Li Jian, Xing Gengyan, Lu Pengfei, Ding Yi
Department of Orthopaedics, China Aerospace Science & Industry Corporation Hospital 731, Beijing, China.
Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing, China.
Orthop Surg. 2024 Mar;16(3):724-732. doi: 10.1111/os.13981. Epub 2024 Jan 6.
Spinal endoscopy radiofrequency is a minimally invasive technique for lumbar disc herniation (LDH) and low back pain (LBP). However, recurring LDH/LBP following spinal endoscopy radiofrequency is a significant problem. Paravertebral musculature plays a crucial role in spine stability and motor function, and the purpose of the present study was to identify whether patients' baseline lumbar muscular electrophysiological function could be a predictor of recurring LDH/LBP.
This was a prospective follow-up and case-control study focusing on elderly patients with LDH who were treated in our department between January 1, 2018, and October 31, 2021. The end of follow-up was recurring LBP, recurring LDH, death, missing to follow-up or 2 years postoperation. The surface electromyography test was performed before the endoscopy C-arm radiofrequency (ECRF) operation to detect the flexion-relaxation ratio (FRR) of the lumbar multifidus (FRR ) and the longissimus erector spinae (FRR ), and the other baseline parameters included the general characteristics, the visual analogue scale, the Japanese Orthopaedic Association score, and the Oswestry Disability Index. Intergroup comparisons were performed by independent t-test and χ -test, and further binary logistic regression analysis was performed.
Fifty-four patients completed the 2-year follow-up and were retrospectively divided into a recurring LDH/LBP group (Group R) (n = 21) and a no recurring group (Group N) (n = 33) according to their clinical outcomes. FRR and FRR in Group N were much higher than those in Group R (p < 0.001, p = 0.009). Logistic regression analysis showed that only the FRR (odds ratio [OR] = 0.123, p = 0.011) and FRR (OR = 0.115, p = 0.036) were independent factors associated with the ECRF outcome.
Lumbar disc herniation patients' baseline FRR and FRR are independent outcome predictors of recurring LDH/LBP after ECRF. For every unit increase in baseline FRR , the risk of recurring LDH/LBP is decreased by 87.7%, and for every unit increase in baseline FRR , the risk of recurring LDH/LBP is decreased by 88.5%.
脊柱内镜下射频消融术是治疗腰椎间盘突出症（LDH）和腰痛（LBP）的一种微创技术。然而，脊柱内镜下射频消融术后LDH/LBP复发是一个严重问题。椎旁肌肉组织在脊柱稳定性和运动功能中起关键作用，本研究的目的是确定患者的基线腰椎肌肉电生理功能是否可作为LDH/LBP复发的预测指标。
这是一项前瞻性随访和病例对照研究，重点关注2018年1月1日至2021年10月31日在我科接受治疗的老年LDH患者。随访终点为复发性LBP、复发性LDH、死亡、失访或术后2年。在内镜C臂射频（ECRF）手术前进行表面肌电图测试，以检测腰大肌的屈伸放松率（FRR ）和竖脊肌的屈伸放松率（FRR ），其他基线参数包括一般特征、视觉模拟量表、日本骨科协会评分和Oswestry功能障碍指数。组间比较采用独立t检验和χ²检验，并进行进一步的二元逻辑回归分析。
54例患者完成了2年随访，根据临床结果回顾性分为复发性LDH/LBP组（R组）（n = 21）和无复发组（N组）（n = 33）。N组的FRR 和FRR 远高于R组（p < 0.001，p = 0.009）。逻辑回归分析显示，只有FRR （比值比[OR]=0.123，p = 0.011）和FRR （OR = 0.1
