The Maine Lumbar Spine Study .3. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis
The Maine Lumbar Spine Study .3. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis
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DOI：
10.1097/00007632-199608010-00012
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发表时间：
1996-08-01
期刊：
影响因子：
3
通讯作者：
Singer, DE
中科院分区：
文献类型：
--
作者：
Atlas, SJ;Deyo, RA;Singer, DE
研究设计.一项前瞻性队列研究，纳入了缅因州骨科和神经外科的腰椎管狭窄症患者。评估腰椎管狭窄症患者手术或非手术治疗的1年预后。背景资料摘要。没有随机试验和少数非实验性研究比较腰椎管狭窄症患者的手术和非手术治疗。作者的目的是评估腰椎管狭窄症患者手术或非手术治疗的1年结果。合格的、同意的患者参加了基线访谈，然后在3、6和12个月时邮寄随访问卷。临床数据来自医生问卷调查。结果包括患者报告的腿部和背部疼痛症状、功能状态、残疾和护理满意度。148例腰椎管狭窄症患者入组研究，其中81例接受手术治疗，67例接受非手术治疗。平均而言，手术组的患者在入组时比非手术组的患者有更严重的影像学表现和症状以及更差的功能状态。少数症状轻微的患者接受手术治疗，少数症状严重的患者接受非手术治疗。然而，在中度症状的患者中，手术或非手术治疗的比例相似。研究进入后一年，28%的非手术治疗患者和55%的手术治疗患者报告其主要症状有明确的改善（P = 0.003）。对于中度症状的患者，手术治疗的患者的结局也比非手术治疗的患者有所改善。手术治疗仍然是1年结局的重要决定因素，即使在调整入组时治疗组间差异后（P = 0.05）。在第一次随访评价时（3个月）观察到手术的最大获益。虽然少数非手术治疗的患者病情恶化，但与研究入组相比，症状和功能状态几乎没有改善。在对患者报告的结果进行1年评价时，重度腰椎管狭窄症患者手术治疗的改善程度大于非手术治疗的患者。由于基线特征的差异，必须谨慎地比较接受的治疗的结局。确定观察到的结果是否持续需要长期随访。
Study Design. A prospective cohort study of patients with lumbar spinal stenosis recruited from the practices of orthopedic surgeons and neurosurgeons throughout Maine.Objective. To assess 1-year outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically.Summary of Background Data. No randomized trials and few nonexperimental studies have compared surgical and nonsurgical treatment of patients with lumbar spinal stenosis. The authors' goal was to asses 1-year outcomes of patents with lumbar spinal stenosis treated surgically or nonsurgically.Methods. Eligible, consenting patients participated in baseline interviews and were then mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, and satisfaction with care.Results. One hundred forty-eight patients with lumbar spinal stenosis were enrolled, of whom 81 were treated surgically and 67 treated nonsurgically. On average, patients in the surgical group had more severe imaging findings and symptoms and worse functional status than patients in the nonsurgical group at entry. Few patients with mild symptoms were treated surgically, and few patients with severe symptoms were treated nonsurgically. However, of the patients with moderate symptoms, a similar percent were treated surgically or nonsurgically. One year after study entry, 28% of nonsurgically and 55% of surgically treated patients reported definite improvements in their predominant symptoms (P = 0.003). For patients with moderate symptoms, outcomes for surgically treated patients were also improved compared with those of nonsurgically treated patients. Surgical treatment remained a significant determinant of 1-year outcome, even after adjustment for differences between treatment groups at entry (P = 0.05). The maximal benefit of surgery was observed by the time of the first follow-up evaluation, which was at 3 months. Although few nonsurgically treated patients experienced a worsening of their condition, there was little improvement in symptoms and functional status compared with study entry.Conclusions. At a 1-year evaluation of patient-reported outcomes, patients with sever lumbar spinal stenosis who were treated surgically had greater improvement than patients treated nonsurgically. Comparisons of outcomes by treatment received must be made cautiously because of differences in baseline characteristics. A determination of whether the outcomes observed persist requires long-term follow-up.