Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
World Neurosurg. 2023 Feb;170:e577-e583. doi: 10.1016/j.wneu.2022.11.070. Epub 2022 Nov 18.
Conservative treatments are important in lumbar disc herniation (LDH), but predictors for poor outcomes are unclear.
Consecutive patients with unilateral single-level LDH at L3-4 or L4-5 were enrolled. Baseline clinical data were collected, and lumbar spine magnetic resonance imaging was evaluated. Foraminal stenosis was evaluated using Lee's approach and further categorized as absence (grade 0 and 1) or presence (grade 2 or 3). Each patient underwent conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) for 6 weeks. Conservative treatments were defined as failed if a patient underwent surgery within 6 weeks or reported poor recovery at 6-week follow-up. Multivariate logistic regressions were used to examine the associations of failed conservative treatments with baseline characteristics and magnetic resonance imaging findings.
The study included 222 patients (mean age 45.5 ± 9.8 years). Of patients, 48 (21.6%) had concurrent ipsilateral foraminal stenosis at the caudal segment, and conservative treatments failed in 39 (17.6%). At baseline, patients with LDH and caudal foraminal stenosis were older (50.79 ± 6.14 years vs. 44.10 ± 10.13 years, P < 0.001), had greater leg pain (7.06 ± 1.17 vs. 6.39 ± 1.40, P = 0.003), and had a higher rate of positive straight leg raising test (54.2% vs. 33.3%, P = 0.008) than patients without caudal foraminal stenosis. In multivariate regression, failure of conservative treatments was associated with positive straight leg raising test (odds ratio 2.26, P = 0.046), and caudal foraminal stenosis (odds ratio 3.20, P = 0.007).
In the presence of caudal foraminal stenosis and positive SLR test, conservative treatments were more likely to fail in patients with LDH.
保守治疗在腰椎间盘突出症（LDH）中很重要，但不良结局的预测因素尚不清楚。
连续纳入单侧单节段 L3-4 或 L4-5 LDH 患者。收集基线临床资料，并对腰椎磁共振成像进行评估。采用 Lee 法评估椎间孔狭窄，并进一步分为无狭窄（0 级和 1 级）或存在狭窄（2 级或 3 级）。每位患者接受 6 周的保守治疗（口服美洛昔康和地塞米松、束腹、后伸运动、物理治疗和手法治疗）。如果患者在 6 周内接受手术或在 6 周随访时报告恢复不佳，则将保守治疗定义为失败。采用多变量逻辑回归分析保守治疗失败与基线特征和磁共振成像发现的相关性。
该研究纳入了 222 例患者（平均年龄 45.5 ± 9.8 岁）。其中 48 例（21.6%）同侧下位节段存在椎间孔狭窄，39 例（17.6%）保守治疗失败。基线时，伴有 LDH 和下位椎间孔狭窄的患者年龄较大（50.79 ± 6.14 岁比 44.10 ± 10.13 岁，P<0.001），腿部疼痛更严重（7.06 ± 1.17 比 6.39 ± 1.40，P<0.001），直腿抬高试验阳性率更高（54.2%比 33.3%，P<0.001）。多变量回归分析显示，保守治疗失败与直腿抬高试验阳性（比值比 2.26，P=0.046）和下位椎间孔狭窄（比值比 3.20，P=0.007）有关。
在存在下位椎间孔狭窄和直腿抬高试验阳性的情况下，LDH 患者的保守治疗更有可能失败。
