单节段腰椎间盘突出症保守治疗与单纯髓核摘除术的远期效果观察

目的 分析比较保守治疗与单纯髓核摘除术对单节段腰椎间盘突出症的远期疗效及其影像学变化,为临床治疗腰椎间盘突出症提供参考.方法 回顾性分析1983年1月-2008年6月收治且随访10年以上的182例单节段腰椎间盘突出症患者的病例资料.其中保守治疗组73例,男49例,女24例,L4-L5突出44例,L5-S1突出29例,随访时间17.61±3.87年；手术治疗组109例,均采用单纯髓核摘除术治疗,男71例,女38例,L4-L5突出68例,L5-S1突出41例,随访时间17.17±3.47年.通过对两组患者临床表现、影像学变化、神经功能评定、病变间隙及其头侧邻近节段椎间隙高度变化、病变间隙头侧邻近节段退变发生率的比较研究,观察保守治疗与单纯髓核摘除术治疗单节段腰椎间盘突出症的远期疗效.结果 保守治疗组73例中8例因出现间歇性跛行而行椎管减压手术,手术治疗组109例中13例因原间隙椎间盘突出复发行二次手术.随访终点手术治疗组病变间隙高度(0.62±0.15cm)显著低于保守治疗组(0.69±0.13cm,P＜0.05),而Oswestry评分(23.9％±6.3％)、病变间隙头侧邻近节段椎间隙高度(0.83±0.11cm)与保守治疗组(分别为23.3％±6 5％、0.82±0.11cm)比较差异无统计学意义.保守治疗组5例、手术治疗组9例出现影像学退行性不稳定表现,但均无明显临床症状.依据UCLA标准,保守治疗组8例(12％)、手术治疗组23例(22％)出现病变间隙头侧邻近节段退变,两组邻近节段退变发生率比较差异具有统计学意义(P＜0.05).结论 保守治疗与单纯髓核摘除术治疗单节段腰椎间盘突出症均可获得较好的远期效果.单纯髓核摘除术后远期病变椎间隙高度明显变窄,邻近节段退变较少引发临床症状.

A long-term follow-up study of the remote result of lumbar discectomy versus conservative treatment for single-level lumbar disc herniation

Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment.Methods The clinical data from 182 patients with single-level lumbar disc herniation,who were treated from January 1983 to June 2008 and followed-up for more than 10 years,were analyzed retrospectively.These patients were divided into conservative treatment(CT) group(n=73) with a mean follow-up time of 17.61±3.87 years,and surgery group(n=109) with a mean follow up time of 17.17±3.47 years.In the CT group,49 patients were male,24 female;there were 44 patients with L4-L5 disc herniation,and 29 L5-S1 disc herniation.In 109 patients in the surgery group,71 were male,38 female;68 had L4-L5 disc herniation,41 had L5-S1 disc herniation,and all of them received lumbar discectomy.The long-term therapeutic effects were reviewed and compared retrospectively in the two groups,including clinical manifestations,image changes,neurofunctional evaluation,height of morbid intervertebral space,adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration.Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group,and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation.At final follow up,the height of morbid intervertebral space(0.62±0.15cm)in surgery group was significantly lower than that in CT group(0.69±0.13cm,P<0.05),the Oswestry score(23.9%±6.3% in surgery group,23.3%±6.5% in CT group) and height of adjacent segment intervertebral space(0.83±0.11cm in surgery group,and 0.82±0.11cm in CT group) were statistically compared,and no significant difference was found between the two groups.Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging,however,none of them presented obvious clinical symptoms.According to UCLA criteria,cephalad adjacent segment degeneration occurred in 8 patients(12%) of CT group,and in 23(22%) of surgery group,and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group(P<0.05).Conclusions The height of morbid intervertebral space is remarkably lower,and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy.Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.