Contemporary Management of Symptomatic Lumbar Disc Herniations

Contemporary Management of Symptomatic Lumbar Disc Hernia tionsKolawole A. Jegede, Anthony Ndu, Jonathan N. Grauerpages 217-224Abstract | Full Text | Full-Text PDF (109 K/article/S0030-5898(10)0000 4-0/abstractContemporary Management of Symptomatic Lumbar Disc Hernia tionsKolawole A. Jegede, BS, Anthony Ndu, MD, Jonathan N. Grauer, MDLumbar disc herniations are common clinical entities that may cause lumbar-related symptoms. The spectrum of treatment op tions is geared toward a patient's clinical presentation and ran ges from nothing to surgical intervention. Many lumbar disc he rniations cause no significant symptoms. In studies of asympto matic individuals who have never experienced lumbar-related sy mptoms, 30% have been reported to have major abnormality on magnetic resonance imaging. The mainstay of treatment of patients with symptomatic disc herniations is accepted to be n onoperative (as long as there are no acute or progressive neur ologic deficits); this includes medications, physical therapy, andpotentially lumbar injection. For patients with symptomatic dis c herniations who fail to respond appropriately to conservative measures, surgical intervention may be considered. For this po pulation, lumbar discectomy is considered to be a good option. 目前对有症状的腰椎间盘突出的治疗Contemporary Management of Symptomatic Lumbar Disc Hernia tionsKolawole A. Jegede, BS, Anthony Ndu, MD, Jonathan N. Grauer, MD*Lumbar disc herniations are common clinical entities that may cause lumbar-related symptoms. The spectrum of treatment op tions is geared toward a patient’s clinical presentation and ran ges from nothing to surgical intervention. Many lumbar disc he rniations cause no significant symptoms. In studies of asympto matic individuals who have never experienced lumbar-related sy mptoms, 30% have been reported to have major abnormality on magnetic resonance imaging.1 The main stay of treatment of patients with symptomatic disc herniations is accepted to be nonoperative (as long as there are no acute or progressive n eurologic deficits); this includes medications, physical therapy, and potentially lumbar injection. 2–4 For patients with sympto matic disc herniations who fail to respond appropriately to conservative measures, surgical intervention may be considered. Fo r this population, lumbar discectomy is considered to be a goo d option.腰椎间盘突出是导致腰椎症状的常见的临床疾病。

根据患者的临床描述，其治疗范围从无需处理到需要手术干预。

许多腰椎间盘突出没有明显症状，对那些从来没有过腰椎症状的无症状个体的研究表明，3 0%被报道存在显著的磁共振改变。

有椎间盘突出症状的患者的治疗主要还是非手术治疗为主（除非出现急性的或者进展性的神经症状），包括药物、理疗、注射治疗等等。

有症状的腰椎间盘突出患者，经非手术治疗无效，才会考虑手术，对于这类患者来说，腰椎间盘摘除术是一个不错的选择。

LUMBAR DISCECTOMY腰椎间盘摘除术Discectomy is the most common operation performed in the U nited States for patients who are experiencing lumbar-related s ymptoms.5 Nonetheless, despite the wide acceptance of discect omy as a treatment option for symptomatic lumbar disc herniat ion, there has been a paucity of level I evidence supporting th e effectiveness of this surgery compared with nonoperative car e.6 Significant regional variation in discectomy rates in the Unit ed States and lower international rates have also raised questi ons about when these surgeries should be performed.7椎间盘摘除术是美国腰椎症状患者最常见的手术方式。

尽管椎间盘摘除术被广泛认为是有症状腰椎间盘突出的手术方式之一，但是仍然缺乏一级证据证明其比非手术治疗更加有效。

美国国内不同区域显著不同的手术率，以及较低的国际手术率也同样产生这样的问题，到底何时应该手术。

Several studies have compared surgical and nonoperative treat ment, but small sample sizes, study design limitations, and fail ure to plan for high crossover rates limit the strength of these studies. Between the years of 1983 and 2007 there were 4 r andomized controlled trials (RCTs) comparing operative care wit h more conservative management, not including the well-publici zed Spine Patient Outcomes Research Trial (SPORT).5,8–12几个研究比较了手术和非手术治疗，但是样本量低、研究设计限制和难以控制的高交叉率使得这些研究缺乏效力。

1983年至2007年之间有四个随机对照试验研究了手术治疗和保守治疗的差异，这其中没有包含总所周知的脊柱患者预后研究实验（SPORT）。

Weber9 performed a controlled, prospective study with 10 year s of follow-up. Of the 280 patients enrolled in this study, 126 were randomized to either surgery or physical therapy. The oth ers were not randomized and had surgery or nonoperative trea tment. The group randomized to surgery had statistically better outcomes after 1 year. After 4 years, however, although thesurgery outcomes were still better, this difference was no long er statistically significant.Weber进行了一组随访达10年的前瞻性对照研究，研究包含280名患者，其中126名被随机分配进行了手术或者理疗，其余患者未进行随机分组，接受了手术或者是理疗。

随机分组中的手术组在1年随访时预后优于保守组，这一点具有统计学意义。