| ObjectiveTo formulate a self - made preoperative objective rating system that can predict the curative effect after lumbar discectomy, and to prove its effect in e-valuating the condition of all patients and predicting the curative effect after operation. Meanwhile this effect was also proved by the comparison of the self-made preoperative objective rating system for lumbar intervertebral disc herhia-tion and some representative (authority) rating systems, including the Japanese Orthopaedic Association's Assessment of Treatment for Low Back Pain ( JOA score) and a revised rating system. And the author confirmed that the self -made rating systems should be fit for Chinese practice condition, not heavy and complicated, easy to clinic use and processing by the computer.Summary of background dataSurgical treatment of lumbar disc herniation was the only method to cure once and for all to bring under permanent control, but failed Back Surgery Syndrome was difficult to be solved. The failure rate reported in the literature varied from 1% to 48%. Inappropriate patient selection continued to be one of the most common causes of Failed Back Surgery Syndrome in the surgical treatment of lumbar disc herniation. Thus the method by means of the patients'symptom and physical sign came into being because of demand.MethodsThis investigation was prospective. Between 2000 and 2002, 177 consecutive patients with lumbar disc herniation who were firstly operated were selected and the self - made rating score was assigned before surgery. And 105 patients completed the follow - up study and were made scores of the patients, preopera-tive and post - operative conditions by the self - made rating system, JOA and a revised rating system, then to input all datum in a computer and analyze the datum by SPSS10.0. There were 45 men and 60 women, ranging in age from 19 to 70 years (44. 7 å¤ 11. 2). Followup averaged 24 months (range, 10 to 46 months ). There were 80 one - level discectomies: L4 - L5 discectomy in 45 patients and L5 - SI in 35. Two - level discectomies numbered 24: L4 - L5 and L5 - SI discectomies in 22 patients and L3 - L4 and L4 - L5 in 2. Three - level discectomies numbered 1: 13 -4, L4 -5 and L5 -SI discectomies. The self-made rating system included the patient'symptom, physical sign and CT - MR Imaging. The average preoperative and post - operative scores were 56. 2 (range, 20-80, standard deviation = 12.9) and 15.1 (range, 0-66, standard deviation = 13. 0) respectively. The curative effect was evaluated by the low back pain criterion of Chinese Orthopedic Association.ResultsOn the basis of the surgical grading scale, 34 patients (32.4% ) had good outcomes; 58 patients (55.2% ) had fair outcomes; and 13 patients (12.4% ) had poor outcomes at long term follow - up. The average preoperative and post-operative scores were 55.9 (range, 33-75, standard deviation = 12.9) and 4.3 (range, 0 - 10, standard deviation =3. 0) among the good outcome patients, 57.5 (range, 28-80, standard deviation = 12.2) and 15.9 (range, 5-40, standard deviation =7. 5) among the pair outcome patients and 51. 3 (range, 30-74, standard deviation = 15.9) and 39. 8 (range, 22-66, standard deviation = 13.3) among the poor outcome patients.The author compared the preoperative scores of three rating systems ( r = -0.865 ,0. 552, P < 0.01), so there was the correlation among the self - made rating system and JOA, the revised rating system. The patients'preoperative and post - operative scores, which were made according to the self - made rating system, were compared and the result showed a highly significant difference between two groups of preoperative and post - operative scores(t =23.086 ,p <0. 01). Three rating systems, scores were divided into groups by same method and the standards are 40 score in the self - made rating system, 16 score in JOA and 40 score in the revised rating system respectively, by which a highly significant difference existed in the curative effect.ConclusionsInappropriate patient selection conti... |
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