Predictors of surgical outcome in degenerative lumbar spinal stenosis
Predictors of surgical outcome in degenerative lumbar spinal stenosis
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DOI：
10.1097/00007632-199911010-00010
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发表时间：
1999-11-01
期刊：
影响因子：
3
通讯作者：
Weinstein, JN
中科院分区：
文献类型：
--
作者：
Katz, JN;Stucki, G;Weinstein, JN
研究设计。一项前瞻性观察性研究。确定退行性腰椎管狭窄手术的预后预测因素。背景资料摘要。退行性腰椎管狭窄症是老年人脊柱手术最常见的指征。超过25%的手术患者预后不佳，但对预测手术预后的因素知之甚少。199例退行性腰椎管狭窄患者行手术治疗，并在4个转诊中心观察术后2年。手术包括椎板减压切除术合并或不合并关节融合术。结果包括经过验证的症状严重程度、行走能力和对手术结果的满意度。结果的潜在预测因素包括社会人口因素和体格检查，以及放射学、心理、社会和临床病史变量。严重疼痛的患者比例从术前的81%下降到术后2年的31%。在手术前，患者报告的良好或极好的健康状况是预测患者行走能力增强、症状减轻和满意度提高的最有力指标。低心血管合并症也预示着良好的结果。患者对自身健康状况和合并症的评估是椎管狭窄手术最可靠的预后预测指标。
Study Design. A prospective, observational study.Objectives. To identify outcome predictors of surgery for degenerative lumbar spinal stenosis.Summary of Background Data. Degenerative lumbar spinal stenosis is the most frequent indication for spine surgery in the elderly. More than 25% of surgical patients have a poor outcome, yet little is known about factors that predict the outcome of surgery.Methods. Surgery was performed on 199 patients with degenerative lumbar spinal stenosis, and they were observed for 2 years after surgery in four referral centers. Surgery consisted of decompressive laminectomy with or without arthrodesis. Outcomes included validated measures of symptom severity, walking capacity, and satisfaction with the results of surgery. Potential predictors of outcome included sociodemographic factors and physical examination, as well as radiographic, psychological, social, and clinical history variables.Results. The proportion of patients with severe pain decreased from 81% before surgery to 31% by 2 years afterward. The most powerful preoperation predictor of greater walking capacity, milder symptoms, and greater satisfaction was the patient's report of good or excellent health before surgery. Low cardiovascular comorbidity also predicted a favorable outcome.Conclusions. Patients' assessments of their own health and comorbidity are the most cogent outcome predictors of surgery for spinal stenosis.