Surgical and nonsurgical management of lumbar spinal stenosis - Four-year outcomes from the Maine lumbar spine study
Surgical and nonsurgical management of lumbar spinal stenosis - Four-year outcomes from the Maine lumbar spine study
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DOI：
10.1097/00007632-200003010-00005
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发表时间：
2000-03-01
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;Keller, RB;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4年结局，背景资料摘要。腰椎管狭窄症的手术治疗显著增加，尽管缺乏随机试验比较手术与非手术治疗。手术系列的长期评估记录了最初症状改善的恶化，但很少有研究比较手术和非手术治疗的长期结果。合格的、同意的患者在3、6和12个月时进行基线访谈，并邮寄随访问卷，此后每年进行一次。临床数据在基线时从医生问卷中获得。结局包括患者报告的腿部和背部疼痛症状、功能状态。和满意度。在最初入组的148名腰椎管狭窄患者中，119名患者（80.4%）获得了4年结局：81名患者中有67名（83%）接受了手术治疗，67名患者中有52名（78%）接受了非手术治疗。与非手术治疗的患者相比，手术治疗的患者在基线时有更严重的症状和更差的功能状态，在4年评估时有更好的结局。4年后，70%的手术治疗和52%的非手术治疗的患者报告说，他们的主要症状，无论是腿部或背部疼痛，是更好的（P = 0.05）。63%的手术治疗患者和42%的非手术治疗患者报告了4年时患者对当前状态的满意度（P = 0.04）。手术治疗仍然是4年满意度的重要决定因素，即使在调整了其他独立预测因素后，（P = 0.001），对于非手术治疗的患者，4年内的结果没有显著变化，而手术治疗的患者在随后的4年内的最初改善略有下降。在4年评估中，手术治疗与患者报告的结局的改善相关性大于非手术治疗，即使在调整了治疗组之间基线特征的差异后。手术的相对获益随时间推移而下降，但仍上级非手术治疗。非手术治疗患者的结局略有改善，并在4年内保持稳定。确定结果是否继续趋同将需要进行长期评价。
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 4-year outcomes for patients with lumbar spinal stenosis treated surgically or nonsurgically,Summary of Background Data. Surgery for lumbar spinal stenosis has increased dramatically despite the lack of randomized trials comparing surgical with nonsurgical treatments. Long-term evaluation of surgical series has documented deterioration in initial symptomatic improvement, but few studies have compared long-term outcomes of surgical and nonsurgical treatment.Methods. Eligible, consenting patients had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months, then annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status. and satisfaction.Results. Of 148 patients with lumbar spinal stenosis initially enrolled, 4-year outcomes were available on 119 patients (80.4%): 67 of 81 (83%) treated surgically and 52 of 67 (78%) treated nonsurgically. The surgically treated patients had more severe symptoms and worse functional status at baseline and better outcomes at 4-year evaluation than the nonsurgically treated patients. After 4 years, 70% of the surgically treated and 52% of the nonsurgically treated patients reported that their predominant symptom, either leg or back pain, was better (P = 0.05). Satisfaction of patients with their current state at 4 years was reported by 63% of the surgically treated and 42% of the nonsurgically treated patients (P = 0.04). Surgical treatment remained a significant determinant of 4-year satisfaction, even after adjustment for other independent predictors (P = 0.001), For the nonsurgically treated patients, there was no significant change in outcomes over 4 years, whereas the initial improvement seen in the surgically treated patients modestly decreased over the subsequent 4 years.Conclusions, For the patients with severe lumbar spinal stenosis, surgical treatment was associated with greater improvement in patient-reported outcomes than nonsurgical treatment at 4-year evaluation, even after adjustment for differences in baseline characteristics among treatment groups. The relative benefit of surgery declined over time but remained superior to nonsurgical treatment. Outcomes for the nonsurgically treated patients improved modestly and remained stable over 4 years. Determining whether outcomes continue to converge will require longer-term evaluation.