Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Orthopaedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Orthop Surg. 2021 Dec;13(8):2196-2205. doi: 10.1111/os.13088. Epub 2021 Oct 13.
After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short-term full rest or conservative treatment. The aim of the study was to demonstrate this short-term recurrent phenomenon, termed rebound pain.
A retrospective study was conducted on 144 patients who underwent single-segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non-rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow-up. Logistic regression analysis was used to identify predictors for rebound pain.
The VAS and ODI exhibited significant improvements at the last follow-up of average 15.4 months (P < 0.001). The successful outcomes according to the modified MacNab criteria reached 94.4%. A total of 15 patients (10.4%) experienced rebound pain. The typical feature was pain that usually began within 1 month after surgery and lasted for less than 1 month. The symptoms were mainly leg pain with or without low back pain. The range of pain was equal to or less than that before surgery. The symptoms were relieved after conservative treatment. In logistic regression model, postoperative return-to-work time > 45 days was found as a protective factor for rebound pain (p = 0.031).
Although rebound pain with multiple characteristics and a short duration had no significant effect on long-term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed.
经皮内镜腰椎间盘切除术（PELD）后，大多数腰椎间盘突出症（LDH）患者的腰痛和腿痛典型症状得到缓解。然而，对于一小部分患者，这些症状在手术后立即缓解，但很快加重，然后在短期充分休息或保守治疗后缓解。本研究旨在展示这种短期复发现象，称为反弹痛。
回顾性分析 2017 年 5 月至 2020 年 6 月期间行单节段 PELD 的 144 例患者。将术后患者分为反弹痛组和非反弹痛组。对于前者，总结反弹痛的一般资料、症状特征和视觉模拟评分（VAS）变化。对于两组患者，在缓解期评估近期腰痛和腿痛的 VAS、Oswestry 功能障碍指数（ODI）和末次随访时改良 MacNab 标准。采用 Logistic 回归分析确定反弹痛的预测因素。
平均随访 15.4 个月时 VAS 和 ODI 均显著改善（P<0.001）。末次随访时改良 MacNab 标准的优良率达到 94.4%。共 15 例（10.4%）患者出现反弹痛。典型特征为术后 1 个月内开始疼痛，持续时间<1 个月。症状主要为下肢痛，可伴或不伴腰痛。疼痛范围与术前相当或小于术前。保守治疗后症状缓解。Logistic 回归模型发现，术后返岗时间>45 天是反弹痛的保护因素（p=0.031）。
尽管反弹痛具有多种特征和短暂的持续时间，但对长期术后疗效无显著影响，但较高的发生率常给患者和医生带来不必要的担忧。因此，需要仔细区分反弹痛与其他术后并发症。
