College of Science, Health & Engineering, La Trobe University, Bundoora, Australia.
Advance Healthcare, Boronia, Australia.
Br J Neurosurg. 2020 Aug;34(4):381-387. doi: 10.1080/02688697.2020.1742288. Epub 2020 Mar 27.
The purpose of this study was to identify a multivariate predictive model for 6-month outcomes on overall pain, leg pain and activity limitation in patients undergoing lumbar discectomy. Identification of predictors of outcome for lumbar discectomy has the potential to assist identifying treatment targets, clinical decision making and disease understanding. Prospective cohort design. Ninety-seven patients deemed by study surgeons to be suitable for lumbar discectomy completed a comprehensive clinical and radiological baseline assessment. At 6-months post surgery outcome measures of overall and leg pain (visual analogue scale) as well as activity limitation (Oswestry Disability Index) were completed. Univariate and multivariate analyses were conducted to determine the best multivariate predictive model of outcome. In the multivariate model, presence of a compensation claim, longer duration of injury and presence of below knee pain and/or parasthesia were negative prognostic indicators for at least two of the outcomes. Peripheralization in response to mechanical loading strategies was a positive prognostic indicator for overall pain and leg pain. A range of other prognostic indicators for one outcome were also identified. The prognostic model explained up to 32% of the variance in outcome. An 11-factor prognostic model was identified from a range of clinically and radiologically assessed variables in accordance with a biopsychosocial model. The multivariate model has potential implications for researchers and practitioners in the field. Further high quality research is required to externally validate the prognostic model, evaluate effect of the identified prognostic factors on treatment effectiveness and explore potential mechanisms of effect.
本研究旨在确定接受腰椎间盘切除术的患者在总体疼痛、腿部疼痛和活动受限方面的 6 个月结局的多变量预测模型。腰椎间盘切除术结局预测因素的确定有可能有助于确定治疗目标、临床决策和疾病认识。前瞻性队列设计。研究外科医生认为适合进行腰椎间盘切除术的 97 名患者完成了全面的临床和放射学基线评估。在手术后 6 个月，完成了总体和腿部疼痛（视觉模拟量表）以及活动受限（Oswestry 残疾指数）的结局测量。进行了单变量和多变量分析，以确定最佳的多变量结局预测模型。在多变量模型中，存在赔偿要求、受伤时间较长以及存在膝下疼痛和/或感觉异常是至少两种结局的负预后指标。对机械加载策略的外周化是总体疼痛和腿部疼痛的阳性预后指标。还确定了其他一些对一个结局有预后意义的指标。该预后模型解释了结局变化的高达 32%。根据生物心理社会模型，从一系列临床和放射学评估的变量中确定了 11 个因素的预后模型。该多变量模型对该领域的研究人员和从业者具有潜在意义。需要进一步进行高质量的研究来对预后模型进行外部验证，评估所确定的预后因素对治疗效果的影响，并探讨潜在的影响机制。
