Adolescent disc protrusions. A long-term follow-up of surgery compared to chymopapain
| Autor: | Robert C. Mulholland, Lester F. Wilson, Neil Bradbury |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Employment Male medicine.medical_specialty Adolescent medicine.medical_treatment Pain Chymopapain Disability Evaluation Discectomy Activities of Daily Living medicine Back pain Humans Orthopedics and Sports Medicine Pain Measurement Sciatica biology business.industry Incidence (epidemiology) Length of Stay medicine.disease Low back pain Surgery Intervertebral disk Treatment Outcome Radicular pain Back Pain biology.protein Female Neurology (clinical) medicine.symptom business Intervertebral Disc Displacement Follow-Up Studies |
| Zdroj: | Spine. 21(3) |
| ISSN: | 0362-2436 |
| Popis: | Study Design. This study compared chymopapain with primary surgery in the treatments of 60 radiologically proven adolescent lumbar disc protrusions and symptoms of low back pain and sciatica; the failures of intradiscal therapy were treated by surgical discectomy. Objectives. To establish whether chymopapain is as good as primary surgery in treating adolescents with proven lumbar disc protrusions. Summary of Background Data. Symptomatic lumbar disc protrusions are rare in white adolescents; the reported incidence varies from 0.8% to 3.2% of all lumbar disc protrusions. This is a largest study with long-term follow-up in the world literature. Methods. Forty-two patients between the ages of 13 and 19 years with proven lumbar disc protrusions were initially treated with chymopapain; the failures of intradiscal therapy were treated by surgical discectomy. Eighteen patients were treated with surgical discectomey. After initial review at 1, 3, 6, and 12 months, the patients were assessed using a postal questionnaire and telephone interview at a minimum of 5 years' follow-up (means: 8.5 years for chymopapain group, 7.2 years for surgery group). Results. Full replies were received from 16 of 18 (89%) in the surgery group and 42 of 42 (100%) in the chymopapain group. The long-term outcome is classed as good or excellent in 81% of the surgical group and 64% in the chymopapain group. If chymopapain is used as a first-line treatment, with surgery reserved for the failures, the long-term outcome is good or excellent in 82%. The chymopapain group had a shorter hospital stay. The surgical group were more likely to be unemployed and were less able to perform manual work and less able to engage in sporting activity. Conclusions. Back pain, radicular pain, and tension signs are common, but neurologic signs are less frequent in this age group. Long-term results of surgery are no better than the results of first-line chymopapain treatment with surgery being reserved for the failures. In 60% to 70% of patients, the morbidity, cost, and hospital stay were lessened. The patient is more likely to be in satisfactory employment after chemonucleolysis than after primary surgery. |
| Databáze: | OpenAIRE |
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