Spine · 2008
SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter?
СтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка NIH: внешняя программаПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pearson Adam M, Blood Emily A, Frymoyer John W, Herkowitz Harry, Abdu William A, Woodward Randy, Longley Michael, Emery Sanford E, Lurie Jon D, Tosteson Tor D, Weinstein James N
Аннотация
STUDY DESIGN: Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort.
OBJECTIVE: This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes.
SUMMARY OF BACKGROUND DATA: Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes.
METHODS: Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined.
RESULTS: The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group.
CONCLUSION: Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.
OBJECTIVE: This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes.
SUMMARY OF BACKGROUND DATA: Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes.
METHODS: Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined.
RESULTS: The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group.
CONCLUSION: Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.