García López Antonio, Herrero Ezquerro María-Trinidad, Martínez Pérez Miguel
Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Universidad de Murcia, Spain.
Heliyon. 2024 Sep 26;10(19):e38549. doi: 10.1016/j.heliyon.2024.e38549. eCollection 2024 Oct 15.
Microdiscectomy is an effective and safe treatment for patients with symptomatic lumbar disc herniation (LDH) that is refractory to conservative interventions. However, some patients experience persistent low back pain (PLBP) after microdiscectomy that is secondary to progressive disc degeneration and segmental instability. This study aimed to clarify the definition of PLBP and analyze its prevalence and associated risk factors.
This retrospective study included patients who underwent microdiscectomy for LDH at our hospital between 2015 and 2019. We divided this cohort into patients who did (PLBP group) or did not (non-PLBP group) experience PLBP after microdiscectomy and compared their clinical, radiological, and anatomical parameters. We analyzed the relationship between PLBP post-microdiscectomy and the following variables: age, sex, disk herniation level, recurrent disk herniation, body mass index (BMI), modic changes on MRI, facet subluxation, preoperative lumbar pain, and lumbosacral transitional vertebrae (LSTV).
PLBP after microdiscectomy was diagnosed in 99 (29.8 %) of the 332 patients enrolled in this study. Based on our multivariate logistic regression analysis, L5-S1 disc herniation level, recurrent disc herniation after microdiscectomy, obesity, modic changes on preoperative MRI, and facet subluxation were independent risk factors for PLBP post-microdiscectomy. Women and patients aged <50 years showed a trend of increased risk for developing PLBP after microdiscectomy; however, this trend did not reach statistical significance.
PLBP after microdiscectomy is a frequent and understudied condition. We found that an L5-S1 disc herniation level, recurrent disc herniation, obesity, modic MRI changes, and facet subluxation were risk factors for PLBP after microdiscectomy. These results can help surgeons in developing a better understanding of lumbar microdiscectomy outcomes.
对于经保守治疗无效的有症状腰椎间盘突出症（LDH）患者，显微椎间盘切除术是一种有效且安全的治疗方法。然而，一些患者在显微椎间盘切除术后会出现持续性腰痛（PLBP），这是由椎间盘进行性退变和节段性不稳定继发引起的。本研究旨在明确PLBP的定义，并分析其患病率及相关危险因素。
这项回顾性研究纳入了2015年至2019年在我院接受显微椎间盘切除术治疗LDH的患者。我们将该队列分为显微椎间盘切除术后出现（PLBP组）或未出现（非PLBP组）PLBP的患者，并比较他们的临床、影像学和解剖学参数。我们分析了显微椎间盘切除术后PLBP与以下变量之间的关系：年龄、性别、椎间盘突出节段、复发性椎间盘突出、体重指数（BMI）、MRI上的Modic改变、小关节半脱位、术前腰痛以及腰骶移行椎（LSTV）。
本研究纳入的332例患者中，99例（29.8%）在显微椎间盘切除术后被诊断为PLBP。基于我们的多因素逻辑回归分析，L5 - S1椎间盘突出节段、显微椎间盘切除术后复发性椎间盘突出、肥胖、术前MRI上的Modic改变以及小关节半脱位是显微椎间盘切除术后PLBP的独立危险因素。女性和年龄<50岁的患者在显微椎间盘切除术后发生PLBP的风险有增加趋势；然而，这种趋势未达到统计学意义。
显微椎间盘切除术后的PLBP是一种常见但研究不足的情况。我们发现L5 - S1椎间盘突出节段、复发性椎间盘突出、肥胖、MRI的Modic改变以及小关节半脱位是显微椎间盘切除术后PLBP的危险因素。这些结果有助于外科医生更好地理解腰椎显微椎间盘切除术的疗效。
