腰椎间盘突出症患者椎间盘切除术后缓解期和残留腰痛的特征：使用详细视觉模拟量表进行分析
Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale.
作者信息
Takahashi Hiroshi, Aoki Yasuchika, Inoue Masahiro, Saito Junya, Nakajima Arata, Sonobe Masato, Akatsu Yorikazu, Koyama Keita, Shiga Yasuhiro, Inage Kazuhide, Eguchi Yawara, Orita Sumihisa, Maki Satoshi, Furuya Takeo, Akazawa Tsutomu, Abe Tetsuya, Funayama Toru, Noguchi Hiroshi, Miura Kousei, Mataki Kentaro, Shibao Yosuke, Eto Fumihiko, Kono Mamoru, Koda Masao, Yamazaki Masashi, Ohtori Seiji, Nakagawa Koichi
机构信息
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaraki, 305-8575, Japan.
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.
出版信息
BMC Musculoskelet Disord. 2021 Feb 11;22(1):167. doi: 10.1186/s12891-021-04015-z.
BACKGROUND
Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally.
METHODS
We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition.
RESULTS
Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025).
CONCLUSIONS
Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.
背景
几位作者报告称，接受椎间盘切除术治疗的腰椎间盘突出症（LDH）患者的腰痛（LBP）取得了良好效果。然而，LDH椎间盘切除术前、后腰痛的特征和部位随时间的详细变化仍不清楚。为了阐明这些问题，我们进行了一项观察性研究，使用详细的双侧视觉模拟量表（VAS）来确定LDH椎间盘切除术前、后腰痛的详细特征和部位。
方法
本研究纳入了65例接受椎间盘切除术治疗的LDH患者。在3种不同情况下对患者进行详细的LBP视觉模拟量表评分：活动时、站立时和坐着时。还对LBP、下肢疼痛（LEP）和下肢麻木（LEN）进行双侧视觉模拟量表评分（患侧与对侧）。使用Oswestry功能障碍指数（ODI）来量化临床状态。研究这些视觉模拟量表评分和ODI随时间的变化。在椎间盘切除术前和术后1年，回顾磁共振成像（MRI）显示的Pfirrmann分级和Modic改变，以确定椎间盘和终板状况。
结果
术前，患者活动时患侧的腰痛明显高于坐着时的腰痛（p = 0.025）。椎间盘切除术后，活动时患侧增加的腰痛明显改善（p < 0.001）。相比之下，术后1年坐着时的残余腰痛明显高于活动或站立时的腰痛（p = 0.015）。椎间盘切除术后1年，Pfirrmann分级（p = 0.002）或Modic类型（p = 0.025）有变化的病例中，坐着时的残余腰痛明显更大。
结论
患者活动时患侧腰痛的改善表明，神经根减压的椎间盘切除术后神经根性腰痛得到改善。此外，残余腰痛可能反映了坐姿时椎间盘和终板上负荷和压力的增加。
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