Tabibkhooei Alireza, Ziaei Sayyed Ehsan, Azar Maziar, Abolmaali Meysam
Department of Neurosurgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, IRN.
Department of Neurosurgery, Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, IRN.
Cureus. 2021 Dec 28;13(12):e20772. doi: 10.7759/cureus.20772. eCollection 2021 Dec.
The most common indications for spinal surgery are low back pain and associated disabilities caused by disc herniation. Given the high prevalence of low back pain, the critical nature of pain assessment in these patients, and knowledge about the influencing and predisposing factors, we sought to evaluate the clinical and radiologic findings associated with pain relief and postoperative recovery in patients who underwent bilateral lumbar discectomy.
From March 2016 to October 2020, a prospective cohort study was conducted. This study included adult patients with symptomatic disc herniation in the L4-L5 and L5-S1 segments who were candidates for bilateral discectomy. Before and after surgery, patients were evaluated for lumbar and radicular pain and the Oswestry Disability Index (ODI) score and at the four, 12, and 24-week follow-up. Meanwhile, a variety of demographic, clinical, and radiologic factors was collected and statistically analyzed.
This study enrolled 30 patients. The average age of the patients was 41.2 years, with 22 males and eight females. Twelve of these patients had disc involvement in the L4-L5 region, while 18 had disc involvement in the L5-S1 region. Statistical analysis revealed that radicular pain and disability associated with low back pain significantly decreased following surgery (P=0.001). However, there was no significant reduction in back pain (P>0.05). Patients with a higher body mass index (BMI) and neurological claudication had a lower reduction in radicular pain (P<0.05). Moreover, a higher BMI and the presence of instability pain are associated with an increased likelihood of postoperative lumbar pain relief (P<0.01). Among the radiological variables, increased disc height was associated with a more rapid recovery from low back disability (P=0.003). Furthermore, a larger diameter of paraspinal muscles at the level of the herniated disc was associated with a more rapid improvement of lower back pain (P=0.021).
The use of discectomy in patients with lumbar disc herniation significantly alleviates postoperative and follow-up radicular pain. Age, BMI, neurological claudication, instability pain, and paraspinal muscle diameter played a role in postoperative pain relief. Increased disc height was associated with a more rapid decline in the ODI score. Future studies with larger sample sizes are recommended.
脊柱手术最常见的适应证是椎间盘突出症引起的腰痛及相关功能障碍。鉴于腰痛的高发病率、这些患者疼痛评估的关键性质以及对影响因素和易感因素的了解，我们试图评估接受双侧腰椎间盘切除术患者疼痛缓解及术后恢复相关的临床和影像学表现。
2016年3月至2020年10月进行了一项前瞻性队列研究。本研究纳入L4-L5和L5-S1节段有症状性椎间盘突出症且适合双侧椎间盘切除术的成年患者。手术前后，对患者进行腰椎和神经根性疼痛以及奥斯维斯特里功能障碍指数（ODI）评分评估，并在术后4周、12周和24周进行随访。同时，收集各种人口统计学、临床和影像学因素并进行统计分析。
本研究共纳入30例患者。患者平均年龄41.2岁，男性22例，女性8例。其中12例患者L4-L5节段椎间盘受累，18例患者L5-S1节段椎间盘受累。统计分析显示，术后与腰痛相关的神经根性疼痛和功能障碍显著减轻（P=0.001）。然而，腰痛无显著减轻（P>0.05）。体重指数（BMI）较高和有神经源性间歇性跛行的患者神经根性疼痛减轻程度较低（P<0.05）。此外，较高的BMI和存在不稳定型疼痛与术后腰痛缓解的可能性增加相关（P<0.01）。在影像学变量中，椎间盘高度增加与从腰椎功能障碍中恢复更快相关（P=0.003）。此外，椎间盘突出水平的椎旁肌直径较大与腰痛改善更快相关（P=0.021）。
腰椎间盘突出症患者采用椎间盘切除术可显著减轻术后及随访期的神经根性疼痛。年龄、BMI、神经源性间歇性跛行、不稳定型疼痛和椎旁肌直径对术后疼痛缓解有影响。椎间盘高度增加与ODI评分更快下降相关。建议开展更大样本量的未来研究。
