MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience.
MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience.
复制标题
DOI：
10.1016/j.spinee.2005.09.004
复制
发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Carreon, Leah
中科院分区：
文献类型：
--
作者：
Glassman, Steven;Gornet, Matthew F;Carreon, Leah
背景：以患者为基础的生活质量量表已经成为腰椎融合手术后评估的关键因素。最广泛的结果数据是通过FDA监管的IDE新技术试验产生的，这些试验产生了极好的数据，但受到严格的登记标准和有限的适应症的限制。这就提出了一个问题，即在这些IDE试验中看到的优秀结果是否可以在标准的临床实践中重现。PURPOSE：这项研究的目的是基于标准化的结果工具，分析一种和两种水平的腰椎融合手术的手术结果。设计/背景：这项研究是对前瞻性收集的基于患者的结果数据的回顾。患者样本：497名患者，他们在五个参与的脊柱中心接受了一或两个水平的腰椎融合，使用了各种手术技术。入选标准包括可用的人口统计学、外科手术和临床结果数据。至少，患者有术前和术后一年的SF-36数据。在许多情况下，可以获得术后两年的SF-36数据和随之而来的OSwestry残疾指数(ODI)数据。65%(N=324)为一级融合，35%(N=173)为二级融合。收集的人口统计学数据包括年龄、性别、体重指数、手术史、吸烟史和工作状态。结果：SF-36身体综合评分(PCS)术后1年平均提高9.9分，术后2年平均提高9.5分。ODI术后1年平均提高22.2分，术后2年平均提高22.1分。术后1年，手术入路亚组的SF-36 PCS数据显示，与PSF、PLIF/TLIF或360度融合组(12.6分对8.8分，9.3分，8.4分)相比，ALIF组有更大的改善(p=0.03)。术后2年，ALIF和PSF组较PLIF/TLIF组和360度融合组有更大的改善(P=0.02)(13.8和11.2分对7.7和6.3分)。SF-36 PCS数据显示，有和没有减压的患者的基线得分相似，但没有腰椎减压手术的患者的改善率明显更高(11.3比7.2，p=0.002)。ODI数据显示，在之前的减压组中，基线时的残疾程度明显更高，没有做过手术的患者有更大的改善(21.7分对17.5分)。结论：基于SF-36和ODI评分，这项研究记录了接受腰椎融合术治疗一级和二级退行性腰椎间盘疾病的患者的结果。这些发现还证明了所研究的所有外科技术的有效性，这表明外科医生可以适当地选择他们最熟练的手术策略。
BACKGROUND CONTEXT: Patient-based quality of life scales have become a critical element of post-op assessment for lumbar fusion surgery. The most extensive outcomes data have been generated through FDA-regulated IDE trials for new technologies, which produce excellent data but are constrained by strict enrollment criteria and limited indications. This raises a question as to whether the excellent results seen in these IDE trials can be reproduced in standard clinical practice.PURPOSE: The purpose of this study was to analyze surgical results based upon standardized outcome tools, across a spectrum of interventions, for one- and two-level lumbar spine fusion procedures.DESIGN/SETTING: This study is a retrospective review of prospectively collected patient based outcomes data.PATIENT SAMPLE: Four hundred ninety-seven patients, who underwent 1- or 2-level lumbar spine fusion at five participating spine centers, utilizing a variety of surgical techniques. Enrollment criteria included available demographic, surgical and clinical outcome data. At a minimum, patients had pre-op and one year post-op SF-36 data. In many cases two-year post-op SF-36 data and concomitant Oswestry Disability Index (ODI) data was available.OUTCOME MEASURES: SF36 and ODI.METHODS: The patient population included 270 females and 227 males, with a mean age of 47 years. Sixty-five percent (N=324) had one level fusions and 35% (N=173) had two level fusions. Demographic data collected included age, gender, BMI, surgical history, smoking history and work status. Data was analyzed with repeated measures analysis of variance (ANOVA).RESULTS: SF-36 Physical Composite Score (PCS) improved a mean 9.9 points at one year post-op and 9.5 points at two years post-op. ODI improved a mean 22.2 points at one year post-op and 22.1 points at two years post-op. SF-36 PCS data for surgical approach subgroups revealed greater improvement (p=.03) in the ALIF group as compared to the PSF, PLIF/TLIF, or 360 degrees fusion groups (12.6 points vs. 8.8, 9.3, 8.4 points) at 1 year post-op. At 2 years post-op, there was greater improvement (p=.02) in the ALIF and PSF groups as compared to the PLIF/TLIF and 360 degrees fusion groups (13.8 and 11.2 points vs. 7.7 and 6.3 points). SF-36 PCS data demonstrated similar baseline scores for patients with and without prior decompression, but a significantly greater rate of improvement (11.3 vs. 7.2 points, p=.002) for patients without prior lumbar decompression surgery. The ODI data indicated a significantly greater disability at baseline in the prior decompression group, with greater improvement (21.7 vs. 17.5 points) in patients without prior surgery.CONCLUSIONS: This study documents improved outcomes, based on SF-36 and ODI scores, in patients undergoing lumbar fusion for one and two level degenerative disc disease. The findings also demonstrate efficacy for all of the surgical techniques studied, suggesting that surgeons can appropriately select the surgical strategy with which they are most adept.