押し出された腰椎椎間板ヘルニアの自発的回帰：臨床結果との相関

OBJECTIVE: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome. METHODS: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI.平均17.0±7.2ヶ月の期間の後、フォローアップ中に保守的なケアのみを受けた40人の患者でMRIを繰り返し採取しました。ヘルニア椎間板の体積の変化が測定されました。患者は次のように3つのグループに割り当てられました。（1）非回帰、（2）部分回帰、および（3）完全な解像度。数値評価尺度（NRS）痛み、オスウェストリー腰痛障害指数（ODI）、筋肉の脱力が評価されました。 結果：T2強調MR画像のディスクボリュームに基づいています。4人の患者（10％）は退行を示さず、6人の患者（15％）が部分的な退行をし、30人の患者（75％）が完全な解像度を持っていました。完全な解像度の患者は、時間の経過とともにNRS疼痛スコアとODIスコア（P <0,001）の有意な改善を示しました。部分的な退行の患者では、ODIスコアのみが大幅に改善されました（P = 0,043）。非回帰群では、臨床結果測定値の改善は示されませんでした（p> 0,05）。NRSスコアの時間の経過に伴う変化は、非回帰群と比較して完全解像度グループで有意に高かった（P = 0.016）。 結論：腰椎椎間板ヘルニアの押し出された患者の大部分は、保守的なケアを伴う症状と機能の改善とともに、長期的にヘルニア椎間板のサイズが小さくなる可能性があります。

OBJECTIVE: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome. METHODS: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated. RESULTS: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016). CONCLUSION: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.