현미경을 이용한 디스크 제거술 후 발생한 요통에서 고주파 시술의 효용성 분석

Abstract

OBJECTIVE: There are many causes of low back pain and it has been demonstrated previously that percutaneous radiofrequency neurotomy (PRN) is an effective management of facet joint pain. But, there were few reports about the management of low back pain (LBP) or buttock pain after microscopic discectomy. Weight bearing on the facet joint is increased after microscopic discectomy. The purpose of this study was to evaluate the result of PRN for low back pain or buttock pain after microscopic discectomy in lumbar disc herniation.

METHODS: Seventy nine patients who were performed percutaneous radiofrequency neurotomy for severe LBP or buttock pain after microscopic discectomy were included in this study. Inclusion criteria were severe low back pain or buttock pain after microscopic discectomy and ≥ 50% Visual Analogue Scale (VAS) reduction on diagnostic blocks. They were divided into two groups by the presence of preoperative LBP as preoperative back pain group (Group I , n=40) and postoperative back pain group (Group Ⅱ, n=39). Pain relief was estimated at preoperative, 1 week, 1 month, 3 months and at 12 months following the procedure using VAS. Above 50 % pain relief was defined as the positive response. Quality of life was measured before and 3 months after treatment with the SF-36 questionnaire.

RESULTS: The procedures were successful in all cases. In all patients, neuritis, myalgia, hypoesthesia, and dysesthesia that may develop after PRN were not noted. Positive responses were shown in 34 patients (85%) at 1 week, 18 patients (45%) at 1 months, 15 patients (37.5%) at 3 months and 4 patients (10%) at 12 months after PRN in Group Ⅰ. In Group Ⅱ, 33 patients (85%), 31 patients (79.5%) and 29 patients (74.5%) and 24 patients (61.5%) responded positively after 1 week , 1 month, 3 months and 12 months after PRN respectively (P=0.0017). Based on the SF 36, the outcome parameters including vitality, pain and physical activities show significant improvement in Group Ⅱ.

CONCLUSION: PRN may be a safe and effective treatment for newly developed or aggravated back pain or buttock pain after microscopic discectomy.