脊柱推拿疗法与椎间盘切除术后腰椎再手术的相关性：回顾性队列研究。
Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study.
机构信息
Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA.
出版信息
BMC Musculoskelet Disord. 2024 Jan 10;25(1):46. doi: 10.1186/s12891-024-07166-x.
BACKGROUND
Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years' follow-up.
METHODS
We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.
RESULTS
Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).
CONCLUSIONS
This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.
REGISTRATION
Open Science Framework ( https://osf.io/vgrwz ).
背景
接受腰椎间盘切除术的患者可能会持续出现腰骶神经根病（LSR），并寻求脊柱手法治疗（SMT）来治疗这些症状。我们假设，与未接受 SMT 的匹配对照组相比，至少在腰椎间盘切除术后一年接受 SMT 治疗 LSR 的成年人，在两年以上的随访中，再次接受腰椎手术的可能性更小。
方法
我们在美国健康记录网络（TriNetX，Inc.）中搜索了年龄≥18 岁的成年人，这些人患有 LSR 和腰椎间盘切除术，至少 1 年以前，没有腰椎融合或器械，时间范围为 2003 年至 2023 年。我们将患者分为两个队列：（1）脊骨神经科 SMT，和（2）没有脊骨神经科 SMT 的常规护理。我们使用倾向匹配来调整与腰椎再手术相关的混杂变量（例如年龄、体重指数、尼古丁依赖），计算风险比（RR），并带有 95%置信区间（CI），同时还探索了再手术的累积发生率和 SMT 随访就诊次数。
结果
在倾向匹配后，每个队列有 378 名患者（平均年龄 61 岁）。与常规护理队列相比，SMT 队列中腰椎再手术的频率较低（SMT：7%；常规护理：13%），RR（95%CI）为 0.55（0.35-0.85；P=0.0062）。在 SMT 队列中，72%的患者接受了≥1 次 SMT 随访（中位数=6）。
结论
这项研究发现，在腰椎间盘切除术后至少一年出现 LSR 的成年人中，与未接受 SMT 的匹配对照组相比，接受 SMT 的患者再次接受腰椎手术的可能性更小。虽然这些发现对临床意义具有启示性，但需要通过包括疼痛、残疾和安全性测量的前瞻性研究来证实其相关性，以确认其相关性。我们不能排除我们的结果源于与非手术临床医生接触的普遍影响的可能性，这种因素可能扩展到物理治疗或针灸等相关领域。
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