Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.
Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.
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DOI：
10.1136/bmjopen-2016-012938
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发表时间：
2016-12-21
期刊：
影响因子：
2.9
通讯作者：
Hasler P
中科院分区：
文献类型：
--
作者：
Gugliotta M;da Costa BR;Dabis E;Theiler R;Jüni P;Reichenbach S;Landolt H;Hasler P
比较手术治疗和保守治疗有症状的腰椎间盘突出症的有效性的证据存在争议。我们试图在常规临床环境中比较手术治疗和保守治疗对腰椎间盘突出症患者坐骨神经痛症状严重程度和生活质量的短期和长期疗效。一项由 370 名患者组成的常规临床实践登记的前瞻性队列研究。结果测量是北美脊柱协会问卷和 36 项简短健康调查，以评估患者报告的背痛、身体功能、神经源性症状和生活质量。主要结果是第 6 周和第 12 周时的背痛。在第 6、12、52 和 104 周时对标准开放椎间盘切除术与保守干预进行了评估。我们通过多重插补填补了缺失的结果变量值，用混合效应模型解释了患者的重复测量，并通过治疗加权的逆概率调整了相关预后指标的基线组差异。与接受保守治疗的患者相比，接受手术治疗的患者在 6 周时报告的背痛较少（−0.97；95% CI -1.89 至 -0.09），更有可能报告背痛症状较基线至 6 周减少 ≥50%（48% vs 17%，风险差异：0.34；95% CI 0.16 至 0.47），并且在 6 周时报告的身体功能障碍较少。 52 周（−3.7； 95% CI -7.4 至 -0.1）。其他评估显示 CI 的组间差异极小，包括零效应。与保守治疗相比，手术治疗可以更快地缓解腰椎间盘突出症患者的背痛症状，但在中长期随访中并未显示出比保守治疗有优势。
Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.