Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.
Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.
复制标题
神经系统缺陷对成人症状性腰椎侧凸手术治疗一年随访中的患者相关结果有负面影响。
DOI：
10.1097/brs.0000000000001800
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发表时间：
2017
期刊：
影响因子：
3
通讯作者：
Bridwell,KeithH
中科院分区：
文献类型：
--
作者：
Kang,DanielG;Baldus,Christine;Glassman,StevenD;Shaffrey,ChristopherI;Lurie,JonD;Bridwell,KeithH
研究设计：一项前瞻性、多中心的美国国立卫生研究院临床试验的回顾分析。目的：本研究的目的是评估神经系统并发症的发生率和新的神经功能缺陷对术后1年患者报告的结果(PROS)的影响。背景数据概述。目前尚有有限的研究评估新的神经功能缺陷对手术后PROS的影响。分析患者的术前和术后1年随访情况[脊柱侧弯研究会(SRS)问卷调查问卷、脊柱侧弯功能障碍指数(ODI)、12项躯体/心理健康综合评分(PCS/MCS)、腰腿痛数值评定量表(NRS)]。术前不同组间的人口学、放射学或PRO数据均无差异。DEF组的手术时间(8.3h比6.9h，P=0.030)、出血量(2832mLvs.2606ml，P=0.022)和住院时间(10.6dvs.7.8d，P=0.004)明显延长。NoDef组报告说，从术前到术后1年，所有的PRO都有显著的改善。DEF组仅有SRS疼痛(术前2.7分，停药后3.4分，P=0.037)、自我映像域(2.7分~3.6分，P=0.004)和NRS腰背痛(6.6分~3.2分，P=0.004)改善，NRS腿痛显著加重(4.1分~6.1分，P=0.045)。一年后的分组比较发现，Def组报告了更多的NRS腿部疼痛(6.1vs.1.7，P<；0.001)和更差的结果比NoDef组(35.7vs.23.1，P=0.016)和PCS(32.6vs.41.9，P=0.007)。结论：我们发现有症状的原发成人腰椎侧弯手术后新的神经功能缺陷率为9.9%，远高于先前的研究。大多数神经功能缺陷在1年的随访中有所改善，但似乎对专业人员有显著的负面影响，有神经功能缺陷的患者报告的术后腿部疼痛增加和患者感知的病理比没有神经功能缺陷的患者更严重。证据水平：3成人脊柱畸形(ASD)手术复杂且具有挑战性，特别是在严重畸形或多种内科合并症的患者中。尽管在手术技术、脊柱器械和神经监测方案方面取得了进步，但ASD手术后新的神经功能障碍仍然是一个主要的担忧和令人担忧的并发症。报道的ASD手术后新的神经功能缺陷的发生率和严重程度差异很大，从0.55%到7%不等，大多数报告神经根缺陷，很少有脊髓缺陷。1-9据我们所知，还没有研究专门评估神经系统并发症对患者报告结果(PRO)的影响，这是因为评估这一主题的研究有限，方法多样(大多是回溯性的)、样本量小、人群不同，以及定义和表征神经缺陷的非标准化方法。因此，就ASD手术的神经系统并发症的风险和预期结果对患者进行适当的咨询仍然是一项艰巨的任务。此外，分析并发症，特别是神经功能缺陷后的PRO的最佳时间框架仍不清楚。
Study Design.A retrospective analysis of prospective, multicenter National Institute of Health clinical trial.Objective.The aim of this study was to assess the rate of neurologic complications and impact of new neurologic deficits on 1-year postoperative patient-reported outcomes (PROs).Summary of Background Data.There are limited studies evaluating the impact of new neurologic deficits on PROs following surgery for primary presentation adult lumbar scoliosis.Methods.Patients were divided into two groups: new postoperative neurological deficit (Def) or no deficit (NoDef). Preoperative and 1-year follow-up PROs were analyzed [Scoliosis Research Society (SRS) Questionnaire, Oswestry Disability Index (ODI), Short Form-12 Physical/Mental Health Composite Scores (PCS/MCS), and back/leg pain Numerical Rating Scale (NRS)].Results.One hundred forty-one patients: 14 Def (9.9%), 127 NoDef (90.1%). No differences were observed in demographic, radiographic, or PRO data between groups preoperatively. Def group had longer surgical procedures (8.3 vs. 6.9 hours, P= 0.030), greater blood loss (2832 vs. 2606 mL, P= 0.022), and longer hospitalizations (10.6 vs. 7.8 days, P= 0.004). NoDef group reported significant improvement in all PROs from preop to 1-year postoperative. Def group only had improvement in SRS Pain (2.7 preop to 3.4 postop, P= 0.037) and self-image domains (2.7 to 3.6, p= 0.004), and NRS back pain (6.6 to 3.2, P= 0.004) scores with significant worsening of NRS leg pain (4.1 to 6.1, P= 0.045). Group comparisons of 1-year postop PROs found that Def group reported more NRS leg pain (6.1 vs. 1.7, P< 0.001) and worse outcomes than NoDef group for ODI (35.7 vs. 23.1, P= 0.016) and PCS (32.6 vs. 41.9, P= 0.007).Conclusion.We found a 9.9% rate of new neurologic deficits following surgery for symptomatic primary presentation adult lumbar scoliosis, much higher than previous studies. Most neurologic deficits improved by 1-year follow-up, but appeared to have a dramatic negative impact on PROs, with increased postoperative leg pain and greater patient-perceived pathology reported in patients experiencing neurological deficits compared with those who did not.Level of Evidence: 3Adult spinal deformity (ASD) surgery is complex and challenging, especially in patients with severe deformity or multiple medical comorbidities. Despite advances in surgical technique, spinal instrumentation, and neuromonitoring protocols, new neurologic deficits following ASD surgery remain a major concern and feared complication. Reported rates and severity of new neurologic deficits following ASD surgery differ widely, ranging from 0.55% to 7%, with most reporting nerve root deficits and few spinal cord deficits. 1–9 To our knowledge, no study has specifically evaluated the impact of neurologic complications on patient-reported outcomes (PROs), due to the limited studies evaluating this topic with variable methodologies (mostly retrospective in nature), small sample sizes, heterogeneous populations, and nonstandardized methods of defining and characterizing neurologic deficits. Therefore, appropriately counseling patients regarding the risk of a neurologic complication with ASD surgery and expected outcome remains a difficult task. Also, the optimal time-frame for analysis of PROs following a complication, particularly a neurologic deficit, remains unknown.