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首页> 外文期刊>Spine >Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography.
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Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography.

机译：前无症状受试者接受实验性唱片记录的下背部疼痛发展的前瞻性对照研究。

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STUDY DESIGN: A prospective controlled longitudinal study. OBJECTIVES: To determine whether subjects, asymptomatic for lower back problems, who undergo experimental discography, will develop lower back problems during the medium term to the full term. SUMMARY OF BACKGROUND DATA: Previous work has shown significant pain on discographic injection in approximately 40% of asymptomatic subjects. It has been suggested that those subjects with painful injections would soon develop lower back pain (LBP) syndromes in the near future: that is, the experimental discography was detecting an imminent "pain generator" before clinically symptomatic. METHODS.: Fifty subjects without low back pain were recruited for clinical and psychometric testing, MRI scanning, and experimental lumbar discography to determine the rate of painful lumbar disc injections in select subjects without LBP history. After determining which subjects had painful injections, all subjects completing the discography protocol were prospectively followed at yearly intervals to determine the occurrence of LBP and LBP disability over time. Statistical methods were then used to determine the correlation, if any, between the asymptomatic subjects' clinical, MRI, and discography findings, and the subsequent LBP measures. Controls, not participating in the lumbar discography study, were also followed. Controls were matched for clinical features, sex, age, and occupational/recreational exposure. Follow-up examinations were performed at yearly intervals by blinded researchers using a scripted interview and completing standard questionnaires. RESULTS: A total of 46 of 50 completed the discogram, and all 46 subjects completed the final 4-year follow-up examination. There was a low incidence of LBP episodes in the experimental groups and control. A painful disc injection, independent of psychological profile, did not predict LBP or any other functional outcome measure at follow-up on multivariate analysis. The presence of an anular fissure seen on discography was weakly associated with the cumulative incidence of LBP episodes after discography (P = 0.08). The presence of high intensity zone on MRI in any disc was also weakly associated with the development of LBP episodes (P = 0.09). Psychometric profiles at the start of the study strongly and independently predicted future back pain (P = 0.01), medication usage (P = 0.002), and work loss (P = 0.01) over the 4-year study. Compared with controls not having undergone discography, there was no significant difference in back pain, function, work loss, doctors visits for back pain, or medication intake in any group. A subset in the injection group with somatization disorder had a higher LBP visual analog score compared with somatization disorder controls at 1 year,but this was not significant at 4 years after testing. CONCLUSIONS: Painful disc injections are poor independent predictors of subsequent LBP episodes in subjects initially without active lower back complaints. Anular disruption is a weak predictor of future LBP problems. Psychological distress and preexisting chronic pain processes are stronger predictors of LBP outcomes.
机译：研究设计：前瞻性对照纵向研究。目的：确定接受实验性唱片检查的无症状的下背部问题的受试者在中期到整个学期是否会发展出下背部的问题。背景数据概述：先前的研究表明，在大约40％的无症状受试者中，使用光盘进行注射有明显的疼痛感。已经提出，那些注射疼痛的受试者将在不久的将来很快发展为下腰痛（LBP）综合征：也就是说，实验性唱片在临床症状出现之前就检测到了即将出现的“疼痛产生器”。方法：招募了五十名没有下背痛的受试者进行临床和心理测试，MRI扫描和实验性腰椎间盘造影，以确定没有LBP病史的特定受试者中腰椎间盘注射的疼痛率。在确定哪些受试者进行了痛苦的注射后，每隔一年按时间间隔对完成唱片协议的所有受试者进行前瞻性随访，以确定随时间推移LBP和LBP残疾的发生情况。然后使用统计方法确定无症状受试者的临床，MRI和唱片检查结果与随后的LBP测量之间的相关性（如果有）。还追踪了不参与腰椎间盘造影研究的对照组。对对照进行临床特征，性别，年龄和职业/娱乐接触的匹配。盲人研究人员使用脚本化访谈并填写标准调查表，每隔一年进行一次随访检查。结果：总共50人中有46人完成了盘状图，所有46位受试者都完成了最后的4年随访检查。在实验组和对照组中，LBP发作的发生率较低。独立于心理状况的疼痛性椎间盘注射不能在多变量分析的随访中预测LBP或任何其他功能性结局指标。椎间盘造影发现肛门裂的存在与椎间盘造影后LBP发作的累积发生率弱相关（P = 0.08）。 MRI在任何椎间盘中的高强度区的存在也与LBP发作的发展有弱关联（P = 0.09）。在研究开始时的心理测验曲线强烈独立地预测了未来四年的背部疼痛（P = 0.01），药物使用（P = 0.002）和工作损失（P = 0.01）。与未进行椎间盘造影的对照组相比，在任何组中，背痛，功能，工作流失，背痛就医或药物摄入量均无显着差异。在1年时，具有躯体化障碍的注射组中的一个子集与躯体化障碍对照组相比，其LBP视觉类似物评分更高，但在测试后4年时无显着性。结论：最初没有活动性下腰主诉的受试者中，疼痛性椎间盘注射不能很好地预测随后的LBP发作。肛门破裂是未来LBP问题的弱预测指标。心理困扰和预先存在的慢性疼痛过程是LBP预后的更强预测指标。

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