Demir-Deviren Sibel, Ozcan-Eksi Emel E, Sencan Savas, Cil Hemra, Berven Sigurd
Department of Orthopaedic Surgery-Spine Center, University of California, San Francisco, CA, USA.
Department of Physical Medicine and Rehabilitation, Pain Management, Medical School, Marmara University, Istanbul, Turkey.
J Back Musculoskelet Rehabil. 2019;32(5):701-706. doi: 10.3233/BMR-181185.
Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care.
To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery.
All patients who underwent CNT for spondylolisthesis (n: 203) were included. CNT consisted of patient education, pain control with transforaminal epidural steroid injections (TFEs) and/or medications, and exercise programs.
Surgical and non-surgical patients were similar in age, smoking status, comorbidity scores, facet joint widening, and translation of spondylolisthesis. After CNT, only 21.6% of patients with DS and 31.3% of patients with SS chose to have surgery in 3-years follow-up. The non-surgical group reported significantly better pain relief (73.6% vs 55%) after TFEs for a longer period (152.8 vs 45.6 days) and lower opioid use than the surgical group (28.2% vs 55.3%).
CNT is effective in spondylolisthesis and more successful in DS than SS. CNT may decrease the need for surgery, particularly in patients who report pain relief greater than 70% for average five months after TFEs.
非手术治疗是腰椎退行性疾病的主要治疗方法，可能涉及多种方式。几乎没有文献指导基于证据的护理方法。
确定综合非手术治疗（CNT）对退行性腰椎滑脱（DS）和峡部裂性腰椎滑脱（SS）患者的有效性，并确定CNT避免手术成功的预测变量。
纳入所有接受CNT治疗腰椎滑脱的患者（n = 203）。CNT包括患者教育、经椎间孔硬膜外类固醇注射（TFE）和/或药物控制疼痛以及运动计划。
手术患者和非手术患者在年龄、吸烟状况、合并症评分、小关节增宽和腰椎滑脱移位方面相似。在CNT治疗后，在3年随访中，只有21.6%的DS患者和31.3%的SS患者选择进行手术。非手术组在接受TFE后报告的疼痛缓解明显更好（73.6%对55%），持续时间更长（152.8天对45.6天），且阿片类药物使用低于手术组（28.2%对55.3%）。
CNT对腰椎滑脱有效，对DS的效果比对SS更成功。CNT可能会减少手术需求，特别是对于那些在接受TFE后平均五个月疼痛缓解大于70%的患者。
