Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Int J Med Sci. 2023 Jul 9;20(8):1115-1122. doi: 10.7150/ijms.85777. eCollection 2023.
Intradiscal biacuplasty (IDB) has been proven to be effective for treating lumbar degenerative disc disease (DDD). However, there has not been a reported prognostic factor for IDB. The present study meticulously evaluates the general and radiographic features that may serve as markers for predicting the therapeutic outcome of IDB. A prospective case series study was conducted, following time-series analysis moving averages models, with forty-one patients suffering from chronic discogenic lower back pain for more than six months. These patients subsequently received lumbar cool radiofrequency IDB and were enrolled in the study. Thirty-seven patients completed follow-up questionnaires at 1, 3, 6, and 12 months. The surgical outcomes were reported using visual analogue scale (VAS), Oswestry disability index (ODI), and the consumption of nonsteroidal anti-inflammatory drugs (NSAID). Furthermore, a univariate analysis was performed to identify prognostic factors associated with pain relief from age, gender, body mass index (BMI), and pre-operative lumbar magnetic resonance imaging reading. : Significant reductions were found in estimated VAS and ODI at the post-operative period at 1, 3, 6, and 12 months ( < 0.001). The NSAID dosage was significantly decreased at 3-month and 1-year follow-up ( < 0.05). No procedure-related complications were detected. The prognosis of IDB was not related to disc height, Pfirrmann grading or Modic endplate change. However, disc extrusions were associated with promising outcomes (VAS improvement ≥ 50%) on pain relief ( < 0.05). IDB is a good alternative choice for treating lumbar DDD. Patients with a painful extrusion lumbar disc may gain some benefits after receiving IDB following a period of failed conservative treatment. These findings may also add some references for physicians in the decision making when treating lumbar DDD.
经皮双极射频椎间盘成形术(IDB)已被证实可有效治疗腰椎退行性椎间盘疾病(DDD)。然而,目前尚未报道 IDB 的预后因素。本研究细致评估了可能作为预测 IDB 治疗效果的标志物的一般和影像学特征。
一项前瞻性病例系列研究采用时间序列分析移动平均值模型进行,共纳入 41 例患有慢性椎间盘源性下腰痛超过 6 个月的患者。这些患者随后接受了腰椎冷射频 IDB,并被纳入研究。37 例患者在 1、3、6 和 12 个月时完成了随访问卷。手术结果采用视觉模拟评分(VAS)、Oswestry 残疾指数(ODI)和非甾体抗炎药(NSAID)的使用情况进行报告。此外,进行了单变量分析以确定与疼痛缓解相关的年龄、性别、体重指数(BMI)和术前腰椎磁共振成像读数相关的预后因素。
术后 1、3、6 和 12 个月,VAS 和 ODI 均显著降低(<0.001)。术后 3 个月和 1 年随访时 NSAID 剂量显著降低(<0.05)。未发现与手术相关的并发症。IDB 的预后与椎间盘高度、Pfirrmann 分级或 Modic 终板改变无关。然而,椎间盘突出与疼痛缓解(VAS 改善≥50%)的良好预后相关(<0.05)。
IDB 是治疗腰椎 DDD 的良好选择。对于接受保守治疗失败后接受 IDB 的腰痛伴突出椎间盘患者,可能会获益。这些发现也可能为医生治疗腰椎 DDD 时的决策提供一些参考。