C_03_Mid-+and+long-term+results+of+open+discectomy+a+clinical+study+with+three+to+twelve+years+of+follow-up_2005

Mid- and long-term results of open discectomy:a clinical study with three to twelve years of follow-up. 2005 1. 제목, 저자, 저널명
Mid- and long-term results of open discectomy:a clinical study with three to twelve years of follow-up. 2005 [|P. Cherubino], [|D. Prestamburgo], [|F. Chiodini], [|M. F. Surace] and [|A. Reggiori] [|Journal of Orthopaedics and Traumatology]

2. 기존 지식
Long-term studies on the results of open discectomy (OD) for the treatment of lumbar disc herniation have shown a high percentage of patients complaining of low back or leg pain and obtaining a permanent disability allowance.

3. 연구목적
We evaluated the clinical results of OD in a consecutive series of patients with 3–12 years of follow-up.

4.연구방법
In May 2003, one of us (FC) interviewed the patients by telephone and administered a questionnaire with questions about working capacity, professional situation, compensation and residual low back pain or pain irradiated to the lower limb.

At the same time, patients were asked to answer to the Oswestry disability questionnaire (ODQ), version 2.0 [12, 13], and we calculated the Oswestry disability index (ODI).

After the telephone interview, patients were invited to a second examination where we performed physical tests, including the straight leg rising test (SLRT) and the cruciate straight leg

5.1 대상자의 특성
Between March 1991 and November 1999 154 consecutive patients underwent open discectomy (OD) surgery for lumbar disc herniation at our institute. The surgical technique included the removal of the herniated disc through an interlaminar approach and a limited laminotomy, followed by the accurate removal of the remaining nucleus polposus. Thus, the follow-up study was performed on 85 patients (55.2% of the initial group), including 48 men and 37 women.

5.2 제일 중요한 연구결과
At the time of the study, 16 patients (18.8%) were involved in light work, 35 patients (41.2%) in medium strenuous work, 26(30.6%) in heavy work and 8 patients (9.4%) were not employed. The level of disc surgery was L3-L4 in one patient (1.2%), L4-L5 in 42 patients (49.4%) and L5-S1 in 41 patients (48.2%). One patient only had two levels operated on at the same surgery: L4-L5 and L5-S1. The mean ODI for the 85 patients was 17.43 (range,0–68; SD=14.32) at a mean follow-up time of 85.9 months (range, 40–146). We compared the mean ODI of patients with 3–6 years of follow-up (mid term) with that of patients with 6–12 years of follow-up (long term): there was no significant difference between the two groups at the t test (p=0.816). There was no correlation between ODI and patient’s age (p=0.25), level of occupational activity (p=0.323) or level of herniation (p=0.31). Of the 85 patients, 40 (47.1%) gave permission to a second clinical exam. There was no significant correlation between ODI and any of the tested findings: SLRT<45° (R2=1.8, p=0.471), CSLRT<60° (R2=0), strength (R2=2.3,p=0.387), sensitivity (R2=1.9, p=0.460), or reflex deficits (R2=0.5, p=0.826). Nine patients out of 40 (22.5%) complained of a persistent sciatica that had never been completely relieved by the surgical procedure; their mean ODI was 32.56 (SD=13.81). Linear regression analysis showed a positive correlation between a higher ODI and the persistence of sciatica (R2=25.8, p<0.001). Furthermore, 29 patients (72.5%) suffered persistent low back pain (LBP); their mean ODI was 21.56 (SD=14.74). LBP was strongly correlated to a high ODI (R2=35.4, p<0.001).Overall, 11 (12.9%) of the 85 patients had undergone re-operation:

6. 고찰
We conclude that even if open discectomy still represents an effective technique, with good results in both the short and mid-long terms, a high rate of patients complaining of low back pain is found within the first decade after surgery.

8.1 이 논문을 읽은 목적
OD를 한 후 중장기 예후를 알고 싶었다.

8.2 이 연구의 단점
표본이 작은거 같다.

8.3 이 연구의 가치
OD의 중장기 예후를 알 수 있어서 OD와 MED를 비교하는 기준을 세우는데 근거가 될 수 있을 것 같다.

8.5 이 논문이 우리 논문에 어떤 도움이 될 것인가
8.3과 같다. 그리고 논문에 인용된 자료들이 매우 유용해 보임. 표본이 크다.