Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Department of Biomedical and Clinical Sciences "L. Sacco", Università degli studi di Milano, Milano, Italy.
Pain Pract. 2021 Jul;21(6):653-661. doi: 10.1111/papr.13006. Epub 2021 Mar 26.
The aim of this study was to retrospectively investigate factors predicting a successful outcome after ozone chemonucleolysis (OCN) in patients with radicular pain and poor response to conservative treatments.
Univariable and multivariable logistic regression analysis was used to identify the predictors of good outcome after OCN. Good outcome was defined as 33% Oswestry Disability Index (ODI) reduction (model 1) or 13-point ODI improvement (model 2) at 1 month after OCN.
Two hundred seventy-three patients were analyzed. A significant pain reduction (pre-operative Numerical Rating Scale [NRS] 6.7 ± 1.5, postoperative NRS 2.6 ± 2.2, P < 0.0001) and ODI improvement (pre-operative ODI 39 ± 13.7, postoperative ODI 21.4 ± 13.8, P < 0.0001) was obtained 1 month after OCN. Pain duration (< 1 year), type of disk herniation based on Michigan State University classification (MSU), stages of disk degeneration revealed by discogram and absence of foraminal stenosis (bony or ligament flavum hypertrophy) appeared as predictors of successful outcome. Age, gender, previous spine surgery, level site of disk herniation, presence of uncontained lumbar disk herniation, and vertebral Modic changes were not statistically associated with the outcome. Both the models showed a good accuracy (model 1, area under the curve [AUC] = 0.84 ± 0.027, 95% confidence interval [CI] = 0.79 to 0.89; model 2, AUC = 0.86 ± 0.024, 95% CI = 0.81 to 0.91).
OCN is an effective treatment for radicular pain due to disk herniation. Pain duration (< 1 year), MSU disk herniation type (1A, 1B, 1C, 2A, and 2B), disk degeneration grade 2, and absence of foraminal stenosis are all associated with the successful outcome and should be carefully evaluated before OCN.
本研究旨在回顾性分析臭氧髓核溶解术（OCN）治疗神经根痛患者的疗效预测因素，这些患者对保守治疗反应不佳。
采用单变量和多变量逻辑回归分析来确定 OCN 后良好结局的预测因素。良好结局定义为 OCN 后 1 个月 ODI 减少 33%（模型 1）或增加 13 分（模型 2）。
共分析了 273 例患者。臭氧髓核溶解术后 1 个月，疼痛明显减轻（术前数字评分法[NRS]为 6.7±1.5，术后 NRS 为 2.6±2.2，P<0.0001），ODI 改善（术前 ODI 为 39±13.7，术后 ODI 为 21.4±13.8，P<0.0001）。OCN 后 1 个月，疼痛持续时间（<1 年）、密歇根州立大学（MSU）分类的椎间盘突出类型、椎间盘造影显示的椎间盘退变阶段以及无椎间孔狭窄（骨或黄韧带肥厚）均为良好结局的预测因素。年龄、性别、既往脊柱手术、椎间盘突出水平、存在非包容型腰椎间盘突出症以及椎体 Modic 改变与结局无统计学关联。两个模型均具有较好的准确性（模型 1，曲线下面积[AUC]为 0.84±0.027，95%置信区间[CI]为 0.79 至 0.89；模型 2，AUC 为 0.86±0.024，95%CI 为 0.81 至 0.91）。
OCN 是治疗椎间盘突出症所致神经根痛的有效方法。疼痛持续时间（<1 年）、MSU 椎间盘突出类型（1A、1B、1C、2A 和 2B）、椎间盘退变 2 级和无椎间孔狭窄与良好结局相关，在进行 OCN 治疗前应仔细评估这些因素。
