Table_1_Graded exercise with motion style acupuncture therapy for a patient with failed back surgery syndrome and major depressive disorder: a case report and literature review.docx

Effective treatment of failed back surgery syndrome (FBSS) remains challenging despite urgent medical attention requirements. Depression is a contributing factor to the development and poor prognosis of FBSS, and vice versa. We report the case of a patient with FBSS and major depressive disorder (MDD) treated with graded exercise combined with motion-style acupuncture therapy (MSAT). A 53-year-old male veteran who had undergone lumbar discectomy and laminectomy with instrumented fusion was admitted to the hospital with re-current back pain and radiative pain in the left leg. The effects of failed surgery triggered MDD as a comorbidity. After a six-week routine treatment without remarkable improvement, a three-week program of graded exercise with MSAT was applied. The numeric rating scale (NRS) and short form-36 (SF-36) were used to assess low back pain with radiating leg pain, and daily functioning levels, respectively. The voluntary walking distance of the patients was measured. To analyze the therapeutic effects and other applications of the intervention, we surveyed clinical trials using MSAT or graded exercise therapy (GET). Three weeks of graded exercise with MSAT reduced physical and mental functional disabilities (SF-36, physical component: 15.0 to 37.2, mental component: 21.9 to 30.1) as well as the intensity of low back pain and/or radiative leg pain (NRS: 50 to 30). Furthermore, as the therapeutic intensity gradually increased, there was a significant corresponding increase in daily walking distance (mean daily walking distance, the first week vs. baseline, second, and third week, 3.05 ± 0.56: 2.07 ± 0.79, 4.27 ± 0.96, and 4.72 ± 1.04 km, p = 0.04, p = 0.02, and p = 0.003, respectively). Three randomized controlled trials of GET were included, all showing statistically significant antidepressant effects in the diseased population. Graded exercise with MSAT may be an effective rehabilitative therapy for patients with FBSS and MDD who have impaired daily routines.

尽管背部手术失败综合征（failed back surgery syndrome, FBSS）存在迫切的医疗需求，但其有效治疗仍颇具挑战。抑郁症是FBSS发生与预后不良的危险因素，二者互为因果。本文报告1例合并重度抑郁症（major depressive disorder, MDD）的FBSS患者，采用分级运动联合动式针刺疗法（motion-style acupuncture therapy, MSAT）进行治疗。患者为53岁男性退伍军人，既往曾接受腰椎间盘摘除术、椎板切除术并内固定融合术，因复发性腰背痛及左下肢放射痛入院。手术失败相关的躯体不适继发共病性MDD。经6周常规治疗后症状无显著改善，遂予以为期3周的分级运动联合MSAT干预方案。分别采用数字疼痛评分量表（numeric rating scale, NRS）与简明健康调查问卷36项版（short form-36, SF-36）评估伴下肢放射痛的腰背痛强度及日常功能水平，并测量患者的自主步行距离。为分析该干预手段的治疗效果与应用价值，我们检索了采用MSAT或分级运动疗法（graded exercise therapy, GET）的临床试验。3周分级运动联合MSAT干预可减轻患者躯体与精神功能残疾：SF-36躯体组分评分从15.0升至37.2，精神组分评分从21.9升至30.1；同时可缓解腰背痛及/或下肢放射痛程度（NRS评分从50降至30）。此外，随着治疗强度逐步提升，患者每日自主步行距离显著升高：基线期、第1、2、3周的平均每日步行距离分别为2.07±0.79 km、3.05±0.56 km、4.27±0.96 km及4.72±1.04 km，对应p值分别为0.04、0.02及0.003。纳入的3项分级运动疗法随机对照试验均显示，该疗法对受试人群具有统计学意义上的抗抑郁效果。综上，分级运动联合MSAT或可作为合并日常功能受损的FBSS合并MDD患者的有效康复治疗手段。