选择性神经根阻滞缓解疼痛对退行性腰椎管狭窄症减压术后患者术后功能结局的预测作用。

Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery.

机构信息

Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu Catholic University, Daegu, South Korea.

Department of Orthopaedic Surgery, School of Medicine, Kyung- pook National University Hospital, Kyungpook National University, Daegu, South Korea.

出版信息

Spine (Phila Pa 1976). 2022 May 1;47(9):666-671. doi: 10.1097/BRS.0000000000004216. Epub 2021 Aug 30.

DOI:10.1097/BRS.0000000000004216

PMID:34468438

Abstract

STUDY DESIGN

Retrospective study of data collected prospectively.

OBJECTIVE

To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life.

SUMMARY OF BACKGROUND DATA

SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter.

METHODS

We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery.

RESULTS

The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified.

CONCLUSION

The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.Level of Evidence: 4.

摘要

研究设计

前瞻性收集数据的回顾性研究。

目的

研究选择性神经根阻滞（SNRB）后小腿放射痛（LLRP）程度的变化，并评估这种变化与术后症状严重程度、功能结果和生活质量改善的相关性。

背景资料概要

SNRB 是治疗伴有 LLRP 的腰椎椎间孔或侧隐窝狭窄的常规初始治疗方法。SNRB 后的改善程度被认为可以预测术后疼痛和功能结果的改善。然而，目前还没有关于该参数预测价值的研究。

方法

我们纳入了 60 名接受 SNRB 后减压手术的患者。他们被分为三组。通过与注射前值的百分比来评估改善程度。通过 Oswestry 功能障碍指数（ODI）和 Roland-Morris 残疾问卷（RMDQ）评估脊柱的功能结果。使用 36 项简明健康调查问卷（SF-36）生理成分评分（PCS）和心理成分评分（MCS）评估生活质量。术前和术后 6、12 和 24 个月测量 LLRP 程度。这些功能结果在术前和术后 12 和 24 个月进行评估。