Faʻaleagaina o le Disc & Sciatica Nonoperative Treatment i El Paso, TX
O se siaki faʻasolosolo, lea e lauiloa foi o se pusa ua paʻu pe vaeluaina, o se tulaga faʻalesoifua maloloina lea e tupu pe a oʻo mai se loimata ile pito i fafo, o le fiva vevela o se intervertebral disk e mafua ai lona susu, vaega tutotonu e oso i fafo mai le mea na faaleagaina, o loʻo siomia ai cartilage. O faʻasolosolo faʻasesega e masani lava ona mafua mai i le pa'ū o le mama pito i fafo o se disse intervertebral, ua taʻua o le anulus fibrosus. Faʻasalaga, faʻavelaina o manuʻa poʻo le faʻamaʻavale e mafai foi ona mafua ai se siaki. O le loimata i le intervertebral disc e mafai ona iu ai i le faamatuu atu o vailaau e mafua ai le ita ma iu ai ina avea ma mafuaʻaga tuusaʻo o tiga ogaoga tiga, e tusa lava pe leai ni aʻa aʻa.
O faʻasalaga masani e masani lava ona atiae pe a uma se faʻasolosolo o le fatu o loʻo i ai nei, o se tulaga faʻalesoifua maloloina lea e tumau ai pea le tulaga o le pito i luga o le fibrosus, ae mafai, e mafai ona paʻu pe afai o le disasi e tuu i lalo o le mamafa. E le pei o se faʻatalanoaga o le CD, e leai se vaega o le gel e vaʻavaʻai ai le disete intervertebral. O faʻamaʻi faʻamaʻi e masani lava ona faʻamalolo i latou lava i totonu ole vaiaso. O faʻafitauli ogaoga o le faʻamalosi atonu e manaʻomia ai taotoga, ae ui i lea, o le tele o suʻesuʻega suʻesuʻe ua faʻaalia ai e le mafai ona togafitia le togafitiga e faʻaleleia atili ma pulea le faagasologa o le toe faʻaleleia o se 'ie e aunoa ma le manaʻomia mo taotoga.
Totogi ma togafitiga e le faʻaaogaina mo le Lumbar Disk Herniation Faʻaaogaina o le Suʻega o Suʻega Patient Result Research Trial (SPORT): O le Faʻasalaga Randomized
lē faʻatino
- Anotusi: O le diskectomy Lumbar o le taotoga taatele o taotoga masani mo faʻamaʻi tua ma vae i tagata maʻi US, ae o le aoga o le taualumaga e faʻatatau i le le tausia o tausiga e tumau pea le fefinauai.
- sini: Iloilo le aoga o le taotoga mo le lumbar intervertebral disk.
- Fuafuaga, Faʻatulaga, ma Tagata Malie: Ole Suʻega ole Suʻega ole Suʻega Suesuega, suʻesuʻeina ole falemaʻi i le va o Mati 2000 ma Novema 2004 mai 13 multinisciplinary spines clinics i 11 US states. O tagata maʻi o ni 501 suʻega tauvaga (tausaga taʻitasi, 42 tausaga; 42% fafine) faʻatasi ai ma le faʻataʻitaʻiina ole lumbar intersetebral dispersion ma le faʻaauau pea o faailoga ma faailoga o le radiculopathy mo le itiiti ifo i le 6 vaiaso.
- Faʻalavelave: Faʻaauau o le diskectomy tatala faʻatasi ma togafitiga le faʻapitoa i le tagata maʻi.
- Faʻamaumauga autu: O le Peraimeri o taunuʻuga o suiga mai le laiga mo le Suʻesuʻega o Suʻesuʻega Faʻapitoa 36-mea Faʻataʻitaʻiga o le Soifua Maloloina o le tino i tiga o le tino ma paleni o le tino ma le suiga o Oswestry Disability Index (American Academy of Orthopedic Surgeons MODEMS version) i 6 vaiaso, 3 masina, 6 masina, ma 1 ma 2 tausaga mai le lesitala. O taunuʻuga lona lua e aofia ai le malosi o le sciatica e pei ona fuaina e le Sciatica Bothersomeness Index, faʻamalieina ma faʻamaoniga, faʻaleleia e le tagata lava ia, ma tulaga faʻafaigaluega.
- Tali: O le faʻaaloalo i togafitiga ua faʻatapulaʻaina: 50% o tagata na togafitia i taotoga na maua le taotoga i totonu o le 3 masina o lesitalaina, ao 30% oi latou ua tofia i le togafitiga le togafitiga na maua le taotoga i le taimi lava e tasi. O suʻesuʻega faʻapitoa-i-togafitiga na faʻaalia ai le tele o faʻaleleia mo taunuʻuga muamua ma le lua i vaega uma o togafitiga. I le va o le eseesega o vaega i le faʻaleleia atili sa masani lava ona fesoasoani i taotoga mo vaitaimi uma ae e laʻititi ma e le taua fuainumera mo taunuʻuga autu.
- Faaiuga: O tagata maʻi i le taotoga lua ma le vaega o togafitiga e le faʻatagaina na faʻaleleia atili i luga o le 2 tausaga. Ona o le toatele o tagata gasegase oe na sopoia i itu uma e lua, o faaiuga e uiga i le sili atu poo le fetaui lelei o togafitiga e le talafeagai e faavae i luga o le iloiloga-i-togafitiga.
- Faamauina o le Faamasinoga: clinicaltrials.gov Faailoaina: NCT00000410
O le diskectomy Lumbar o le taotoga taatele o taotoga masani e faia i totonu o le Iunaite Setete mo maʻi ua toe foi mai ma faailoga vae; o le tele o taualumaga e filifilia. E ui i lea, o le lumbar disk herniation e masani lava ona maua i le faʻataʻitaʻiina o suʻesuʻega i le leai o ni [1,2] ma e mafai ona toe faʻamalosi i luga o le taimi e aunoa ma se taotoga [3] E oʻo atu i le 15-fesuiaiga eseese o fuainumera o diskectomy i le Iunaite Setete [4] faʻavae faavaomalo fesili e uiga i le talafeagai o nisi o nei taotoga. [5,6]
E tele suʻesuʻega ua faʻatusatusa i taotoga ma le leai o se faʻalavelave faiga o maʻi ma palapeti, ae o le eseesega o faavae i le va o togafitiga, vaega laiti laiti, po o le le lava o fuafaatatau o taunuuga o nei suesuega e le maua ai faaiuga e faavae i faamaoniga e uiga i togafitiga lelei. [7-12] Na amataina le Mati 2000 i le Mati 13 faʻatusatusa taunuuga o togafitiga faʻapitoa ma togafitiga mo le lumbar intervertebral disorders, vaʻaia o le vaovao, poʻo le spondylolisthesis degenerative. [2] O le faamasinoga na aofia uma ai se vaega faʻapitoa ma se vaega o le vaʻavaʻai o loʻo musu e faʻafeiloaʻi i le filifilia o a latou lava togafitiga ae faʻafeiloaʻi ai uma isi taiala mo le aofia ai ma oe na malilie e mulimulitai e tusa ai ma le maliega tutusa. O lenei tusiga o loʻo lipotia ai faʻamoemoega e faia i luga o XNUMX tausaga mo le kulupu faʻavalea.
Metotia
Suesuega Suesue
SPORT sa faia i 13 multinisciplinary spin practice i 11 US states (Kalefonia, Georgia, Ilinoi, Maine, Michigan, Misuri, Nebraska, New York, New Hampshire, Ohio, Pennsylvania). O le komiti o mataupu a tagata taʻitasi o loʻo aʻafia ai na faʻatagaina se faʻasalalauga faʻamaonia. O tagata gasegase na tuʻuina mai se maliega tusitusia tusitusia. O se faamaumauga tutoatasi ma le mataituina o le saogalemu o le siakiina o le suesuega i vaitau o 6-masina [13]
Onosaʻi o le Onosaʻi
O tagata maʻi na mafaufauina mo le aofia ai pe afai latou 18 tausaga ma matutua atu ma ua maua e fomaʻi aoga i le vaitaimi o le lesitalaina o suʻesuʻega e pei o le vaeluaina o le disverbral disk ma le faʻaauau pea o faʻamaoniga e ui i togafitiga e le faʻamalosia mo le itiiti ifo i le 6 vaiaso. O mea o loʻo i ai i le tausiga o le lesitalaina e leʻo faʻamaoniaina i le maliega ae aofia ai aʻoga / faufautua (71%), togafitiga faʻapitoa (67%), inisal epidural (42%), chiropractic therapy (32%), anti-inflammatory (61% ), ma suʻesuʻega opioid (40%).
Specific inclusion criteria at enrollment were radicular pain (below the knee for lower lumbar herniations, into the anterior thigh for upper lumbar herniations) and evidence of nerve-root irritation with a positive nerve-root tension sign (straight leg raise�positive between 30� and 70� or positive femoral tension sign) or a corresponding neurologic deficit (asymmetrical depressed reflex, decreased sensation in a dermatomal distribution, or weakness in a myotomal distribution). Additionally, all participants were surgical candidates who had undergone advanced vertebral imaging (97% magnetic resonance imaging, 3% computed tomography) showing disk herniation (protrusion, extrusion, or sequestered fragment)[14] at a level and side corresponding to the clinical symptoms. Patients with multiple herniations were included if only one of the herniations was considered symptomatic (ie, if only one was planned to be operated on).
Exclusion criteria included prior lumbar surgery, cauda equina syndrome, scoliosis greater than 15�, segmental instability (>10� angular motion or >4-mm translation), vertebral fractures, spine infection or tumor, inflammatory spondyloarthropathy, pregnancy, comorbid conditions contraindicating surgery, or inability/unwillingness to have surgery within 6 months.
Suʻesuʻega o Suesuega
O le taotoga o se tuulafoaia o le diskectomy tatala ma le suʻesuʻega o aʻafiaga o aʻafiaga aʻafia. [15,16] O le faʻatinoga na malilie i ai nofoaga uma sa auai na faia i lalo o faʻamaʻi lautele poʻo le faʻaleagaina i le lotoifale, faʻatasi ai ma tagata gasegase i le tulaga o le gasegase po o le tulivae. Sa faʻamalosia aliʻi tipitipi e faʻaaoga le faʻamalosi poʻo le microscope. I le faʻaaogaina o se faʻataʻotoga o le midline e atagia mai ai maso fomaʻi, na ulufale ai le avanoa vavalalata e pei ona faamatalaina e Delamarter ma McCullough. [15] I nisi tulaga, na aveeseina le tuaoi o le pito i luga o le pito i luga ina ia maua ai se vaaiga manino o le aʻa o le namu aafia. I le faʻaaogaina o se mea itiiti, na aveeseina ai le vaega o le vaʻaia e pei ona faamatalaina e Spengler. [16] Na asiasia le taivai ma faʻapipiʻi vaʻalele mo le toe vaega poʻo le pateni. O le aʻa o le namu na faʻalavelaveina, ma le faʻavavevave.
The nonoperative treatment group received �usual care,� with the study protocol recommending that the minimum nonsurgical treatment include at least active physical therapy, education/counseling with home exercise instruction, and nonsteroidal anti-inflammatory drugs, if tolerated. Other nonoperative treatments were listed, and physicians were encouraged to individualize treatment to the patient; all nonoperative treatments were tracked prospectively.[13,17]
Suʻesuʻega
O fua muamua o suʻesuʻega a le Fomaʻi Suesueina 36-Item Short-Form Health Survey (SF-36) tiga o le tino ma paleni o le tino (18-21) ma le American Academy of Orthopedic Surgeons MODEMS version o le Oswestry Disability Index (ODI). [22] E pei ona faʻamaonia i totonu o le faʻataʻitaʻiga, o taunuʻuga autu o suiga ia mai le laina amata i nei fua i 6 vaiaso, 3 masina, 6 masina, ma 1 ma 2 tausaga mai le lesitalaina.
E aofia ai ma le Sciatica Bothersomeness Index (laina, 23-0, o maualuga maualuga e sili atu ona sili ona leaga). [24]
Totogiina, Faʻasalaga, ma le Faʻasologa
O se tausisoifua sailiili i nofoaga taʻitasi ua faailoagofie tagata auai ma faamaonia le agavaa. Mo le faʻafaigaluegaina ma le faʻatagaina o le faʻatagaga, o faʻataʻitaʻiga o faʻataʻitaʻiga na faʻamatalaina ai togafitiga faʻapitoa ma togafitiga e leai ni togafitiga ma faʻamoemoega e ono faʻamoemoeina, lamatiaga, ma le le mautonu. [26,27] Na ofoina atu le aufaigaluega i totonu o le faamasinoga tuʻufaʻatasia poʻo se auvaʻa mataʻituina tutusa, o taunuuga e lipotia i se soa soalaupule.
O le lesitala na amata i le Mati 2000 ma faaiuina ia Novema 2004. O fesuiaiga o vaevaega na aoina aʻo le i faʻamaonia. Tomaʻi tagata taʻitoʻatasi ua lipotia mai ma tagata faʻaleaganuʻu e faʻaaoga ai National Institute of Health Health.
Faʻatonuina o le faʻaaogaina o komepiuta i luga ole poloka komipiuta o 6, 8, 10, ma 12) [28] i totonu o nofoaga na tutupu i le taimi lava na uma ai le lesitalaina e ala i se masini faʻautauta i luga o saite taʻitasi, faʻamautinoa le faʻamaonia lelei o le tufatufaga. O fuataga suʻesuʻe na aoina i le laina amata ma i taimi uma e faʻatulagaina ai asiasiga mulimuli. O asiasiga mo taimi pupuu na tutupu i 6 vaiaso ma 3 masina. Afai o le taotoga na tolopoina i tua atu o 6 vaiaso, na maua mai ai faʻamaumauga mulimuli mai 6 vaiaso ma 3 masina mulimuli ane. O asiasiga uumi taimi na tutupu i 6 masina, 1 tausaga mai le lesitala, ma tausaga taʻitasi mulimuli ane.
Iloiloga Faʻamaumauga
We originally determined a sample size of 250 patients in each treatment group to be sufficient (with a 2-sided significance level of .05 and 85% power) to detect a 10-point difference in the SF-36 bodily pain and physical functioning scales or a similar effect size in the ODI. This difference corresponded to patients’ reports of being �a little better� in the Maine Lumbar Spine Study (MLSS).[29] The sample size calculation allowed for up to 20% missing data but did not account for any specific levels of nonadherence.
The analyses for the primary and secondary outcomes used all available data for each period on an intent-to-treat basis. Predetermined end points for the study included results at each of 6 weeks, 3 months, 6 months, 1 year, and 2 years. To adjust for the possible effect of missing data on the study results, the analysis of mean changes for continuous outcomes was performed using maximum likelihood estimation for longitudinal mixed-effects models under �missing at random� assumptions and including a term for treatment center. Comparative analyses were performed using the single imputation methods of baseline value carried forward and last value carried forward, as well as a longitudinal mixed model controlling for covariates associated with missed visits.[30]
Mo taunuʻuga lona lua, na faʻapipiʻiina faʻataʻitaʻiga o le faʻaogaina o le logistic longitudinal i le faʻaaogaina o le equations equations equations equations [31] pei ona faʻatinoina i le PROC GENMOD program o le SAS version 9.1 (SAS Institute Inc, Cary, NC). O togafitiga o togafitiga na fuafuaina e pei o eseesega i le fuainumera fuafuaina i vaega o togafitiga 2.
P <.05 (2-itu) na faʻaaoga e faʻamautu ai fuainumera taua. Mo taunuʻuga autu, 95% vaʻaia talitonuina (CI) mo uiga togafitiga togafitiga na fuafuaina i taimi atofaina taimi uma. O suʻesuʻega o le lalolagi i le tuʻufaʻatasiga o le leai o se aʻafiaga i soʻo se taimi atofaina na faʻatinoina e faʻaogaina ai suʻega a Wald [32] e pei ona faʻatinoina i le SAS. O nei faʻataʻitaʻiga faʻatulagaina mo le faʻavasega faʻapitoa ona o le tele o taimi e fua ai.
Nonadherence to randomly assigned treatment may mean that the intention-to-treat analysis underestimates the real benefit of the treatment.[33,34] As a preplanned sensitivity analysis, we also estimated an �as-treated� longitudinal analysis based on comparisons of those actually treated surgically and nonoperatively. Repeated measures of outcomes were used as the dependent variables, and treatment received was included as a time-varying covariate. Adjustments were made for the time of surgery with respect to the original enrollment date to approximate the designated follow-up times. Baseline variables that were individually found to predict missing data or treatment received at 1 year were included to adjust for possible confounding.
i'uga
SPORT na maua uma le lesitalaina, faʻatasi ai ma le 501 (25%) o tagata gasegase o le 1991 o loʻo lesitalaina i le faamasinoga faʻavasegaina. O le aofaʻi o 472 tagata auai (94%) na maeʻa le aulia le 1 faʻasalalauga ma sa aofia ai i le suʻega. Na avanoa faʻamatalaga i le va o 86% ma le 73% o maʻi i taimi taʻitasi e mulimuli ai (Figure 1).
Ata 1: Taumafa Ata o le SPORT Iloiloga Faʻatonuina o Vaʻaia o le Disk Herniation: Faʻasalaga, Faʻailogaina, Faʻasalalau, ma le tulitatao.
Uiga o le Onosai
O uiga o le patient o loʻo faʻaalia ile Table 1. I le aotelega, o le faitau aofaʻi o le faitau aofaʻi o tausaga o le 42 tausaga, ma le toʻatele o tane, paʻepaʻe, faigaluega, ma le auai i le kolisi; 16% o loʻo maua se taui faʻaletonu. O tagata gasegase uma lava na i ai le tiga o le vae, 97% i se tufatufaina o le dermatomal. O le tele o faʻaleagaga o loʻo i L5-S1, posterolateral, ma o faʻamalosaga e ala i ata faʻataʻitaʻiga. [14] O le 2 vaega faʻapitoa na tutusa le tutusa i le laina.
Togafitiga e le faʻalogo
O le tele o togafitiga e leʻi faʻaaogaina sa faʻaaogaina i le taimi o suʻesuʻega (Laulau 2). O le tele o tagata mamaʻi na mauaina aʻoga / faufautua (93%) ma vailaau faʻamaʻi-inflammatory (61%) (faʻamaʻi-anti-inflammatory drugs, inhibitors 2 cyclooxygenase, poʻo steroid); 46% maua ni auiliiliga; sili atu nai lo le 50% mauaina inisiua (faʻataʻitaʻiga, faʻamaʻi faʻamaʻi); ma 29% na faʻatapulaʻaina tapulaa gaoioiga. E fa sefulu fasefulu pasene na maua le togafitiga faʻapitoa i le taimi o le faamasinoga; ae ui i lea, na maua e 67% ao le i lesitalaina.
Togafitiga Faʻasologa ma Faʻafitauli
O le Ata 3 o loʻo maua ai uiga o togafitiga faʻapitoa ma faʻafitauli. O le vaitau o taotoga o vailaʻau o 75 minute (laina faʻapipiʻi, 58-90), faʻatasi ai ma le gau toto o le 49.5 mL (laina telefoni, 25-75). Naʻo 2% manaʻomia ni faʻasalaga. E leʻi i ai ni oti faʻapitoa; O le patient 1 na maliu mai faʻafitauli o le fanauina o 11 masina talu ona lesitalaina. O le faʻateleina o le faʻaaogaina o mea faʻapitoa o le loimata tele (4%). E leʻi i ai ni faʻafitauli faʻapitoa i le 95% o maʻi. O le faʻatautaia na tupu i le 4% o maʻi i totonu o le 1 tausaga o le taoto muamua; e sili atu nai lo le 50% o le faʻasologaina ona o le faʻaauau pea ona faʻateleina i le tulaga tutusa.
Faʻaaloalo
Nonadherence to treatment assignment affected both groups, ie, some patients in the surgery group chose to delay or decline surgery, and some in the nonoperative treatment group crossed over to receive surgery (Figure 1). The characteristics of crossover patients that were statistically different from patients who did not cross over are shown in Table 4. Those more likely to cross over to receive surgery tended to have lower incomes, worse baseline symptoms, more baseline disability on the ODI, and were more likely to rate their symptoms as getting worse at enrollment than the other patients receiving nonoperative treatment. Those more likely to cross over to receive nonoperative care were older, had higher incomes, were more likely to have an upper lumbar disk herniation, less likely to have a positive straight leg�raising test result, had less pain, better physical function, less disability on the ODI, and were more likely to rate their symptoms as getting better at enrollment than the other surgery patients.
Missing Data
O fua faatatau o faʻamaumauga na misi, e tutusa i le va o vaega i taimi taitasi, e aunoa ma se faʻamaoniga o le faʻafitauli o le eseesega e tusa ai ma togafitiga ua atofaina. O uiga o tagata gasegase ma asiasiga na leiloloa na talitutusa lava ma latou o totoe o le kulupu sei vagana ai o tagata gasegase i le misi o faamatalaga e itiiti lava le faaipoipo, atonu o le a maua ai le le atoatoa o le malosi o le tino, sili atu ona ulaula, sili atu ona faʻaalia le vaivai vaivai , ma sa i ai laʻasaga otooto o le mafaufau mafaufau i le SF-36.
Fuafuaga mo le Manatu-i-Togafitiga
Table 5 shows estimated mean changes from baseline and the treatment effects (differences in changes from baseline between treatment groups) for 3 months, 1 year, and 2 years. For each measure and at each point, the treatment effect favors surgery. The treatment effects for the primary outcomes were small and not statistically significant at any of the points. As shown in Figure 2, both treatment groups showed strong improvements at each of the designated follow-up times, with small advantages for surgery. However, for each primary outcome the combined global test for any difference at any period was not statistically significant. This test accounts for intraindividual correlations as described in the �Methods� section.
Ata 2: Uiga o le Siʻosiʻomaga i luga o le Taimi mo le SF-36 Paʻu ma le Faʻatinoga o le Faʻatinoga ma le Faʻamaumauga o le Lotoifale o Oswestry.
Laulau 5: Faʻafitauli mo Togafitiga mo taunuʻuga o le Peraimeri ma le Maualuga e faavae i Suʻesuʻega-ma-Togafitiga Suʻega *
Mo le tulaga lua taunuʻuga o le sciatica faʻasoesa fafine, Laulau 5 ma le Ata 3 faʻaalia ai sa i ai sili atu faʻaleleia i le Sciatica Bothersomeness Index i le vaega o taotoga i uma atofaina taimi tulitatao: 3 masina (togafitiga aʻafiaga,? 2.1; 95% CI,? 3.4 i le? 0.9), 1 tausaga (togafitiga faʻataʻitaʻi,? 1.6; 95% CI,? 2.9 i le? 0.4), ma le 2 tausaga (togafitiga faʻafitauli,? 1.6; 95% CI,? 2.9 i le? 0.3), ma iʻuga o o le suʻesuʻe o le lalolagi suʻega e taua tele (P = .003). Onosaʻi faʻamalieina ma faʻailoga ma togafitiga faʻaalia ai laiti aʻafiaga i le taotoga o taotoga ae o galuega tulaga na faʻaalia ai ni faʻafitauli laiti i le le faʻaaogaina o tausiga, ae leai se tasi o nei suiga na taua faʻamaumauga. O le alualu i luma o oe lava na alualu i luma na faʻaalia ai se tamaʻi aoga taua mo le taotoga (P = .04).
Ata 3: Fua i luga o le Taimi mo Sciatica Bothersomeness Index, Tulaga o Galuega, Satisfaction With Symptoms, Satisfaction With Care, ma le Faʻatinoina o le Manatu.
O suʻesuʻega e pei ona togafitia e faʻavae i togafitiga na mauaina na faʻatinoina ma fetuʻunaʻiga mo le taimi o taotoga ma mea e aʻafia ai togafitiga faʻasolosolo ma faʻamaumauga leiloa. O nei mea na maua ai sili eseʻesega faʻaiuga nai lo le faʻamoemoega-to-togafiti suʻesuʻega, ma malosi, fuainumera taua taua vaʻaia mo taotoga i taimi uma tulitatao taimi e oʻo i le 2 tausaga. Mo se faʻataʻitaʻiga, i le 1 tausaga le fuafuaina o togafitiga togafitiga mo le SF-36 tino tino ma unaʻi faʻamalositino una, le ODI, ma le sciatica fua o 15.0 (95% CI, 10.9 i le 19.2), 17.5 (95% CI, 13.6 i le 21.5 ),? 15.0 (95% CI,? 18.3 i le 11.7), ma le? 3.2 (95% CI,? 4.3 i le? 2.1).
Sensitivity analysis was performed for 4 different analytic methods of dealing with the missing data. One method was based on simple mean changes for all patients with data at a given time point with no special adjustment for missing data. Two methods used single imputation methods�baseline value carried forward and last value carried forward.[32] The latter method used the same mixed-models approach for estimating mean changes as given in Table 5 but also adjusted for factors affecting the likelihood of missing data. Treatment effect estimates at 1 year ranged from 1.6 to 2.9 for the SF-36 bodily pain scale, 0.74 to 1.4 for the physical function scale, ?2.2 to ?3.3 for the ODI, and ?1.1 to ?1.6 for the sciatica measures. Given these ranges, there appear to be no substantial differences between any of these methods.
Dr. Alex Jimenez's Insight
O faʻamaʻiloga o faʻamaʻi faʻamaloilo e eseese i le tulaga o le tulaga ma luga o masini mūmū vaʻaia o loʻo aʻafia i luga o le tui. O le faʻasolosolo o le Lumbar, o se tasi o nofoaga e sili ona taatele mo faiva faʻamalosi e tupu ai, o loʻo faʻaalia e le aʻafiaga o aʻa o le aʻa i le pito i lalo ma mafai ai ona mafua ai faʻamaoniga o le sciatica. O le taotoga e masani lava ona fautuaina e togafitia ai le faʻamaʻiina o le disk, e ui i lea, o le tele o auala togafitiga e mafai ona fesoasoani e pulea le tulaga e aunoa ma le manaomia o togafitiga taoto. O se suʻesuʻega suʻesuʻega na faia i luga o sciatica na mafua mai i le faʻamalosiina o masini ua faʻamoemoeina e tusa ma le 73 pasene o tagata auai na latou maua se faʻaleleia atili o faʻamaoniga ma togafitiga e le faʻaalia. O taunuʻuga o lenei tusiga na faʻauʻuina e faapea, o togafitiga e le faʻaaogaina e mafai ona aoga e pei o le taotoga i le togafitiga o vaʻavaʻa.
manatu
O tagata gasegase ma tagata e le o faʻamalosia le faʻamaʻiina o le eletise e faʻaleleia atili le sili atu i le 2 tausaga. O le iloiloga o mea-i-togafitiga i lenei faamasinoga, e leai ni aafiaga faʻapitoa mo togafitiga mo taunuʻuga autu; o le tulaga lona lua o le sciatica ma le alualu i luma o le tagata lava ia na faʻaalia mai na faʻaalia ai tulaga taua tele mo le taotoga. O nei taunuuga e tatau ona vaʻaia i le uiga o le tele o fua faatatau o le le faʻaaloalo i togafitiga ua atofaina. O le mamanu o le le faʻaaloalo e afaina ona, e le pei o le tele o suʻesuʻega taʻavale, na aʻafia uma ai le taotoga ma le leai o se togafitiga. [35] O le faʻataʻitaʻiga muamua na maua muamua [8] na i ai le 26% crossover i le taotoga i le 1 tausaga, ae naʻo le 2% crossover out o taotoga. O le faʻafefiloi o togafitiga e mafua mai i le crossover e mafai ona faʻamoemoe e fatuina ai se faʻaituau i le leai o se mea. [34] O le tele o mea na vaaia i le suʻesuʻeina ma togafitiga faʻapitoa ma uiga o tagata gasegase o loʻo fautua mai e le manatu faʻamaonia le faʻamaoni o le mafaufau-i-treat aafiaga o taotoga.
O suʻega a le SPORT e ogatusa ma le poto masani i lena toomaga o le tiga o le vae o le mea aupito sili lea ona mataʻutia ma tumau faifaipea ma taotoga. O le mea sili ona taua, o tagata uma lava i lenei tofotofoga na i ai le tiga o le vae ma le suʻeina o le tino ma suʻesuʻega faʻataʻitaʻiga na faʻamautuina ai le vavalalata o le vaʻa. E itiiti ni molimau o le afaina mai togafitiga. E leai ni gasegase i totonu o vaega e lua na atiina ae le maʻi o le cauqu equina; 95% o tagata gasegase e leai ni faʻalavelave faʻaoga. O le faʻalavelave sili ona taatele, o loimata loimata, na tupu i le 4% o tagata mamaʻi, e tutusa ma le 2% i le 7% ua faʻamatalaina i le tolu-iloiloga e Hoffman et al, 7 2.2% na vaaia i le MLSS, [29] ma le 4% i le faasologa lata mai mai Stanford. [36]
E tasi le tapulaa o le leai o se sui o tagata gasegase ua malilie e vaʻaia i taotoga poʻo le le faʻaeteete; ae o le uiga o tagata gasegase e malilie e auai i le SPORT e talitutusa lava ma isi suʻesuʻega. [29,36] O le tausaga laʻititi o 42 tausaga e talitutusa ma tausaga o le MLSS, [29] le faasologa o Spangfort, [37] ma le laʻititi o le faamasinoga a Weber, [8] ma na o sina laʻititi lava nai lo i totonu o le faasologa talu ai nei mai Stanford (37.5 tausaga) [36] O le fuainumera o tagata gasegase na maua le taui a le aufaigaluega i SPORT (16%) e tutusa ma le vaega i le faitau aofaʻi o Stanford (19%) ae maualalo ifo nai lo lena i le faitau aofai o le MLSS (35%). O le tulaga amata o le tulaga faavae tutusa foi, faatasi ai ma se faiga faavae o le ODI o le 46.9 i SPORT vs 47.2 i le Stanford series, ma o se fua faatatau autu o le SF-36 physical function score of 39 i SPORT vs 37 i le MLSS.
Ae peitai, o le mausali o tulaga agavaa mo le agavaa, e ui i lea, e mafai ona faatapulaaina le le mautonu o nei taunuuga. O tagata maʻi e le mafai ona faʻafeiloaʻi faʻamaoniga mo 6 vaiaso ma le manaʻomia muamua o togafitiga faʻapitoa e leʻo aofia ai, e le o ni gasegase e aunoa ma ni faʻamaoniga ma ni faʻaaliga manino o le faʻasalaga ma faʻamaonia faʻamaonia. E le mafai ona tatou faia ni faaiuga e uiga i le aoga o taotoga i isi vaega. Ae ui i lea, o la matou faʻataʻitaʻiga e mulimulitai i taʻiala ua faʻasalalau mo le maʻitaga mo le filifiliga o le diskectomy, ma o matou taunuuga e tatau ona faʻaaoga i le tele o tagata o loʻo feagai ma togafitiga. [38,39]
To fully understand the treatment effect of surgery compared with nonoperative treatment, it is worth noting how each group fared. The improvements with surgery in SPORT were similar to those of prior series at 1 year: for the ODI, 31 points vs 34 points in the Stanford series; for the bodily pain scale, 40 points vs 44 in the MLSS; and for sciatica bothersomeness, 10 points vs 11 in the MLSS. Similarly, Weber[8] reported 66% �good� results in the surgery group, compared with the 76% reporting �major improvement� and 65% satisfied with their symptoms in SPORT.
O le faʻaleleia o le faʻaleleia ma togafitiga e le faʻaaogaina i le SPORT e sili atu nai lo i le MLSS, ma mafua ai le faʻaititia o togafitiga tau togafitiga. O le faʻaleleia o le 37, 35, ma le 9 i tiga o le tino, galuega faaletino, ma le sciatica faʻalavelave, faasolosolo, na sili atu nai lo le faʻaleleia o le 20, 18, ma le 3 o loʻo lipotia i le MLSS. O le faʻaleleia atili o le togafitiga faʻapitoa i le SPORT e mafai ona fesoʻotai i le tele o tagata gasegase (43%) o loʻo faia taotoga i lenei vaega.
The major limitation of SPORT is the degree of nonadherence with randomized treatment. Given this degree of crossover, it is unlikely that the intent-to-treat analysis can form the basis of a valid estimate of the true treatment effect of surgery. The �as-treated� analysis with adjustments for possible confounders showed much larger effects in favor of surgical treatment. However, this approach does not have the strong protection against confounding that is afforded by randomization. We cannot exclude the possibility that baseline differences between the as-treated groups, or the selective choice of some but not other patients to cross over into surgery, may have affected these results, even after controlling for important covariates. Due to practical and ethical constraints, this study was not masked through the use of sham procedures. Therefore, any improvements seen with surgery may include some degree of �placebo effect.�
O le isi mea e gata mai ai, o le filifiliga o togafitiga e le faʻaaogaina i le faitalia a le fomaʻi togafitiga ma le onosaʻi. Ae ui i lea, ona o le faʻamaoniga faʻamaonia e faatatau i le aoga mo le tele o togafitiga e le faʻamalosia mo le lumanaʻi o le lumbar ma suiga o le tagata i le tali atu, o le faia o se tapulaa, faʻapitoa mo togafitiga e le mafai ona faʻamalosi pe mafai foi ona mafai. O le faʻaaogaina o togafitiga na faʻaaogaina na ogatusa ma taiala ua lolomiina. [17,38,39] Faʻatauina i le MLSS, SPRUV e itiiti lona faʻaaogaina o le faʻatapulaʻaina o galuega, togafiti faʻamaʻavaleina, faʻavaveina o le namu eletise, ma faʻamalosi ma corsets, ma maualuga maualuga o iniseti epidural injections ma le faʻaaogaina o nakoti analgesics. O lenei faʻafitauli faʻapitoa e leai se faʻalavelave na i ai le lelei o le tagata taʻitoʻatasi na ia manatu o maʻi e sili ona fiafia i le filifiliga o togafitiga e le faʻamalosia ma le faʻaalia o le faʻagaoioi masani i agavaʻa o multinisciplinary. Ae peitai, e le mafai ona tatou faia se faaiuga e uiga i le aafiaga o le taotoga ma soo se togafitiga faapitoa e le o togafitiga. I se tulaga talitutusa, e le mafai ona tatou vaʻaia lelei le fesoʻotaʻiga vavalalata o soʻo se eseesega i metotia tifaga.
iʻuga
O tagata maʻi i le taotoga ma faʻamaʻi togafitiga e le faʻatagaina na faʻaleleia atili i luga o le 2 tausaga muamua. I le va o le eseesega o vaega i le faʻaleleia atili, e masani ona fesoasoani i taotoga mo taunuʻuga uma ma i taimi uma, ae na laʻititi ma e le taua fuainumera sei vagana ai le tulaga lua o le sciatica ma le faʻaleleia o le tagata lava ia. Ona o le maualuga o le gasegase oe na sopoia i itu uma e lua, o faaiuga e uiga i le sili atu poo le fetaui lelei o togafitiga e le tatau ona maua mai i luga o le iloiloga o mea e fai-ma-togafiti.
Faʻafetai & Faamatalaga pito i lalo
Ncbi.nlm.nih.gov/pmc/articles/PMC2553805/
Manipulation poʻo Microdiskectomy mo Sciatica? O se Suʻesuʻega o Suʻesuʻega mo Suʻesuʻega Faʻatonu
lē faʻatino
sini: O le faʻamoemoe o lenei suʻesuʻega o le faʻatusatusaina lea o le aoga o le togafitiga o le vaʻaia faasaga i le microdiskectomy i tagata gasegase i le sciatica lona lua i le lumana disordered herniation (LDH).
Metotia: E selausefulusesesesesesesegase na tuʻuina atu e ala ile suʻega filifilia e fomai tipitipi muamua i fomai tipitipi o le neurosurgical na vaʻaia faʻamaonia mo le faʻamaonia o le LLNUMX-3, L4-4, poʻo le L5-S5. E fa sefulu faʻasefulu faʻalua ona faʻatagaina tagata gasegase na latou faʻapipiʻiina le tuʻuina atu o faʻamaumauga (e le gata i le faʻamamaina o le 1 masina e aunoa ma le faʻaaogaina o togafitiga e aofia ai togafitiga faʻatasi ai ma analgesics, suiga o le olaga, physiotherapy, massage togafitiga, ma / poo le acupuncture). Faʻasalaga i le isi togafitiga na faʻatagaina ina ua mavae masina 3.
Tali: O se faʻaleleia lelei i vaega uma e lua o togafitiga faʻatusatusa i numera o laina i luga o le taimi sa matauina i fua uma o fuataga. A maeʻa le 1 tausaga, o le faʻataʻitaʻiga o le faʻataʻitaʻiga e le faʻaalia se faʻafitauli i le taunuʻuga e faʻavae i le uluai togafitiga na maua. Ae ui i lea, o tagata 3 na sopoia mai le taotoga i le togavao ma ua le mafai ona toe faaleleia. E valu tagata gasegase na sopoia mai le togafiti o le tino i le taotoga ma faaleleia atili i le tikeri e tutusa ma a latou taotoga muamua.
Faaiuga: E ono pasene o tagata gasegase ma le sciatica o ē na le manuia isi togafitiga faafomai na faamanuiaina mai le togafitia i le vaeluaina i le tikeri tutusa e pei o latou faia le taotoga. O le 40% o loʻo totoe le le faamalieina, o le taotoga faʻapitoa mulimuli ane e maua ai se taunuuga lelei. O tagata mamaʻi e iai faʻamaoniga LDH e le lelei le puleaina o togafitiga e tatau ona mafaufau i togafiti faʻamaʻi ma sosoo ai ma taotoga pe afai e manaʻomia.
I le faʻasalaga, o le faʻamaʻiina o le fatu e mafua ai le loimata ma le ogatotonu o se 'intervertebral disiki e faʻafefe ai loimata i lona pito i fafo, mama filo e mafua mai i le faʻaleagaina, faʻalavelave, faʻalaʻoina o manuʻa poʻo le faʻalavelave. O le tele o faʻasalaga e mafai ona faʻamalolo i latou lava ae oi latou e manatu mamafa e ono manaomia ai togafitiga faʻapitoa e togafitia ai i latou. Suesuega suʻesuʻega, e pei o le maualuga o loʻo i luga, ua faʻamaonia ai e le mafai ona togafitia le togafitiga e aunoa ma le manaomia ole taotoga. Faʻamatalaga mai le National Center for Biotechnology Information (NCBI). O le lautele o a tatou faʻamatalaga e faʻapulaʻaina i le faʻamaʻi faʻamaʻi faʻapea foi ma manua ma tuʻutuʻu. Ina ia talanoaina le mataupu, faamolemole ia lagona le saoloto e fesili ia Dr. Jimenez pe faʻafesoʻotaʻi mai i matou 915-850-0900 .
Faʻailoina e Dr. Alex Jimenez
Aʻoaʻoga Faʻaopoopo: Paʻu Paʻa
E tusa ai ma fuainumera, e tusa ma le 80% o tagata o le a oʻo i faʻamaoniga o tiga i tua e le itiiti ifo ma le tasi i o latou olaga atoa. O le tiga mulimuli o se faasea masani lea e mafai ona mafua ona o le tele o manuaga ma / poo tuutuuga. O le tele o taimi, o le faʻaleagaina masani o le vaʻai ma le matutua e ono mafua ai le tiga. E iai faʻamaʻi vaʻaia pe a oʻo i le mea e faʻavaivaia, e pei o le gel-like o le 'intervertebral disc' e ala i loimata i lona taamilosaga, o le pito i fafo o le cartilage, faʻamalosi ma faʻafefe ai aʻa aʻa. O faʻasalaga faʻasalalau e masani lava ona tutupu i le pito i lalo, poʻo le lumine spine, ae e mafai foi ona tupu i luga o le tui o le au, poo le ua. O le afaina o neura e maua i le maualalo ona o le manua ma / poʻo se tulaga faʻateleina e mafai ona oʻo atu ai i faailoga o le sciatica.
FAʻAALIGA TOPIC: TUʻUʻU FAʻATASI: O Oe Lelei Oe!
AUTU TULAGA FAATINO: FAʻAALIGA: Taʻaloga Taʻaloga? | Vincent Garcia | Patient | El Paso, TX Chiropractor
