Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis.
Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis.
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DOI：
10.1097/brs.0000000000003587
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发表时间：
2020-11-01
期刊：
影响因子：
3
通讯作者：
Manson N
中科院分区：
文献类型：
--
作者：
Hébert JJ;Abraham E;Wedderkopp N;Bigney E;Richardson E;Darling M;Hall H;Fisher CG;Rampersaud YR;Thomas KC;Jacobs WB;Johnson M;Paquet J;Attabib N;Jarzem P;Wai EK;Rasoulinejad P;Ahn H;Nataraj A;Stratton A;Manson N
我们调查了退行性腰椎管狭窄症手术后结果的潜在预测因素。在这项529例患者的纵向研究中，大约三分之一的患者经历了不良的临床结局。人口统计学、健康和临床因素比手术相关因素更能预测临床结局。前瞻性收集数据的纵向分析。研究退行性腰椎管狭窄症（LSS）手术后不良结局的潜在预测因素。LSS是老年人接受脊柱手术的最常见原因，但很少有信息可用于告知患者选择。我们从13个骨科和神经外科中心招募了LSS外科候选人。潜在的结果预测因素包括人口统计学、健康、临床和手术相关变量。结果指标为术前和术后3、12和24个月获得的腿部和背部疼痛数字评定量表和奥斯韦斯特里残疾指数评分。我们根据腿部疼痛的轨迹和总体结果（腿部疼痛、背部疼痛和残疾）的复合指标对手术结果进行分类。纳入了529例患者的数据（平均[SD]年龄=66.5 [9.1]岁; 46%为女性）。 总共有36.1%和27.6%的患者分别被归类为腿部疼痛结局和总体结局较差。对于这两种结果，接受补偿或有抑郁/抑郁风险的患者更有可能，参加定期锻炼的患者不太可能有不良结果。较低的健康相关生活质量、既往脊柱手术史和术前抗惊厥药物的使用与不良的腿痛结局相关。阿萨评分大于2分、术前残疾程度较大、疼痛持续时间较长或手术等待时间较长的患者总体结局较差。接受术前整脊或物理疗法治疗的患者报告总体结局不佳的可能性较小。多变量模型显示了较差至可接受（腿部疼痛）和极好（总体结局）的区分。大约三分之一的LSS患者经历了与手术无应答一致的不良临床结局。人口统计学、健康和临床因素比手术相关因素更能预测临床结局。这些预测因子可以帮助外科医生选择患者，并为有症状的LSS患者提供共同决策。证据等级：2
We investigated for potential predictors of outcome following degenerative lumbar spinal stenosis surgery. In this longitudinal study of 529 patients, approximately one in three patients experienced a poor clinical outcome. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. Longitudinal analysis of prospectively collected data. Investigate potential predictors of poor outcome following surgery for degenerative lumbar spinal stenosis (LSS). LSS is the most common reason for an older person to undergo spinal surgery, yet little information is available to inform patient selection. We recruited LSS surgical candidates from 13 orthopedic and neurological surgery centers. Potential outcome predictors included demographic, health, clinical, and surgery-related variables. Outcome measures were leg and back numeric pain rating scales and Oswestry disability index scores obtained before surgery and after 3, 12, and 24 postoperative months. We classified surgical outcomes based on trajectories of leg pain and a composite measure of overall outcome (leg pain, back pain, and disability). Data from 529 patients (mean [SD] age = 66.5 [9.1] yrs; 46% female) were included. In total, 36.1% and 27.6% of patients were classified as experiencing a poor leg pain outcome and overall outcome, respectively. For both outcomes, patients receiving compensation or with depression/depression risk were more likely, and patients participating in regular exercise were less likely to have poor outcomes. Lower health-related quality of life, previous spine surgery, and preoperative anticonvulsant medication use were associated with poor leg pain outcome. Patients with ASA scores more than two, greater preoperative disability, and longer pain duration or surgical waits were more likely to have a poor overall outcome. Patients who received preoperative chiropractic or physiotherapy treatment were less likely to report a poor overall outcome. Multivariable models demonstrated poor-to acceptable (leg pain) and excellent (overall outcome) discrimination. Approximately one in three patients with LSS experience a poor clinical outcome consistent with surgical non-response. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. These predictors may assist surgeons with patient selection and inform shared decision-making for patients with symptomatic LSS. Level of Evidence: 2