Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea.
Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
PLoS One. 2018 Jun 12;13(6):e0199042. doi: 10.1371/journal.pone.0199042. eCollection 2018.
Low back pain (LBP) is a globally prevalent disorder with high social significance. Invasive surgical procedures are increasingly being used to treat LBP despite a lack of solid evidence supporting their long-term benefits. This nationwide retrospective cohort study investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP.
Using the National Health Insurance Service Sample Cohort Database for 2002-2013, we identified newly diagnosed LBP patients in Korea between 2004 and 2010 and divided them into an acupuncture group and control group according to whether or not they received acupuncture. Propensity scores based on age, sex, income, and Charlson Comorbidity Index were matched between the two study groups. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. In addition to the overall analysis, stratified analyses were also conducted in different age, sex, and income strata. Sensitivity analyses were further performed using varying definitions of acupuncture treatment.
After matching, 130,089 subjects were included in each study group. The lumbar surgery rate was significantly lower in the acupuncture group than in the control group (hazard ratio [HR] 0.633, 95% confidence interval [CI] 0.576-0.696). Decrease in HR was consistently observed in the acupuncture group for all age strata, except for patients in their 20s (HR 1.031, 95% CI 0.804-1.323). HR for lumbar surgery tended to be further reduced in the older age groups upon acupuncture treatment, with no apparent sex-related differences. Lowered HR in the acupuncture group was continuously observed across all income groups; the higher income group showed a tendency of greater decrease. Sensitivity analyses showed that the number of acupuncture sessions had no major impact on the likelihood of lumbar surgery, but also that more intensive acupuncture treatment was associated with further reduction in lumbar surgery rates.
The present results found that administration of acupuncture treatment is associated with lower lumbar surgery rates for LBP patients in Korea. Prospective studies are warranted in the future to further investigate the effect of acupuncture treatment on lumbar surgery incidence.
腰痛（LBP）是一种全球普遍存在的疾病，具有很高的社会意义。尽管缺乏长期获益的坚实证据，但是越来越多的侵袭性手术被用于治疗 LBP。本项全国性回顾性队列研究旨在调查腰痛患者接受针刺治疗与腰椎手术率之间的关系。
我们使用 2002 年至 2013 年的国家健康保险服务样本队列数据库，确定了韩国 2004 年至 2010 年间新诊断为腰痛的患者，并根据是否接受过针刺治疗将其分为针刺组和对照组。根据年龄、性别、收入和 Charlson 合并症指数对两组研究对象进行倾向评分匹配。计算两组患者在首次就诊（对照组）或首次针刺治疗（针刺组）后两年内的腰椎手术率。除了总体分析外，还在不同年龄、性别和收入分层中进行了分层分析。进一步使用不同的针刺治疗定义进行了敏感性分析。
匹配后，每组各纳入 130089 名患者。与对照组相比，针刺组的腰椎手术率显著降低（风险比 [HR] 0.633，95%置信区间 [CI] 0.576-0.696）。除 20 多岁的患者外（HR 1.031，95% CI 0.804-1.323），针刺组在所有年龄分层中均观察到 HR 持续下降。在接受针刺治疗后，年龄较大的患者腰椎手术的 HR 进一步降低，但无明显的性别差异。在所有收入组中，针刺组的 HR 持续下降，收入较高的组显示出更大降低的趋势。敏感性分析表明，针刺治疗次数对腰椎手术的可能性没有重大影响，但更密集的针刺治疗与进一步降低腰椎手术率有关。
本研究结果发现，针刺治疗与韩国腰痛患者的腰椎手术率降低相关。未来需要前瞻性研究进一步探讨针刺治疗对腰椎手术发生率的影响。
