Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT).
Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT).
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DOI：
10.1097/brs.0b013e31827c99f0
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发表时间：
2013-04-01
期刊：
影响因子：
3
通讯作者：
Weinstein J
中科院分区：
文献类型：
--
作者：
Radcliff K;Curry P;Hilibrand A;Kepler C;Lurie J;Zhao W;Albert TJ;Weinstein J
前瞻性随机数据库的亚组分析。本研究的目的是比较手术或患者特征，例如融合、器械或肥胖，以确定这些因素是否与椎管狭窄再次手术风险增加相关。随着减少再次手术（例如运动保留）的策略的制定，这些预后信息对患者、医疗保健专业人员和社会都很有价值。由于指数级病理或邻近节段疾病复发而再次手术是常见的临床问题。尽管有多项关于再次手术发生率的研究，但很少有比较研究确定椎管狭窄术后再次手术的危险因素。该亚组分析的假设是，腰椎融合或特定的患者特征（例如肥胖）将使腰椎狭窄患者更容易接受指数或邻近水平的再次手术。研究人群结合了参加 SPORT 治疗椎管狭窄的随机队列和观察队列。接受手术治疗的患者根据再次手术患者（n=54）或未再次手术患者（n=359）进行分层。在基线、1 年、2 年、3 年和 4 年评估结果指标。在每个随访期确定接受再手术者和未接受再手术者之间的改善差异。在413名因椎管狭窄接受手术治疗的患者中，54名患者在四年内接受了再次手术。在基线时，再手术组和非再手术组之间的人口统计学特征或临床结果评分没有显着差异。此外，各组之间在症状严重程度、肥胖程度、体检体征、狭窄程度、狭窄部位、狭窄严重程度、融合程度、椎板切除程度、减压程度、手术时间、术中或术后并发症方面没有差异。再次手术组中症状持续时间超过 12 个月的患者比例有所增加（再次手术组为 56%，未再次手术组为 36%，p<0.008）。在最终随访时，再手术组的 SF36 PF（14.4 vs 22.6，p < 0.05）、ODI（−12.4 vs. -21.1，p < 0.01）和坐骨神经痛指数（−5 vs -8.1，p < 0.006）的改善明显较小。与非融合技术相比，腰椎融合和内固定与指数或邻近水平的再手术率增加无关。椎管狭窄治疗后再次手术的唯一具体危险因素是治疗前症状持续时间 > 12 个月。椎管狭窄手术再次手术的总体发生率为 13%，再次手术在索引和相邻腰椎节段之间均匀分布。再次手术可能与脊柱退行性疾病的自然史有关。
Subgroup analysis of prospective, randomized database. The purpose of this study was to compare surgical or patient characteristics, such as fusion, instrumentation, or obesity, to identify whether these factors were associated with increased risk of reoperation for spinal stenosis. This prognostic information would be valuable to patients, healthcare professionals, and society as strategies to reduce reoperation, such as motion preservation, are developed. Reoperation due to recurrence of index level pathology or adjacent segment disease is a common clinical problem. Despite multiple studies on the incidence of reoperation, there have been few comparative studies establishing risk factors of reoperation after spinal stenosis surgery. The hypothesis of this subgroup analysis was that lumbar fusion or particular patient characteristics, such as obesity, would render patients with lumbar stenosis more susceptible to reoperation at the index or adjacent levels. The study population combined the randomized and observational cohorts enrolled in SPORT for treatment of spinal stenosis. The surgically treated patients were stratified according to those who had reoperation (n=54) or no-reoperation (n= 359). Outcome measures were assessed at baseline, 1 year, 2 years, 3 years, and 4 years. The difference in improvement between those who had reoperation and those who did not was determined at each follow-period. Of the 413 patients who underwent surgical treatment for spinal stenosis, 54 patients had a reoperation within four years. At baseline, there were no significant differences in demographic characteristics or clinical outcome scores between reoperation and non-reoperation groups. Furthermore, between groups there were no differences in the severity of symptoms, obesity, physical examination signs, levels of stenosis, location of stenosis, stenosis severity, levels of fusion, levels of laminectomy, levels decompressed, operation time, intraoperative or postoperative complications. There was an increased percentage of patients with duration of symptoms greater than 12 months in the reoperation group (56% reoperation vs 36% no-reoperation, p<0.008). At final follow-up, there was significantly less improvement in the outcome of the reoperation group in SF36 PF (14.4 vs 22.6, p < 0.05), ODI (−12.4 vs. −21.1, p < 0.01), and Sciatica Bothersomeness Index (−5 vs −8.1, p < 0.006). Lumbar fusion and instrumentation were not associated with increased rate of reoperation at index or adjacent levels compared to nonfusion techniques. The only specific risk factor for reoperation after treatment of spinal stenosis was duration of pretreatment symptoms > 12 months. The overall incidence of reoperations for spinal stenosis surgery was 13% and reoperations were equally distributed between index and adjacent lumbar levels. Reoperation may be related to the natural history of spinal degenerative disease.