Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Acta Neurochir (Wien). 2023 Mar;165(3):797-805. doi: 10.1007/s00701-023-05522-9. Epub 2023 Feb 19.
Lumbar disc herniation is often managed conservatively; nevertheless, surgical intervention can be required. Majority of patients experience a drastic relief of symptoms after surgery, but previous studies have reported that their health-related quality of life remains inferior compared to the general population for several years. There may be a major cumulative loss of health-related quality of life for young patients as they have long expected life ahead of them.
A total of 526 eligible adult patients under the age of 40 underwent surgery for lumbar disc herniation from 1990 to 2005. Patients' baseline characteristics were acquired by chart review to confirm eligibility to the study. Follow-up quality of life data was acquired by sending patients EQ-5D questionnaire at median 18 years after index surgery, and those 316 patients responding to the questionnaire (60%) were included in the study. Propensity score matching was utilized to match every study patient with two general population sample participants from a large Finnish population health study. Primary objective was to compare the quality of life to that of the control population. Secondary objective was to explore which patient characteristics lead to inferior outcome.
The mean EQ-index for the patient cohort was 0.86, while it was 0.84 for the age and gender-matched general population sample (difference 0.02, 95% CI - 0.0004 to 0.049). Within the patient cohort, an increasing number of lifetime lumbar surgeries was associated with progressively deteriorating EQ-index scores (p = 0.049) and longer duration of symptoms prior to the surgery correlated with lower score (p = 0.013).
Patients who underwent surgery for lumbar disc herniation nearly two decades ago reported quality of life comparable to the age and gender-matched general population. However, patients who had undergone numerous lumbar surgeries had significantly worse outcome. Therefore, possible ways to prevent cumulation of lumbar surgeries could improve long-term health-related quality of life.
腰椎间盘突出症通常采用保守治疗；然而，可能需要手术干预。大多数患者术后症状明显缓解，但以前的研究报告称，他们的健康相关生活质量在几年内仍低于一般人群。对于年轻患者来说，由于他们预期未来的生活还有很长一段时间，因此可能会有大量的健康相关生活质量损失。
1990 年至 2005 年间，共有 526 名年龄在 40 岁以下的符合条件的成年患者因腰椎间盘突出症接受了手术。通过病历回顾获得患者的基线特征，以确认符合研究条件。通过向患者发送 EQ-5D 问卷获得中位时间为 18 年的术后生活质量数据，316 名对问卷做出回应的患者（60%）被纳入研究。采用倾向评分匹配，将每位研究患者与来自大型芬兰人群健康研究的两名普通人群样本参与者进行匹配。主要目的是比较生活质量与对照组的差异。次要目的是探讨哪些患者特征导致较差的结果。
患者队列的平均 EQ 指数为 0.86，而年龄和性别匹配的普通人群样本为 0.84（差异 0.02，95%CI - 0.0004 至 0.049）。在患者队列中，一生中接受腰椎手术的次数越多，EQ 指数得分恶化越严重（p=0.049），手术前症状持续时间越长，得分越低（p=0.013）。
近二十年前接受腰椎间盘突出症手术的患者报告的生活质量与年龄和性别匹配的普通人群相当。然而，接受过多腰椎手术的患者的结果明显较差。因此，可能的预防腰椎手术累积的方法可以改善长期健康相关的生活质量。
