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요추간판탈출증의 수술 전 보존적 치료 기간과 각종 수술 방법의 과학적 근거에 대한 분석
Review of Preoperative Conservative Treatment Period and Evidence of Surgeries for Herniated Lumbar Disc

Korean Journal of Spine 2009년 6권 3호 p.111 ~ p.123

신동아(Shin Dong-Ah) - 포천중문의과대학교 신경외과학교실
김은상(Kim Eun-Sang) - 성균관대학교 의과대학 신경외과학교실
임승철(Rhim Seung-Chul) - 울산대학교 의과대학 신경외과학교실

Abstract

Background: The purpose of this study was 1) to review the length of an adequate period of conservative treatment and the appropriate surgical indications for herniated lumbar disc(HLD), 2) to collate the scientific evidences on surgeries for HLD, and 3) to collect expert opinions on HLD.

Methods: We searched for articles in PubMed, the Cochrane Library and KoreaMed up to 1 October 2008, and these articles were concerned with the natural history of HDL, systemic reviews of HDL and expert opinions on HLD. We also searched for meta-analyses and randomized or quasi-randomized controlled trials(RCTs or QRCTs) of surgery for HLD. We performed a meta-analysis using the Cochrane method. The survey consisting of 21 questions was delivered to all the members of the Korean Spinal Neurosurgery Society(KSNS) via E-mail.

Results: A total of 59 articles were included in this study. There were 16 articles concerning the period of conservative management and the surgical indications. Among the 33 articles on surgery for HLD, there were 4 meta-analyses, 27 RCTs, and 2 QRCTs. Among the 938 members of the KSNS, 72 responded to the survey. A minimum of 1 to 3 months of conservative management was the most preferred answer(58%), followed by a conservative management period of less than 1 month(33%). Percutaneous endoscopic discectomy was more preferred by the hospitals that specialized in spine- treatment than by the university hospitals(p<0.05).

Conclusion: Conservative management for a minimum of 2 weeks to 3 months is recommended for patients with tole- rable pain only. The patients with neurological compromise or intolerable pain should be considered for surgery. There is strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is no scientific evidence on the effectiveness of any other form of minimally invasive procedure.

키워드

Herniated lumbar disc, Evidence-based medicine, Natural history, Surgery

KMID : 1099620090060030111

원문 및 링크아웃 정보

학회

등재저널 정보

주제코드

주제명(Target field)

연구대상(Population)

연구참여(Sample size)

대상성별(Gender)

질병특성(Condition Category)

연구환경(Setting)

연구설계(Study Design)

연구기간(Period)

중재방법(Intervention Type)

중재명칭(Intervention Name)

키워드(Keyword)

유효성결과(Recomendation)

There is no scientific evidence on the effectiveness of any other form of minimally invasive procedures including percutaneous endoscopic discectomy.

연구비지원(Fund Source)

근거수준평가(Evidence Hierarchy)

출판년도(Year)

참여저자수(Authors)

대표저자

DOI

KCD코드

ICD 03

건강보험코드

요추간판탈출증의 수술 전 보존적 치료 기간과 각종 수술 방법의 과학적 근거에 대한 분석 Review of Preoperative Conservative Treatment Period and Evidence of Surgeries for Herniated Lumbar Disc

Abstract

키워드

요추간판탈출증의 수술 전 보존적 치료 기간과 각종 수술 방법의 과학적 근거에 대한 분석
Review of Preoperative Conservative Treatment Period and Evidence of Surgeries for Herniated Lumbar Disc