Article

OBJECTIVE: To investigate the excess risk of degeneration and segmental
instability in operated segments late after lumbar disc surgery in patients with
presurgically stable segments, and whether local pathological findings relate to
patients' back health. DESIGN: This retrospective analysis reports on 69 patients
12 years after first-time, uncomplicated lumbar disc surgery. Two independent
radiologists evaluated the patients' lumbar functional x-rays; the Back Pain
Rating Score (LBP-RS) assessed back-specific function. RESULTS: At 12 years after
lumbar disc surgery, degenerative changes as well as segmental instability
occurred significantly more frequently in the operated than nonoperated lumbar
segments, but there was no association between increased degeneration and
segmental instability rates.
The risk for acquiring segmental instability was
significantly associated with surgery (odds ratio, 6.5; 95% confidence interval,
1.5-28.8). Prevalence of segmental instabilities was associated with better
LBP-RS scores. Analyses of LBP-RS subscores revealed a clear association of
segmental instability with physical function, but not with pain or activities of
daily living. CONCLUSIONS: Lumbar disc surgery seems to be associated with an
increased risk of degeneration and segmental instability in the long term. This
structural impairment, however, seems functionally well compensated and does not
seem to be a relevant causal factor for a chronic back pain syndrome. TO CLAIM
CME CREDITS: Complete the self-assessment activity and evaluation online at
http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this
article, the reader should be able to: (1) Describe the impact of lumbar disc
surgery on segmental instability and degenerative changes; (2) Recognize the lack
of association between degenerative changes and segmental instability after
lumbar disc surgery; and (3) State the value of lumbar spinal functional tests in
the evaluation of patients after lumbar disc surgery.
LEVEL: Advanced
ACCREDITATION:: The Association of Academic Physiatrists is accredited by the
Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians. The Association of Academic Physiatrists
designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s).
Physicians should only claim credit commensurate with the extent of their
participation in the activity.

Langue : ANGLAIS