medical University, Vienna, Austria (JL, GA); Section for Medical Statistics, Institute for Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria (F König); Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria (MS, F Kainberger); and German Institute of Health Research, Bad Elster and Dresden, Germany (KLR).
Am J Phys Med Rehabil. 2016 Dec;95(12):871-879. doi: 10.1097/PHM.0000000000000522.
To investigate the excess risk of degeneration and segmental instability in operated segments late after lumbar disc surgery in patients with presurgically stable segments, and whether local pathological findings relate to patients' back health.
This retrospective analysis reports on 69 patients 12 years after first-time, uncomplicated lumbar disc surgery. Two independent radiologists evaluated the patients' lumbar functional x-rays; the Back Pain Rating Score (LBP-RS) assessed back-specific function.
At 12 years after lumbar disc surgery, degenerative changes as well as segmental instability occurred significantly more frequently in the operated than nonoperated lumbar segments, but there was no association between increased degeneration and segmental instability rates. The risk for acquiring segmental instability was significantly associated with surgery (odds ratio, 6.5; 95% confidence interval, 1.5-28.8). Prevalence of segmental instabilities was associated with better LBP-RS scores. Analyses of LBP-RS subscores revealed a clear association of segmental instability with physical function, but not with pain or activities of daily living.
Lumbar disc surgery seems to be associated with an increased risk of degeneration and segmental instability in the long term. This structural impairment, however, seems functionally well compensated and does not seem to be a relevant causal factor for a chronic back pain syndrome.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the impact of lumbar disc surgery on segmental instability and degenerative changes; (2) Recognize the lack of association between degenerative changes and segmental instability after lumbar disc surgery; and (3) State the value of lumbar spinal functional tests in the evaluation of patients after lumbar disc surgery.
Advanced ACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
探讨术前节段稳定的患者腰椎间盘手术后晚期手术节段退变及节段性不稳定的额外风险，以及局部病理结果是否与患者的背部健康相关。
这项回顾性分析报告了69例首次接受单纯腰椎间盘手术12年后的患者情况。两名独立的放射科医生评估患者的腰椎功能X线片；背痛评分量表（LBP-RS）评估背部特定功能。
腰椎间盘手术后12年，手术节段的退变及节段性不稳定的发生频率显著高于未手术节段，但退变增加与节段性不稳定发生率之间无关联。获得节段性不稳定的风险与手术显著相关（优势比，6.5；95%置信区间，1.5 - 28.8）。节段性不稳定的患病率与更好的LBP-RS评分相关。对LBP-RS子评分的分析显示，节段性不稳定与身体功能有明确关联，但与疼痛或日常生活活动无关。
腰椎间盘手术似乎与长期退变及节段性不稳定风险增加相关。然而，这种结构损害在功能上似乎得到了很好的代偿，似乎不是慢性背痛综合征的相关因果因素。
高级。认证：学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会将该活动指定为最多1.5个美国医学协会（AMA）医师认可的第1类学分™。医生应仅根据其参与活动的程度申请相应学分。
