Omidi Pouya, Abrishamkar Saeid, Mahmoodkhani Mehdi, Sourani Arman, Dehghan Amin, Foroughi Mina, Baradaran Mahdavi Sadegh, Sheibani Tehrani Donya, Nik Khah Roham, Veisi Shaahin
Neurosurgeon, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
World Neurosurg X. 2024 Mar 7;23:100333. doi: 10.1016/j.wnsx.2024.100333. eCollection 2024 Jul.
To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy.
This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes.
Two hundred and forty patients ( = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS( < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS ( = 0.001). Age had a negative impact on G2 recurrence( = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index.
L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.
评估腰骶化（LS）对L4-L5微创椎间盘切除术手术效果的作用。
本前瞻性队列研究在一家大学附属医院进行。纳入符合L4-L5椎间盘突出症且适合微创椎间盘切除术的患者，并分为G1组（存在腰骶化）和G2组（不存在腰骶化）。在L4-L5微创椎间盘切除术后对患者进行随访，收集临床和影像学参数以研究其对手术效果的影响。将复发、下腰痛结局评分（LBOS）和Oswestry功能障碍指数（ODI）定义为主要结局。
最终分析纳入240例患者（每组120例）。两组间基线特征无差异。腰骶化组术后神经根性疼痛和背痛更严重（P<0.05）。单因素分析显示，腰骶化组的复发率显著更高，且与术后背痛持续存在和低LBOS直接相关（P=0.001）。年龄对G2组的复发有负面影响（P=0.008）。腰骶化对LBOS和ODI评分有负面影响。术后神经根性疼痛和更高的腰椎前凸与更高的功能障碍（ODI）指数相关。
腰骶化患者行L4-L5微创椎间盘切除术与更高的复发率、更差的ODI和LBOS评分、术后轴向背痛持续存在以及神经根性疼痛相关。术后轴向背痛和较差的LBOS结果可有效预测腰骶化患者L4-L5微创椎间盘切除术后更高的复发率。
