下背痛伴或不伴神经根性腿痛是一种极其常见的健康状况,显著影响患者的活动和生活质量。当保守管理失败时,硬膜外注射只能暂时缓解,经常使用。盘内氧气-臭氧可以提供硬膜外注射的替代方案,并进一步减少对显微椎间盘切除术的需要。
比较单节段腰椎间盘突出症致难治性神经根性腿痛患者使用椎间盘内氧气-臭氧与显微椎间盘切除术的非劣效性治疗状况和临床效果。
在三个欧洲医院脊柱中心进行的多中心前瞻性前瞻性非劣效性随机对照试验。
49名患者(平均年龄40岁,17名女性/32名男性)患有单级腰椎间盘突出症,神经根腿部疼痛超过六周,对医疗管理的抵抗力是随机的,25用于椎间盘内氧气-臭氧,24用于显微椎间盘切除术。88%(49个中的43个)接受了指定的治疗,并构成了AS治疗(AT)人群。
主要结果是腿部疼痛总体改善6个月。其他验证的临床结果,包括背部数字疼痛评分(NRS),罗兰莫里斯残疾指数(RMDI)和EQ-5D,是在基线时收集的,1周,1-,3-,和6个月。记录程序技术结果,并在所有随访间隔评估不良事件。
氧气臭氧治疗作为门诊日间手术,包括通过校准的输送系统以35±3μg/cc的氧气-臭氧浓度输送的一次性椎间盘内注射。作为开放微盘切除术的开腹手术,没有脊柱仪器,而不是小而全的显微切除术。使用治疗后(AT)和意向治疗(ITT)人群进行了6个月累积加权平均腿部疼痛NRS评分的非劣效性差异为-1.94点的主要分析。在事后分析中,在每次随访时比较治疗组相对于基线改善的差异,使用基线腿部疼痛作为协变量。
在初步分析中,使用AT人群的治疗组之间的腿部疼痛改善的总体6个月差异为-0.31(SE,0.84)支持显微椎间盘切除术和使用ITT人群,差异为0.32(SE,0.88)有利于氧气-臭氧的观点。氧-臭氧和显微椎间盘切除术之间的差异没有超过AT治疗差异的非劣效性95%的置信下限(95%的下限,-1.72)或ITT(95%下限,-1.13)人口。两种治疗方法均导致腿部疼痛的基线快速且具有统计学意义的改善。背痛,RMDI,和EQ-5D持续随访。组间差异对任何结果均不显著。在6个月的随访中,71%(24人中的17人)接受氧气臭氧治疗的患者,避免显微椎间盘切除术。氧气-臭氧的平均手术时间明显比微椎间盘切除术快58分钟(p<.0010),并且氧气-臭氧手术的平均放电时间明显较短(4.3±2.9小时与44.2±29.9小时,p<.001)。任一治疗组均未发生重大不良事件。
椎间盘内氧气-臭氧化学溶核术治疗单节段腰椎间盘突出症,对医疗管理无反应,在6个月平均腿部疼痛改善后,符合显微椎间盘切除术的非劣效性标准。两个治疗组取得了相似的快速显著临床改善,持续和总体,71%的人接受椎间盘内氧气臭氧能够避免手术。
Low back pain with or without radicular leg pain is an extremely common health condition significantly impacting patient\'s activities and quality of life. When conservative management fails, epidural injections providing only temporary relief, are frequently utilized. Intradiscal oxygen-ozone may offer an alternative to epidural injections and further reduce the need for microdiscectomy.
To compare the non-inferiority treatment status and clinical outcomes of intradiscal oxygen-ozone with microdiscectomy in patients with refractory radicular leg pain due to single-level contained lumbar disc herniations.
Multicenter pilot prospective non-inferiority blocked randomized control
trial conducted in three European hospital spine centers.
Forty-nine patients (mean 40 years of age, 17 females/32 males) with a single-level contained lumbar disc herniation, radicular leg pain for more than six weeks, and resistant to medical management were randomized, 25 to intradiscal oxygen-ozone and 24 to microdiscectomy. 88% (43 of 49) received their assigned treatment and constituted the AS-Treated (AT) population.
Primary outcome was overall 6-month improvement over baseline in leg pain. Other validated clinical outcomes, including back numerical rating pain scores (NRS), Roland Morris Disability Index (RMDI) and EQ-5D, were collected at baseline, 1 week, 1-, 3-, and 6-months. Procedural technical outcomes were recorded and adverse events were evaluated at all follow-up intervals.
Oxygen-ozone treatment performed as outpatient day surgeries, included a one-time intradiscal injection delivered at a concentration of 35±3 μg/cc of oxygen-ozone by a calibrated delivery system. Discectomies performed as open microdiscectomy inpatient surgeries, were without spinal instrumentation, and not as subtotal microdiscectomies. Primary analyses with a non-inferiority margin of -1.94-point difference in 6-month cumulative weighted mean leg pain NRS scores were conducted using As-Treated (AT) and Intent-to-Treat (ITT) populations. In post hoc analyses, differences between treatment groups in improvement over baseline were compared at each follow-up visit, using baseline leg pain as a covariate.
In the primary analysis, the overall 6-month difference between treatment groups in leg pain improvement using the AT population was -0.31 (SE, 0.84) points in favor of microdiscectomy and using the ITT population, the difference was 0.32 (SE, 0.88) points in favor of oxygen-ozone. The difference between oxygen-ozone and microdiscectomy did not exceed the non-inferiority 95% confidence lower limit of treatment difference in either the AT (95% lower limit, -1.72) or ITT (95% lower limit, -1.13) populations. Both treatments resulted in rapid and statistically significant improvements over baseline in leg pain, back pain, RMDI, and EQ-5D that persisted in follow-up. Between group differences were not significant for any outcomes. During 6-month follow-up, 71% (17 of 24) of patients receiving oxygen-ozone, avoided microdiscectomy. The mean procedure time for oxygen-ozone was significantly faster than microdiscectomy by 58 minutes (p<.0010) and the mean discharge time from procedure was significantly shorter for the oxygen-ozone procedure (4.3±2.9 hours vs. 44.2±29.9 hours, p<.001). No major adverse events occurred in either treatment group.
Intradiscal oxygen-ozone
chemonucleolysis for single-level lumbar disc herniations unresponsive to medical management, met the non-inferiority criteria to microdiscectomy on 6-month mean leg pain improvement. Both treatment groups achieved similar rapid significant clinical improvements that persisted and overall, 71% undergoing intradiscal oxygen-ozone were able to avoid surgery.