Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 16902, Prague, Czech Republic.
Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Acta Neurochir (Wien). 2023 Sep;165(9):2633-2640. doi: 10.1007/s00701-023-05666-8. Epub 2023 Jun 22.
With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD).
This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery.
During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work.
Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings.
ClinicalTrials.gov Identifier: NCT04876586.
目前的影像学检查和诊断测试很难确定非特异性慢性下腰痛（CLBP）患者的疼痛源。越来越多的证据表明 SPECT/CT 检查在诊断脊柱疼痛源方面的有效性。本研究旨在探讨后路椎体间融合术对单节段 SPECT/CT 阳性腰椎退行性椎间盘疾病（DDD）的影响。
这是一项对接受单节段 SPECT/CT 阳性 DDD 手术的慢性下腰痛（CLBP）患者进行的前瞻性研究。主要结果是视觉模拟评分（VAS）和 Oswestry 残疾指数（ODI）的变化。次要结果是并发症、重返工作岗位、满意度和再次接受手术的意愿。
在 3 年期间，38 例患者接受了单节段融合手术。术前 VAS 评分的平均为 8.4（±1.1），降至 2 年随访时的 3.2（±2.5，p<0.001），术前 ODI 的平均为 51.5（±7.3），改善至 20.7（±14.68，p<0.001）。84.2%的患者达到了最小临床重要差异（VAS 和 ODI 降低 30%）。71%的患者对手术结果满意，89.4%的患者会再次接受手术。有 4 例并发症，2 例患者接受了翻修手术。82.9%的患者重返工作岗位。
对于单节段 SPECT/CT 阳性腰椎 DDD，融合术可显著改善临床症状，并使患者对手术治疗满意。因此，SPECT/CT 成像可能对评估 CLBP 患者有用，尤其是那些 MRI 结果不明确的患者。
ClinicalTrials.gov 标识符：NCT04876586。
