Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests
Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests
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DOI：
10.1007/s00586-009-1201-8
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发表时间：
2010-01-01
影响因子：
2.8
通讯作者：
Milano, Carlo
中科院分区：
文献类型：
--
作者：
Mariconda, Massimo;Galasso, Olimpio;Milano, Carlo
本回顾性对照研究的目的是评估至少21年前接受腰椎间盘切除术的患者的腰椎放射学退变及其临床意义。事实上，以前没有关于腰椎间盘切除术后发生退行性变化的研究，并进行了相当长的随访。研究参与者包括50名因腰椎间盘突出症接受椎间盘切除术的患者。平均随访时间为25.3 +/-A3.0年。通过简明健康调查表（SF-36）、奥斯韦斯特里残疾指数和研究特定问卷对患者进行评估。所有患者的腰椎影像学检查结果与50名无症状对照者的腰椎影像学检查结果进行比较。采用五步已发表分类法评估影像学变化的严重程度增加。CT或MRI扫描也可用于27例接受椎间盘切除术的患者。45例患者（90%）和34例对照（68%）分别出现中度至重度影像学改变（P = 0.013）。最常见的MRI/CT变化是椎间盘高度丢失（89%）、小关节炎（89%）和终板变化（57%）。在过去12个月内报告疼痛的33例受试者中，有32例（97%）的X线片出现显著变性，变化频率高于无疼痛的受试者（P = 0.040）。总之，标准腰椎间盘切除术经常导致影像学检查的长期退行性变化。中度至重度退行性变的存在与自我报告的疼痛相关。
The aim of this retrospective controlled study was to evaluate radiographic degeneration in the lumbar spine of patients who had undergone lumbar discectomy minimum 21 years earlier and its clinical meaning. Indeed, no previous investigation on degenerative changes occurring after lumbar discectomy with a comparable long follow-up has been published. The study participants consisted of 50 patients who had undergone discectomy for lumbar disc herniation. The mean length of follow-up was 25.3 +/- A 3.0 years. Patients were assessed by Short Form-36 Health Survey (SF-36), Oswestry Disability Index, and a study-specific questionnaire. Radiographic views of the lumbar spine were obtained from all patients and compared to those of 50 asymptomatic controls. A five-step published classification was used to assess the increasing severity of radiographic changes. CT or MRI scans were also available for 27 patients who had undergone discectomy. Moderate to severe radiographic changes were present in 45 patients (90%) and 34 controls (68%), respectively (P = 0.013). The most prevalent MRI/CT changes were loss of disc height (89%), facet joint arthritis (89%), and endplate changes (57%). Thirty-two of 33 subjects (97%) reporting pain during the last 12 months had significant degeneration on their radiographs, and the frequency of changes was higher with respect to subjects without pain (P = 0.040). In conclusion, standard lumbar discectomy frequently leads to long-term degenerative changes on imaging tests. The presence of moderate to severe degeneration is associated with self-reported pain.