11. 椎间盘内干预后的10年结果：穿刺椎间盘无加速退变，具有持续的长期益处

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100705

Andreas Veihelmann MD, PhD

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引用次数: 0

摘要

背景：椎间盘内干预和椎间盘造影术治疗椎间盘源性疼痛或伴有神经根症状的椎间盘突出仍有争议。值得注意的是，Carragee等人的一项研究表明，穿刺健康椎间盘会加速其退变。目的：本研究旨在评估椎间盘造影、椎间盘内电热治疗和椎间盘内减容等椎间盘内干预治疗后10年的长期疗效。研究设计/设置：回顾性临床观察性试验。患者样本：我们联系了162名在2009年至2013年期间接受椎间盘造影术或椎间盘内手术的患者，我们试图达到n=50来完成评估。结果：对腰椎术前和术后mri（间隔约10年）进行分析。在10年随访期间，还使用数字评定量表（NRS）、Oswestry残疾指数（ODI）和SF-36来测量长期结果。方法采用Pfirrmann分类对椎间盘退变进行评估，并将同一椎间盘内的退变与邻近未穿刺的椎间盘进行比较。使用Pfirrmann分类的评估由经验丰富的MRI放射科医生和脊柱外科医生独立进行，评估了内部和内部的可靠性。结果121例患者中，50例符合纳入和排除标准(30例接受腰椎手术；41人因一般健康原因不能参加)。在椎间盘退变评估中观察到较高的内部和内部可靠性。9-10年间，穿刺和未穿刺的椎间盘均表现出明显的退变。然而，在穿刺椎间盘和未穿刺椎间盘之间，退变率没有统计学上的显著差异。个体间比较也得出了类似的结果。穿刺尺寸（椎间盘造影术为22号，椎间盘内手术为17号）对结果没有显著影响。术后10年，NRS、ODI和SF-36评分均有显著改善。结论：在这个队列中，在10年的时间里没有观察到穿刺椎间盘加速退变的证据。椎间盘内手术是安全的，并在所有测量参数的疼痛和残疾评分方面提供了显著、持续的改善。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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11. Ten-year outcomes following intradiscal interventions: no accelerated degeneration in punctured discs with sustained long-term benefits

BACKGROUND CONTEXT

Intradiscal interventions and discography for managing discogenic pain or disc protrusions with radicular symptoms remain controversial. Notably, a study by Carragee et al suggested that puncturing healthy discs accelerates their degeneration.

PURPOSE

This study aimed to evaluate long-term outcomes 10 years after intradiscal interventions such as discography, intradiscal electrothermal therapy, and intradiscal volume reduction.

STUDY DESIGN/SETTING

Retrospective clinical observational trial.

PATIENT SAMPLE

We contacted 162 patients who underwent discography or intradiscal procedures between 2009 and 2013, of which we were abel to achieve n=50 for complete assessment.

OUTCOME MEASURES

Pre- and postprocedure MRIs (approximately 10 years apart) of the lumbar spine were analyzed. Long-term outcomes were also measured using the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and SF-36 at the 10-year follow-up.

METHODS

Disc degeneration was assessed using the Pfirrmann classification and compared within the same disc over time and against a neighboring nonpunctured disc. Evaluations using the Pfirrmann classification were performed independently by an experienced MRI radiologist and a spine surgeon, with intra- and inter-rater reliability assessed.

RESULTS

Of the 121 patients contacted, 50 met the inclusion and exclusion criteria (30 underwent lumbar spine surgery; 41 could not participate due to general health reasons). High intra- and inter-rater reliability was observed in disc degeneration assessments. Both punctured and nonpunctured discs showed significant degeneration over 9–10 years. However, there was no statistically significant difference in the rate of degeneration between punctured and nonpunctured discs. Intraindividual comparisons yielded similar results. Puncture size (22-gauge for discography and 17-gauge for intradiscal procedures) did not significantly influence outcomes. NRS, ODI, and SF-36 scores demonstrated significant improvement 10 years post-procedure.

CONCLUSIONS

In this cohort, no evidence of accelerated degeneration in punctured discs was observed over 10 years. Intradiscal procedures were safe and provided significant, sustained improvements in pain and disability scores across all measured parameters.