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腰椎间盘,症状持续时间对手术的指示的重要性

Nikolaus Kögl, Ondra Petr, Wolfgang Löscher

Deutsches Arzteblatt international

|June 5, 2024

概括

对于症状的腰椎间盘,建议在6-12周内进行保守治疗,除非存在严重的神经学缺陷或尾巴马体综合征. 早期手术可以改善严重运动缺陷的结果.

科学领域:

神经外科神经外科
整形外科整形外科整形外科
脊柱外科手术脊柱外科手术

背景情况:

腰椎间盘是常见的脊柱疾病,需要手术干预.
目前对症状性椎间盘的治疗策略正在发展.

研究的目的:

审查目前对症状性腰椎间盘的治疗建议.
概述保守与外科手术治疗的指示.

主要方法:

在PubMed中选择性的文献搜索,使用术语[定时] 和[腰椎间盘].
附加了其他相关文章和临床指南.

主要成果:

60-80%的患者在6-12周内出现症状消失; 80-90%的患者长期出现症状消失.
建议在没有显著的神经学缺陷的情况下进行6-12周的保守治疗.
早期手术适用于疼痛恶化,新的神经学缺陷或尾巴马综合征 (24-48小时内).
患有严重运动缺陷 (MRC ≤ 3/5) 的患者可以在三天内从手术中受益.
轻度 (MRC 4/5) 可能需要为功能障碍进行早期手术.

结论:

较长的症状持续时间和较低的运动分数与较差的结果和减少的神经恢复相关.
运动缺陷恢复率因治疗时间,方式和初始运动分数而异 (33-75%).

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