Department of Anesthesiology and Pain Medicine, Inha University Hospital, Inha University School of Medicine, Jung-gu, Incheon, Korea.
Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea.
Pain Physician. 2022 Oct;25(7):E1095-E1103.
Nucleoplasty and neuroplasty are often performed in patients with refractory lower back pain when conservative treatment is ineffective. Lumbar spinal stenosis (LSS) is caused by multiple factors; in some cases, a single procedure of nucleoplasty or neuroplasty alone does not provide sufficient treatment effect.
This study aimed to investigate and compare the pain relief and pain-free interval among patients with LSS who underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty.
Retrospective study.
In-ha University hospital pain clinic.
This is a retrospective study of the medical records and survey of 98 patients with LSS who visited a pain clinic between 2019 and 2020 and underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty. Patients with disc height < 50% of the adjacent disc on magnetic resonance imaging and those with moderate and severe extraforaminal stenosis were excluded. Thus, 60 patients who underwent nucleoplasty (n = 20), neuroplasty (n = 20), and combined balloon neuroplasty and nucleoplasty (n = 20) for LSS were analyzed. The patients were instructed to rate their pain intensity via an 11-point numeric rating score (NRS) before and after the procedure. The Korean version of the Oswestry Disability Index (ODI) questionnaire was checked before and after the procedure.
The pain intensity decreased to NRS 3 ± 0.14 and 1.85 ± 0.19 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, indicating a significant difference (P = 0.003). ODI was significantly decreased after the procedure compared with that before the procedure in all groups. After the procedure, ODI decreased to 13.89 ± 0.20 and 11.21 ± 0.33 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, with a significant difference between the 2 groups (P < 0.05). The patients in the nucleoplasty group achieved pain relief for 4.93 ± 1.22 months after the procedure, whereas those in the balloon neuroplasty group achieved pain relief for 5 ± 1.37 months. In the combined balloon neuroplasty and nucleoplasty group, pain relief was maintained for 10.2 ± 1.11 months (P = 0.003).
The pain was assessed with NRS without considering the patients' pain medication. There may be differences in the outcome of the procedure depending on the surgeon.
The pain reduction effect was greater and was retained for a longer period with combined balloon neuroplasty and nucleoplasty than with nucleoplasty or neuroplasty alone.
当保守治疗无效时，常对患有难治性下腰痛的患者进行髓核成形术和神经成形术。腰椎管狭窄症（LSS）由多种因素引起；在某些情况下，单独进行一次髓核成形术或神经成形术并不足以达到充分的治疗效果。
本研究旨在调查和比较接受髓核成形术、神经成形术和球囊神经成形术联合髓核成形术治疗的 LSS 患者的疼痛缓解和无痛间隔。
回顾性研究。
在仁荷大学医院疼痛诊所。
这是一项回顾性研究，分析了 2019 年至 2020 年间在疼痛诊所就诊并接受髓核成形术、神经成形术和球囊神经成形术联合髓核成形术治疗的 98 例 LSS 患者的病历和调查。排除了 MRI 显示椎间盘高度<相邻椎间盘的 50%和中度至重度椎间孔外狭窄的患者。因此，分析了 60 例接受髓核成形术（n = 20）、神经成形术（n = 20）和球囊神经成形术联合髓核成形术（n = 20）治疗的 LSS 患者。在术前和术后，患者通过 11 点数字评分量表（NRS）来评估疼痛强度。在术前和术后检查了韩文版 Oswestry 残疾指数（ODI）问卷。
髓核成形术和球囊神经成形术联合髓核成形术组的疼痛强度分别降至 NRS3±0.14 和 1.85±0.19，差异具有统计学意义（P = 0.003）。所有组在术后的 ODI 均较术前显著降低。术后，髓核成形术组和球囊神经成形术联合髓核成形术组的 ODI 分别降至 13.89±0.20 和 11.21±0.33，两组间差异有统计学意义（P < 0.05）。髓核成形术组术后疼痛缓解持续 4.93±1.22 个月，球囊神经成形术组术后疼痛缓解持续 5±1.37 个月。球囊神经成形术联合髓核成形术组疼痛缓解持续 10.2±1.11 个月（P = 0.003）。
疼痛评估采用 NRS，未考虑患者的止痛药物。手术效果可能因手术医生的不同而有所差异。
与单独进行髓核成形术或神经成形术相比，球囊神经成形术联合髓核成形术的止痛效果更大，且止痛效果持续时间更长。
