Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes
Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes
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DOI：
10.1016/j.jos.2016.12.022
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发表时间：
2017-05-01
影响因子：
1.7
通讯作者：
Deguchi, Tsuyoshi
中科院分区：
文献类型：
--
作者：
Minamide, Akihito;Yoshida, Munehito;Deguchi, Tsuyoshi
关于腰椎管狭窄症（LSS）合并退行性腰椎侧凸（DLS）的最合适手术治疗方法仍存在争议：单纯减压、减压伴有限脊柱融合或长脊柱融合以矫正畸形。退行性狭窄和畸形并存是一种常见情况;尽管如此，选择适当的手术干预需要全面了解患者的临床病理学和影像学参数。LSS合并DLS患者行微创（MIS）减压手术。本研究的目的是（1）研究MIS减压手术治疗LSS伴DLS患者的临床结局，（2）确定MIS手术后影像学和临床结局的预测因素。本研究入组了438例连续患者。入选标准为LSS和DLS的证据，冠状面曲率测量值大于10。在术前和术后2年以上评价日本骨科协会（乔亚）评分、乔亚恢复率、腰痛（LBP）和影像学特征。在438例患者中，122例被纳入最终分析，平均随访2.4年。乔亚恢复率为47.6%。LBP在最终随访时显著改善。术后Cobb角保持2年（p = 0.159）。椎间孔狭窄患者的临床结局与性别、术前高Cobb角和脊柱侧凸进展显著相关（p = 0.008）。在重度脊柱侧凸患者中，乔亚恢复率为44%，并且显著取决于脊柱侧凸的进展（Cobb角：术前29.6，2年随访36.9）以及骨盆倾角（PI）和腰椎前凸（LL）之间的不匹配（术前PI LL 35.5 +/- 21.2度）（p = 0.028）。本研究调查了微创减压手术治疗LSS伴DLS患者的临床结局。预测临床结局的危险因素为严重脊柱侧凸、椎间孔狭窄、进行性脊柱侧凸和PI LL大不匹配。(C)2016年日本骨科协会。由爱思唯尔公司出版
There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6, 2-years follow-up 36.9) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI LL 35.5 +/- 21.2 degrees) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe scoliosis, foramina stenosis, progressive scoliosis and large mismatch of PI LL. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V.