Wallis棘突间动态稳定系统在腰椎间盘突出症治疗中的早期疗效观察

[目的]比较髓核摘除术结合Wallis系统与单纯髓核摘除术治疗腰椎间盘突出症的早期疗效.[方法]2008年2月～2010年2月采用髓核摘除术结合Wallis系统治疗腰椎间盘突出症患者18例,以同期行单纯髓核摘除术治疗腰椎间盘突出症的18例患者为对照组.术后12个月为观察点,采用下腰痛及腿痛的视觉模糊评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)等指标来评估2组疗效.[结果]36例患者均获12 ～24个月随访,平均16个月,两组患者术后12个月的VAS评分及ODI指数均有明显下降,较术前比较有统计学意义(P=0.0000＜0.05),Wallis组术后12个月的下腰痛VAS评分及Oswestry指数与对照组比较有统计学意义(P =0.000 0 ＜0.05),而腿痛的VAS评分两组比较无统计学意义(P =0.074 ＞0.05).[结论]Wallis系统置入简单,创伤小,结合髓核摘除术治疗腰椎间盘突出症能提高疗效.     

加速康复外科理念在老年骨质疏松性腰椎压缩性骨折椎体成形术和后凸成形术后康复中的应用

目的：探讨按照加速康复外科（enhanced recovery after surgery,ERAS）理念指导术后规律性核心肌力训练对老年骨质疏松腰椎压缩性骨折椎体成形术（percutaneous vertebroplasty,PVP）和椎体后凸成形术（percutaneous kyphoplasty,PKP）术后康复的作用。方法：将2016年1月至2018年1月期间94例符合纳入、排除标准的因骨质疏松性腰椎压缩骨折而行PKP或PVP手术的老年患者分成观察组和对照组,术后均常规抗骨质疏松治疗。观察组47例,男18例,女29例,年龄（62.62±3.21）岁;对照组47例,男17例,女30例,年龄（62.38±2.84）岁。对照组按照传统的方式训练,观察组按ERAS理念指导患者规律性核心肌力训练。术后1、3、6个月随访,根据患者的Barthel量表、日本骨科协会（Japanese Orthopaedic Association,JOA）腰痛评分,Oswestry功能障碍指数对患者病情进行量化评估,统计分析。比较两组治疗效果的差异性。结果：94例完成随访,术后1、3个月观察组的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均优于对照组（P<0.05）。术后6个月观察组的Oswestry功能障碍指数优于对照组（P<0.05）,但两组JOA腰痛评分、Barthel量表差异无统计学意义（P>0.05）。两组患者术后1、3、6个月的Barthel量表、JOA腰痛评分、Oswestry功能障碍指数均明显好转（P<0.05）。结论：早期规律性核心力量训练在老年骨质疏松性腰椎压缩骨折PKP或PVP术后早期功能恢复及改善生活能力方面具有积极的作用,符合加速康复外科理念。     

Intradiscal methylene blue injection for the treatment of chronic discogenic low back pain

This article was a preliminary report of prospective clinical trial of a group of patients with chronic discogenic low back pain who met the criteria for lumbar interbody fusion surgery but were treated instead with an intradiscal injection of methylene blue (MB) for the pain relief. Twenty-four patients with chronic discogenic low back pain underwent diagnostic discography with intradiscal injection of MB. The principal criteria to judge the effectiveness included alleviation of pain, assessed by visual analog scale (VAS), and improvement in disability, as assessed with the Oswestry Disability Index (ODI) for functional recovery. The mean follow-up period was 18.2 months (range 12–23 months). Of the 24 patients, 21 (87%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement in the changes in the ODI and the VAS scores were obtained in the patients with chronic discogenic low back pain (P=0.0001) after the treatment. The study suggests that the injection of MB into the painful disc may be a very effective alternative for the surgical treatment of chronic discogenic low back pain.     

基于肌筋膜链理论手法治疗退变性腰椎失稳的疗效观察

目的:探讨基于肌筋膜链理论推拿手法治疗退变性腰椎失稳的临床疗效。方法:对2018年1月至2019年12月收治的57例退变性腰椎失稳患者进行回顾性分析,均采用推拿手法治疗。其中基于肌筋膜链理论手法治疗组(肌筋膜链组)29例,男14例,女15例;年龄40～69(51.76±5.07)岁;病程(3.4±1.6)年。基于中医经络理论手法治疗组(中医经络组)28例,男12例,女16例;年龄42～70(52.48±4.31)岁;病程(3.3±1.7)年。分别于治疗前和治疗结束后、治疗结束后1和3个月采用视觉模拟疼痛评分(visual analogue scale,VAS)评价腰痛程度,并采用日本骨科协会(Japanese Orthopaedic Association,JOA)下腰痛评分及改良的Oswe stry功能障碍指数(Oswestry Disability Index,ODI)评价腰椎功能改善情况,腰部肌肉肌张力变化评价临床疗效。结果:两组治疗后VAS评分、JOA评分、改良ODI评分及腰部肌肉肌张力均较治疗前明显改善(P0.05)。肌筋膜链组治疗前及治疗结束后的VAS评分、JOA评分、改良ODI评分及腰部肌肉肌张力与中医经络组比较差异无统计学意义(P0.05)。但肌筋膜链组治疗结束后1和3个月VAS评分、JOA评分、改良ODI评分及腰部肌肉肌张力较中医经络组改善更为明显(P0.05)。结论:基于肌筋膜链理论手法治疗退变性腰椎失稳可有效缓解腰痛症状,改善腰椎功能,值得临床推广。     

Failure of the Wallis interspinous implant to lower the incidence of recurrent lumbar disc herniations in patients undergoing primary disc excision

BACKGROUND: Ipsilateral recurrent disc herniation after lumbar discectomy is a significant problem in the management of lumbar disc disease and may necessitate repeat surgical intervention. A population-based study in Finland found that about 14% of all primary lumbar discectomies required additional surgical interventions. Interspinous devices, which have been shown to unload the posterior anulus, may reduce the occurrence of recurrent herniations. We report our short-term experience with the use of the Wallis device in the management of patients with lumbar disc herniation undergoing primary disc excision. PATIENTS AND METHODS: Thirty-seven consecutive patients (23 males and 14 females, average age 36 y) underwent primary lumbar disc excision followed by fixation of the segment with the Wallis implant during a period of 1 year. Indications for implanting the Wallis device were a voluminous disc herniation and preservation of at least 50% of disc space height. Surgery was performed at level L4-5 in most patients. Average follow-up after surgery was 16 months (range 12 to 24). The last 14 patients were also evaluated by the preoperative and postoperative Oswestry Disability Index (ODI) questionnaire, the SF-36 survey, and by a visual analog scale (VAS) for back and leg pain. RESULTS: The average ODI dropped from 43 to 12.7. The average VAS for back pain dropped from 6.6 to1.4 and the average Vas for leg pain dropped from 8.2 to 1.5. Five patients (4 males and 1 female) with relapsing leg pain were diagnosed by contrast-enhanced magnetic resonance imaging as suffering from recurrent herniation (5/37, 13%). All reherniations occurred at level L4-5 level between 1 and 9 months after the index surgery. Two of the 5 patients subsequently underwent additional discectomy and fusion. SUMMARY: The current Wallis implant is probably incapable of reducing the incidence of recurrent herniations, but it still may be useful in patients with discogenic back pain due to early degenerative disc disease.     

Greek versions of the Oswestry and Roland-Morris Disability Questionnaires

Disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment and research methodology of low back pain. Their use in different countries and cultural groups must follow certain guidelines for translation and cross-cultural adaptation. The translation of such an instrument must be tested for its reliability and validity to be applied and to allow comparability of data. The Oswestry Disability Index and the Roland-Morris Disability Questionnaire are two disability questionnaires most commonly used as outcome measures in patients with low back pain. The two questionnaires were translated for use with the Greek population, were back translated and tested, and became available in a final version. The Greek versions of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire were tested in 697 patients with low back pain. Internal consistency reliability for the Greek translation of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire reached a Cronbach's alpha coefficient of 0.833 and 0.885 respectively. Face validity and content validity were ensured. Concurrent validity was assessed using a six-point pain scale as a criterion. The correlation of both scales was significant. The Greek translation of these disability questionnaires provided reliable and valid instruments for the evaluation of Greek-speaking patients with low back pain.     

单侧椎弓根螺钉固定并椎间融合治疗极外侧腰椎间盘突出症

目的:探讨单侧椎弓根螺钉固定结合单枚Cage椎体间融合治疗极外侧椎间盘突出症的可行性及临床疗效。方法:2007年1月至2011年1月,手术治疗18例极外侧腰椎间盘突出症患者,男13例,女5例;年龄42～73岁,平均58.5岁;均为单节段突出,其中L3,45例,L4,510例,L5S13例。采用单侧显露症状侧关节突及椎板外侧部分,单侧置入椎弓根螺钉,经椎间孔入路切除突出椎间盘及终板软骨,自体骨植骨,斜向植入单枚Cage。术后及随访期间对腰痛和腿痛视觉模拟评分(VAS)与Oswestry功能障碍指数评分进行观察,并与术前进行比较。结果:18例患者均顺利完成手术,未发生手术并发症。平均手术时间105min(85～125min),术中出血量145ml(90～340ml),术后及随访期间腰痛和腿痛VAS与Oswestry功能障碍指数评分,与术前相比均明显改善。经平均23个月(12～48个月)随访,所有患者椎体间融合良好,未发生断钉及Cage移位。结论:单侧椎弓根螺钉固定结合单枚Cage椎体间融合手术具有创伤小、恢复快、缩短手术时间等优点,是治疗极外侧椎间盘突症可供选择的手术方式。     

Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy.

STUDY DESIGN: A prospective double-blind randomized controlled trial was performed. OBJECTIVE: To assess the efficacy of percutaneous radiofrequency articular facet denervation for low back pain. SUMMARY OF BACKGROUND DATA: Uncontrolled observational studies in patients with low back pain have reported some benefits from the use of facet joint radiofrequency denervation. Because the efficacy of percutaneous radiofrequency had not been clearly shown in previous studies, a randomized controlled trial was conducted to assess the efficacy of the technique for improving functional disabilities and reduce pain. METHODS: For this study, 70 patients with low back pain lasting of more than 3 months duration and a good response after intraarticular facet injections under fluoroscopy were assigned randomly to receive percutaneous radiofrequency articular facet denervation under fluoroscopic guidance or the same procedure without effective denervation (sham therapy). The primary outcomes were functional disabilities, as assessed by the Oswestry and Roland-Morris scales, and pain indicated on a visual analog scale. Secondary outcomes included spinal mobility and strength. RESULTS: At 4 weeks, the Roland-Morris score had improved by a mean of 8.4% in the neurotomy group and 2.2% in the placebo group, showing a treatment effect of 6.2% (P = 0.05). At 4 weeks, no significant treatment effect was reflected in the Oswestry score (0.6% change) or the visual analog pain score (4.2% change). At 12 weeks, neither functional disability, as assessed by the Roland-Morris scale (2.6% change) and Oswestry scale (1.9% change), nor the pain level, as assessed by the visual analog scale (-7.6% change), showed any treatment effect. CONCLUSIONS: Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.     

Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain

STUDY DESIGN: Prospective series of consecutive cases. OBJECTIVES: To observe if kinesiophobia was altered through an education- and quota-based exercise physical therapy program, and to observe the relationship of kinesiophobia with other measures related to chronic low back pain. BACKGROUND: The role of kinesiophobia in worsening the chronic low back pain predicament has been documented in numerous studies. However, less is known of the effect of an exerciseonly-based physical therapy program's ability to alter kinesiophobia and improve functional abilities in patients with chronic low back pain. METHODS: Eighty-two patients with at least 3 months of low back pain, and a moderate level of disability (Oswestry score greater than or equal to 20) were willing to participate in this study. Sixty-eight of these patients completed treatment. For 68 compliant patients, females comprised 56%, the mean age was 43 years, the mean duration of symptoms was 28 months, and the primary anatomic diagnosis was disc degeneration (70%). Patients underwent a course of non-pain-contingent, quota-based physical therapy to address impairments in flexibility, strength, and lifting capacity. These were quantified prior to and following treatment using validated methods. Before and after treatment, patients completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK) Questionnaire, Oswestry Disability Index (ODI) Questionnaire, and a 0-to-10 visual analog scale for back and lower extremity pain. A 12-month follow-up was conducted using mailed questionnaires. RESULTS: The mean number of physical therapy visits was 14. Clinically and statistically significant (P<.001) improvement in flexibility, strength, and lifting ability were observed. Statistically significant (P<.001) improvement in back pain, disability, and measures of kinesiophobia were also noted at discharge and maintained at 12-month follow-up. At discharge, Oswestry scores correlated with TSK (r = .59, P<.001), FABQ-Activities (r = .55, P<.001), and FABQ-Work (r = .50, P<.001) scores. CONCLUSION: In this study we observed that kinesiophobia decreased during an intensive physical therapy program in which exercises were performed in a quota-based manner. Following the successful performance of non-pain-contingent, quota-based exercise, patients' fears of injury lessened, and this may have had a positive influence on disability.     

Responsiveness of common outcome measures for patients with low back pain.

STUDY DESIGN: A prospective cohort study assessing the responsiveness of two disease-specific questionnaires and a generic health questionnaire for patients with low back pain and sciatica. OBJECTIVES: To compare the responsiveness of the eight scales and two summery scales of the SF-36 questionnaire with that of the Oswestry Disability Index and Low Back Outcome Score questionnaires. SUMMARY OF BACKGROUND DATA: Evaluation of treatment outcome is being determined more frequently from a patient's perspective, particularly the impact treatment has on current health status. METHODS: Patients were recruited from two orthopedic back pain clinics in a tertiary hospital. Patients completed the pretreatment questionnaire 1 month before treatment and follow-up questionnaires a minimum of 2-6 months after treatment. Patients undergoing surgery were also observed for a minimum of 2 years. RESULTS: Overall, the Oswestry Disability Index was most responsive; however, individual scales from the SF-36 questionnaire showed equal or greater sensitivity to change than the Oswestry Disability Index in each of the patient subgroups. The SF-36 Role Physical scale was prone to floor effects (a high percentage of respondents score zero), and the change scores from the SF-36 Role Emotional scale varied by 100 points in either direction in each of the patient subgroups. CONCLUSION: Responsiveness varied according to which method was used in its calculation. The responsiveness of the SF-36 questionnaire shows that it can be a useful adjunct in the assessment of patients with low back pain when combined with disease-specific questionnaires.     

单侧椎弓根螺钉内固定联合椎间融合术治疗腰椎间盘突出症

目的评价单侧椎弓根螺钉内固定联合椎间融合术治疗伴有椎间不稳的单间隙腰椎间盘突出症的临床疗效。方法 2008年3月至2009年11月,采用后入路单侧椎弓根螺钉内固定联合椎间融合术治疗26例伴有椎间不稳的单间隙腰椎间盘突出症患者,其中男性16例,女性10例;L4～5椎间盘突出症19例,L5～S1椎间盘突出症7例。记录术前疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)腰腿痛评分等功能参数,手术时间、术中出血量,术后住院天数、住院费用,末次随访时VAS、ODI及JOA评分,融合率及并发症情况。结果所有患者均获随访16～28个月,平均22个月;末次随访时功能参数均优于术前,具有统计学差异(P<0.001)。结论单侧椎弓根螺钉内固定联合椎间融合术治疗伴有椎间不稳的单间隙腰椎间盘突出症的中期随访表明,单侧内固定能提供与双侧内固定相同的疗效,且手术时间短、创伤小、出血少、费用低。     

A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication

BACKGROUND: The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. METHODS: Sixty-two patients with lumbar spinal stenosis and neurogenic claudication were prospectively enrolled in the study. All underwent preoperative magnetic resonance imaging and/or computed tomography myelography, and all were treated with decompressive surgery and were followed for a minimum of two years. The evaluation included treadmill and bicycle exercise tests as well as patient self-assessment with use of the Oswestry Disability Index and a visual analog pain scale preoperatively and postoperatively. RESULTS: Preoperatively fifty-eight (94%) of the patients had a positive result (provocation of symptoms) on the treadmill test and twenty-seven (44%) had a positive result on the bicycle test, whereas postoperatively six and twelve, respectively, had positive results. The mean preoperative scores on the Oswestry Disability Index and visual analog pain scale were 58.4 and 7.1, respectively. Postoperatively, these scores decreased to 21.1 and 2.3, respectively, and both decreases were significant (p < 0.05). Forty-seven (76%) of the patients were seen to have central stenosis on the preoperative imaging studies; forty-one of them had a cross-sectional area of the dural tube of <100 mm (2) at at least one level and twelve had a cross-sectional area of <100 mm (2) at at least two levels. CONCLUSIONS: A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.     

Minimally invasive anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis: minimum 5-year follow-up

Background contextWe previously reported the preliminary results of minimally invasive anterior lumbar interbody fusion (mini-ALIF) with percutaneous pedicle screw fixation (PPF) in 2004.PurposeTo investigate the long-term results of mini-ALIF followed by PPF for the treatment of back and leg pain in adult isthmic spondylolisthesis.Study designRetrospective study with a minimum 5-year follow-up. Sixty-three patients with a mean age of 49 years were included in this study. Each patient had mini-ALIF followed by PPF. Visual analog scale pain and intensity (back and leg), Oswestry Disability Index scores, and the patient's return-to-work status.MethodsOf the initial 73 patients who underwent mini-ALIF with PPF between October 2000 and February 2002, 63 patients could be contacted after 5 to 7 years. Clinical follow-up and radiological follow-up with dynamic lumbar X-ray, three-dimensional computed tomography scans, and lumbar magnetic resonance imaging for checking the adjacent segmental disease (ASD) were completed in patients. Radiological results including the intervertebral disc height, the degree of listhesis, segmental lumbar lordosis, and whole lumbar lordosis were analyzed by statistical analysis.ResultsThe mean follow-up period was 72 months. Among the 63 patients, 56 (88.9%) had an excellent or good clinical result and five (7.9%) had a fair result based on the Macnab criteria. Two (3.2%) patients had a poor result. The last scores of visual analog scale and Oswestry Disability Index were significantly decreased compared with the preoperative baseline. Radiographs of all patients at the last follow-up showed solid fusion. There was one case of screw fracture. However, last follow-up study showed solid fusion state. ASD was proven to be progressing in 6 out of 63 (9.5%) patients, but only two patients (3.2%) had symptoms associated with ASD.ConclusionsThe long-term outcome after mini-ALIF with PPF in patients with low-grade isthmic spondylolisthesis was successful. Furthermore, in terms of ASD, there is low incidence of ASD after the procedure.     

Muscle energy technique in patients with acute low back pain: a pilot clinical trial

STUDY DESIGN: A prospective, pilot clinical trial. OBJECTIVE: Examining the outcomes of Muscle Energy Technique (MET) in patients with acute low back pain. BACKGROUND: MET is commonly used to treat patients with acute low back pain. No randomized controlled trials examining the outcomes of this treatment in symptomatic populations has been reported in the literature. METHODS AND MEASURES: Ten men and 9 women diagnosed with acute low back pain were randomly assigned with stratification to 1 of 2 treatment groups. Patients were matched according to age, gender, and initial Oswestry score. The control group received supervised neuromuscular re-education and resistance training while the experimental group received the same exercises coupled with MET. Both groups received the selected treatment 8 times over a 4-week period (2 times per week). Patients completed an Oswestry Disability Index on their first and eighth visits and change scores were calculated. RESULTS: A 2-tailed t test (P < .05) demonstrated a statistically significant difference with the experimental group showing greater improvement in the Oswestry Disability Index score than the control group. CONCLUSION: MET combined with supervised motor control and resistance exercises may be superior to neuromuscular re-education and resistance training for decreasing disability and improving function in patients with acute low back pain.     

Mini-open versus open decompression and fusion for lumbar degenerative spondylolisthesis with stenosis

The outcome of less invasive surgical techniques in comparison to traditional surgical techniques has been the source of debate. In this retrospective study, 51 patients who had undergone posterior lumbar fusion along with bilateral decompression were enrolled. Twenty-one patients underwent fusion using a standard, midline open technique (open group) and 30 patients underwent fusion using a mini-open technique, with a small, central incision for the decompression and bilateral paramedian incisions for the posterolateral fusion and placement of cannulated pedicle screws (mini-open group). Surgical variables were compared between the 2 groups. Patients in both groups experienced significant improvements in leg pain at 12 months, with a reduction in visual analog scale scores from 7.6 to 2.4 in the open group, and 7.8 to 2.3 in the mini-open group. There were no statistical differences between the groups in the magnitude of improvement of either the visual analog scale or Oswestry Disability Index scores. Operative times, blood loss, and length of hospitalization failed to show statistically significant differences between the groups, although there was a trend toward less blood loss and shorter hospitalization in the mini-open group. Fusion results and complications were similar between the 2 groups. Both techniques resulted in similarly statistically significant improvements in pain and clinical function.     

腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的相关性研究

目的探讨分析腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的相关性。方法回顾性分析我院于2010年2月~2011年6月收治的38例接受腰椎融合术的腰椎退行性疾病且术后发生下腰痛患者的临床资料,于所有患者出院后进行为期24个月的随访。在手术前及随访期间收集所有患者站立位X线片腰椎前凸的Cobb角,并分析其与患者下腰痛程度之间的相关性。结果术后12个月及24个月与手术前的腰椎矢状位Cobb角比较,均无统计学意义(分别为t=0.042,P=0.967及t=0.268,P=0.789);术后12个月及24个月的腰椎矢状位Cobb角与正常角度的差值与手术前比较均无统计学意义(分别为t=0.450,P=0.900及t=0.174,P=0.862)。术后12个月及24个月的VAS评分与手术前相比,有明显改善(分别为t=2.838,P=0.006及t=3.251,P=0.002),而术后12个月及24个月的ODI评分与手术前相比也有明显改善(分别为t=2.300,P=0.024及t=3.320,P=0.001)。术后12个月及24个月所有患者的腰椎前凸丢失与VAS评分及ODI评分均呈正相关(P0.05)。结论腰椎前凸角度的丢失与腰椎退行性疾患腰椎融合术后的腰痛关系密切,手术过程中腰椎前凸的重建十分重要。     

Evaluation of specific stabilizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation

AIM: The aim of the study was to evaluate the outcome of outpatient rehabilitation in patients with low back pain and lumbar disk disease with a specific stabilizing exercise of the M. multifidus and M. transversus abdominis. METHOD: 99 outpatients admitted to a rehabilitation unit were included in a prospective randomized controlled interventional trial. The interventional group consisted of 50 patients (34 male, 16 female; mean age 41.1 +/- 9.1, range; 21 - 54 years), 49 patients (31 male, 18 female; mean age 37.9 +/- 9.5, range; 19 - 55 years) were in the control group. Outcomes were assessed at the beginning and the end of the treatment and at a three month follow-up with the Oswestry Low Back Pain Disability Questionnaire, the Hannover Functional Ability Questionnaire FFbH-R, the pain scale SES and a numeric rating scale. RESULTS: In both groups there was a significant functional improvement as measured with the Oswestry Score and the FFbH-R. The interventional group showed better values at the end of the treatment. Pain as well could be reduced significantly by the treatment, but no differences were noted between the two groups. CONCLUSION: Outpatient rehabilitation improved functional capacity and pain in both groups. Advantages could be seen in the interventional group concerning functional status. The specific stabilizing exercise approach appears to be effective in conservative treatment programs of low back pain and lumbar disk disease.     

Radiotherapy for pain in chronic, degenerative low back pain syndrome--results of a prospective randomized study

AIM OF STUDY: A low-dose radiotherapy with 5 Gy on the lumbar spine in patients with chronic low back pain was investigated. METHOD: 31 patients with non-radicular low back pain since three years at the age of at least 50 years (64.3 years on average) were treated. A psychosomatic etiology of pain was excluded. 5 Gy or 0.5 Gy (placebo dose) were applied in five fractions to the lumbar spine including the facet joints. The pain was evaluated by means of the Oswestry-Disability-Score before, six weeks after therapy, and every three months during the follow-up (22.4 months on average). Drug therapy, physiotherapy, and physical treatment were continued. RESULTS: According to the randomised distribution, 18 patients were treated with 5 Gy and 13 patients with 0.5 Gy. The Friedman-Test did not reveal any significant difference (p > 0.05) of the Oswestry-Disability-Index before and after therapy for both single questions and the sum of questions in both groups. CONCLUSION: No significant decrease of the Disability Index after radiotherapy on the lumbar spine with 5 Gy could be demonstrated in the verum and placebo group. The authors do not recommend radiotherapy in cases of chronic low back pain. Individual successes have to be attributed to conservative treatment or placebo effects.     

综合疗法治疗老年腰椎间盘突出症合并骨质疏松的临床研究

目的 探讨综合疗法治疗老年腰椎间盘突出症合并骨质疏松患者的疗效,观察抗骨质疏松治疗在老年腰椎间盘突出症合并骨质疏松患者治疗中的作用.方法 60例老年腰椎间盘突出合并骨质疏松患者随机分为治疗组和对照组各30例,对照组采用腰椎牵引及物理因子治疗(包括干扰电疗法、微波治疗).治疗组在对照组治疗方法的基础上配合治疗骨质疏松的药物及脉冲电磁场(骨质疏松治疗仪)治疗.结果 治疗组治疗后的疼痛目测类比评分法(visual analogous scale,VAS)分值低于对照组(P<0.01).两组患者下腰痛评分比较,治疗前、后组内差异均有统计学意义(P<0.01),但治疗组治疗后的下腰痛评分优于对照组(P<0.01).两组患者的改善指数间差异有统计学意义(P<0.01).结论 配合抗骨质疏松治疗的综合疗法能提高老年腰椎间盘突出合并骨质疏松患者治疗的疗效.     

Transpedicular decancellation osteotomy in the treatment of peridural fibrosis

From 1992 to 1997 a series of 12 multiply operated (averaging 2.5 previous operations) patients with recurrent peridural fibrosis and postlaminectomy kyphosis underwent surgery at our clinic. The surgery was designed to restore the physiological lordosis and relax tethered cord and epidural veins by transpedicular decancellation osteotomy at a vertebra other than the vertebra with peridural fibrosis. This paper presents the long-term functional outcome of these 12 patients. Clinical assessments were conducted pre-operatively and at 3-month intervals postoperatively and included X-ray assessment and evaluation of the patients’ functional status by Oswestry Disability Index (ODI) and of pain by visual analogue scale (pain VAS). All symptoms and the pain due to peridural fibrosis disappeared in the early postoperative period. Patients had lower disability and pain scores at their early and long-term follow-ups (follow-up period 24–74 months, mean 36.3 months). For patients with failed medical therapy for peridural fibrosis accompanied by lumbar kyphosis or hypolordosis, transpedicular decancellation osteotomy should be the surgical treatment of choice. Received: 30 July 2000