PDF(Pubmed)
Abstract：
UNASSIGNED: The North American Spine Society (NASS) assembled the first ever comprehensive naming system for describing lumbar disc disease, including lumbar disc herniation. The objectives of this study were (1) to determine which NASS descriptors are most predictive of independent patient-reported outcomes after microdiscectomy and (2) to identify the inter-rater reliability of each NASS descriptor.
UNASSIGNED: Adult patients (≥18 years) who underwent a lumbar microdiscectomy from 2014-2021 were retrospectively identified. Patient-reported outcome measures (PROMs) were collected at preoperative, 3-month, and 1-year postoperative time points. Lumbar disc herniations were evaluated and classified on preoperative MRI using the NASS lumbar disc nomenclature specific to disc herniation.
UNASSIGNED: About 213 microdiscectomy patients were included in the final analysis. Herniation descriptors exhibiting the greatest reliability included sequestration status (κ=0.83), axial disc herniation area (κ=0.83), and laterality (κ=0.83). The descriptor with the lowest inter-rater reliability was direction of migration (κ=0.53). At 3 months, a sequestered herniation was associated with lower odds of achieving the minimal clinically important difference (MCID) for ODI (p=.004) and MCS (p=.032). At 12 months, a similar trend was observed for Oswestry Disability Index (ODI) MCID achievement (p=.001). At 3 months, a herniation with larger axial area was a predictor of MCID achievement in ODI (p=.004) and the mental component summary (MCS) (p=.009). Neither association persisted at 12 months; however, larger axial disc herniation area was able to predict MCID achievement in the Visual Analogue Scale (VAS) leg (p=.031) at 12 months.
UNASSIGNED: The utility of the NASS nomenclature system in predicting postoperative outcomes after microdiscectomy has yet to be studied. We showed that sequestration status and disc area are both reliable and able to predict the odds of achieving MCID in certain clinical outcomes at 3 months and 12 months after surgery. Hence, preoperative imaging analysis of lumbar disc herniations may be useful in accurately setting patient expectations.
UNASSIGNED: Adult patients (≥18 years) who underwent a lumbar microdiscectomy from 2014-2021 were retrospectively identified. Patient-reported outcome measures (PROMs) were collected at preoperative, 3-month, and 1-year postoperative time points. Lumbar disc herniations were evaluated and classified on preoperative MRI using the NASS lumbar disc nomenclature specific to disc herniation.
UNASSIGNED: About 213 microdiscectomy patients were included in the final analysis. Herniation descriptors exhibiting the greatest reliability included sequestration status (κ=0.83), axial disc herniation area (κ=0.83), and laterality (κ=0.83). The descriptor with the lowest inter-rater reliability was direction of migration (κ=0.53). At 3 months, a sequestered herniation was associated with lower odds of achieving the minimal clinically important difference (MCID) for ODI (p=.004) and MCS (p=.032). At 12 months, a similar trend was observed for Oswestry Disability Index (ODI) MCID achievement (p=.001). At 3 months, a herniation with larger axial area was a predictor of MCID achievement in ODI (p=.004) and the mental component summary (MCS) (p=.009). Neither association persisted at 12 months; however, larger axial disc herniation area was able to predict MCID achievement in the Visual Analogue Scale (VAS) leg (p=.031) at 12 months.
UNASSIGNED: The utility of the NASS nomenclature system in predicting postoperative outcomes after microdiscectomy has yet to be studied. We showed that sequestration status and disc area are both reliable and able to predict the odds of achieving MCID in certain clinical outcomes at 3 months and 12 months after surgery. Hence, preoperative imaging analysis of lumbar disc herniations may be useful in accurately setting patient expectations.
摘要：
■北美脊柱学会（NASS）组装了第一个用于描述腰椎间盘疾病的综合命名系统，包括腰椎间盘突出症。这项研究的目的是（1）确定哪些NASS描述符最能预测显微椎间盘切除术后独立患者报告的结果，以及（2）确定每个NASS描述符的评估者间可靠性。
■对2014-2021年接受腰椎显微椎间盘切除术的成年患者（≥18岁）进行回顾性分析。术前收集患者报告的结果指标（PROM），3个月,和术后1年的时间点。使用针对椎间盘突出的NASS腰椎间盘命名法在术前MRI上对腰椎间盘突出症进行评估和分类。
■最终分析中包括了大约213例显微椎间盘切除术患者。表现出最大可靠性的疝气描述符包括隔离状态（κ=0.83），轴向椎间盘突出面积（κ=0.83），和侧向性(κ=0.83)。评分者间可靠性最低的描述符是迁移方向(κ=0.53)。3个月时,隔离疝与ODI(p=.004)和MCS(p=.032)的最小临床重要差异(MCID)的几率较低相关.12个月时,Oswestry残疾指数（ODI）MCID成就也观察到类似的趋势（p=.001）。3个月时,具有较大轴向面积的突出是ODI(p=.004)和心理分量总结(MCS)(p=.009)的MCID成就的预测因子。这两个协会都在12个月时持续存在；然而，较大的轴向椎间盘突出面积能够预测12个月时视觉模拟评分（VAS）腿部的MCID成就（p=0.031）。
■NASS命名系统在预测显微椎间盘切除术后结局方面的实用性还有待研究。我们表明，隔离状态和椎间盘面积都是可靠的，并且能够预测在手术后3个月和12个月的某些临床结果中实现MCID的几率。因此，腰椎间盘突出症的术前影像学分析可能有助于准确设定患者的期望.
■对2014-2021年接受腰椎显微椎间盘切除术的成年患者（≥18岁）进行回顾性分析。术前收集患者报告的结果指标（PROM），3个月,和术后1年的时间点。使用针对椎间盘突出的NASS腰椎间盘命名法在术前MRI上对腰椎间盘突出症进行评估和分类。
■最终分析中包括了大约213例显微椎间盘切除术患者。表现出最大可靠性的疝气描述符包括隔离状态（κ=0.83），轴向椎间盘突出面积（κ=0.83），和侧向性(κ=0.83)。评分者间可靠性最低的描述符是迁移方向(κ=0.53)。3个月时,隔离疝与ODI(p=.004)和MCS(p=.032)的最小临床重要差异(MCID)的几率较低相关.12个月时,Oswestry残疾指数（ODI）MCID成就也观察到类似的趋势（p=.001）。3个月时,具有较大轴向面积的突出是ODI(p=.004)和心理分量总结(MCS)(p=.009)的MCID成就的预测因子。这两个协会都在12个月时持续存在；然而，较大的轴向椎间盘突出面积能够预测12个月时视觉模拟评分（VAS）腿部的MCID成就（p=0.031）。
■NASS命名系统在预测显微椎间盘切除术后结局方面的实用性还有待研究。我们表明，隔离状态和椎间盘面积都是可靠的，并且能够预测在手术后3个月和12个月的某些临床结果中实现MCID的几率。因此，腰椎间盘突出症的术前影像学分析可能有助于准确设定患者的期望.
