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Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries
被引:5
作者:
Gornet, Matthew F.
[1
]
Eastlack, Robert K.
[2
]
Peacock, James
[3
]
Schranck, Francine W.
[4
]
Lotz, Jeffrey C.
[5
]
机构:
[1] Orthoped Ctr St Louis, 14825 N Outer Forty Rd, Suite 200, St. Louis, MO 63017 USA
[2] Scripps Clin, Dept Orthoped Surg, San Diego, CA USA
[3] Aclarion Inc, Broomfield, CO USA
[4] SPIRITT Res, St. Louis, MO USA
[5] Univ Calif San Francisco, San Francisco, CA USA
关键词:
Low back pain;
Magnetic resonance spectroscopy;
Pain biomarkers;
Lumbar disc surgery;
OSWESTRY DISABILITY INDEX;
FUSION;
REPLACEMENT;
METAANALYSIS;
DISEASE;
D O I:
10.1007/s00586-023-07665-w
中图分类号:
R74 [神经病学与精神病学];
学科分类号:
摘要:
PurposeMRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up.MethodsDisc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS (R); Aclarion Inc.) calculated disc-specific NOCISCORES (R) that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (>= 15-point ODI improvement) was compared between surgeries that were "Concordant" (Group C) versus "Discordant" (Group D) with NOCISCORE-based diagnosis for painful discs.ResultsSuccess rates were higher for Group C versus Group D: 6 months (88% vs. 62%; p = 0.01), 12 months (91% vs. 56%; p < 0.001), and 24 months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6 months: - 35 (- 61%) versus - 23 (- 39%), (p < 0.05); 12 months: - 39 (- 69%) versus - 22 (- 39%), (p < 0.01); and 24 months: - 38 (- 66%) versus - 26 (- 48%), (p < 0.05).ConclusionMore successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels.
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页码:1973 / 1984
页数:12
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