终板源性腰痛的诊断和外科治疗分析

目的探讨严重终板源性腰痛的诊断和外科治疗方法。方法所有患者行影像学检查,并用腰椎间盘造影术确定疼痛椎间隙融合节段。用视觉疼痛模拟评分（VAS）和Oswestry功能障碍问卷调查表,对每个患者术前和术后的腰痛症状和腰椎功能障碍指数（ODI）分别评分,评估腰椎融合术疗效。结果本组21例患者,经腰椎间盘造影术诊断为终板源性腰痛,全部行腰椎前路或后路融合术。术后随访2—6年,平均3年5个月。除1例仍有腰痛外,其余20例（95％）腰痛症状明显改善或完全消失,腰椎物理功能明显改善。VAS和ODI评分在术前和术后的比较,差异有统计学意义（P=0．0001）。结论研究表明腰椎间盘造影术是诊断终板源性腰痛的可靠手段,腰椎融合术是治疗终板源性腰痛的有效方法。

Diagnosis and surgical treatment of back pain originating from endplate

OBJECTIVE: To explore the methods of diagnosis and surgical treatment for patients with back pain originating from endplate. METHODS: All patients received examinations of radiography, CT, and MR imaging. Pain level of disc was decided by discography in each patient. The principal outcome judgment were pain and disability, and the efficacy of surgical treatment was assessed by visual analog scale (VAS) for pain, and the Oswestry disability index (ODI) for functional recovery. RESULTS: All patients with a diagnosis of back pain originating from endplate according to discography were treated with anterior or posterior fusion surgery. The mean follow-up period was three years and five months (from 2 to 6 years). Among of the 21 patients, 20 (95%) 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 on the ODI and the VAS scores were obtained in the patients with chronic low back pain originating from endplate (P = 0.0001) after treatment. CONCLUSIONS: The study suggests that the discography and fusion surgery may be very effective methods for the diagnosis and treatment of chronic back pain originating from endplate respectively.