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脊柱注射在优化脊柱手术患者选择中的作用:一项针对176例下背痛患者的概念验证研究。

The role of spinal injections towards optimizing patient selection for spinal surgery: A proof-of-concept study in 176 lower back pain patients.

作者信息

Voelker Anna, Kroboth Katharina, Heyde Christoph-Eckhard

机构信息

Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Germany.

出版信息

Patient Saf Surg. 2024 Oct 31;18(1):31. doi: 10.1186/s13037-024-00414-y.

Abstract

BACKGROUND

Managing degenerative lumbar diseases is challenging due to the complexity of identifying symptom causes, especially when multiple pathologies coexist. This study evaluated the impact of patient-specific lumbar spine infiltrations on therapeutic strategies in patients with multiple spinal pathologies (MSP) or specific spinal pathologies (SSP).

METHODS

A retrospective cohort of 176 patients treated for subacute or chronic lumbar pain with targeted spinal infiltrations was analyzed. Patients were categorized based on the presence of MSP or SSP. The primary endpoint was the relief of lumbar spine-specific symptoms following each infiltration. Secondary endpoints included epidemiological factors and comorbidities, while tertiary endpoints focused on post-treatment recommendations and performed treatments.

RESULTS

High rates of spinal pain (97.1% in both groups) and radiating symptoms (88.2% in SSP and 92.3% in MSP) were reported. Psychological conditions were significantly more prevalent in female patients (19.4% vs. 7.7%, p = 0.0307), whereas hip osteoarthritis was more common in male patients (20.5% vs. 9.2%, p = 0.0490). Among all infiltration types, lumbar transforaminal injections were the most effective, leading to pain reduction in 80.1% of SSP patients and 72.2% of MSP patients. Facet joint and sacroiliac joint infiltrations also frequently resulted in pain reduction in both groups. Overall, conservative treatment was recommended for most patients (73.3%), while only 22.7% of all evaluated patients were recommended for surgical intervention. Additionally, seven patients received a hip prosthesis.

CONCLUSIONS

Patient-specific lumbar spine infiltrations effectively relieve pain, support therapeutic decision-making, and tend to favor conservative treatment approaches. These findings highlight the role of infiltration therapies in managing both mixed and specific lumbar spine pathologies, suggesting their potential to reduce the need for surgical interventions.

摘要

背景

由于确定症状原因的复杂性,尤其是多种病变共存时,退行性腰椎疾病的管理具有挑战性。本研究评估了针对患者的腰椎浸润对患有多种脊柱病变(MSP)或特定脊柱病变(SSP)患者治疗策略的影响。

方法

分析了176例接受靶向脊柱浸润治疗亚急性或慢性腰痛患者的回顾性队列。患者根据是否存在MSP或SSP进行分类。主要终点是每次浸润后腰椎特异性症状的缓解情况。次要终点包括流行病学因素和合并症,而三级终点侧重于治疗后建议和实施的治疗。

结果

报告的脊柱疼痛发生率较高(两组均为97.1%)和放射状症状发生率较高(SSP组为88.2%,MSP组为92.3%)。心理状况在女性患者中明显更为普遍(19.4%对7.7%,p = 0.0307),而髋骨关节炎在男性患者中更为常见(20.5%对9.2%,p = 0.0490)。在所有浸润类型中,腰椎经椎间孔注射最有效,使80.1%的SSP患者和72.2%的MSP患者疼痛减轻。小关节和骶髂关节浸润在两组中也经常导致疼痛减轻。总体而言,大多数患者(73.3%)被建议进行保守治疗,而所有评估患者中只有22.7%被建议进行手术干预。此外,7例患者接受了髋关节假体植入。

结论

针对患者的腰椎浸润有效缓解疼痛,支持治疗决策,并倾向于采用保守治疗方法。这些发现突出了浸润疗法在管理混合性和特定性腰椎病变中的作用,表明其有可能减少手术干预的需求。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9aa8/11526551/e9406c261c87/13037_2024_414_Fig1_HTML.jpg

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