Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?
Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?
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DOI：
10.1007/s00586-013-2786-5
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发表时间：
2013-09-01
影响因子：
2.8
通讯作者：
Yoshida, Munehito
中科院分区：
文献类型：
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作者：
Tsutsui, Shunji;Kagotani, Ryohei;Yoshida, Munehito
对于腰椎管狭窄（LSS）合并退行性腰椎侧凸（DLS）的患者，通常建议进行减压融合术。然而，老年 LSS 和 DLS 患者往往伴有其他合并症，手术治疗必须安全有效。本研究的目的是调查单纯减压手术是否可以缓解 LSS 和 DLS 患者的腰痛 (LBP)，并确定术后残留 LBP 的预测因素。 共有 75 名患者（33 名男性和 42 名女性），平均年龄 71.8 岁（范围 53-86 岁）接受 LSS 减压手术并 DLS（科布角 a 千分之一日元 10A 度），并且最小随访期1年，采用日本骨科学会腰椎疾病评估评分系统（JOA评分）进行回顾性评价。射线照相测量包括冠状和矢状 Cobb 角、顶椎旋转（Nash-Moe 方法）以及前后和侧向滑脱。采用Logistic回归分析探讨术后残余LBP的预测因素。49例患者术前有LBP，其中29例（59.1%）术后LBP缓解。 Logistic 回归分析表明，术前 X 线摄影显示的顶椎旋转程度与术后残余 LBP 显着相关（比值比，8.16，95% 置信区间，1.55-83.81，p = 0.011）。因此，较高的顶椎旋转程度可能是 LSS 和 DLS 患者机械性 LBP 的指标。应建议这些患者进行融合减压。
Decompression with fusion is usually recommended in patients with lumbar spinal stenosis (LSS) combined with degenerative lumbar scoliosis (DLS). However, elderly patients with LSS and DLS often have other comorbidities, and surgical treatment must be both safe and effective. The aim of this study was to investigate whether decompression surgery alone alleviates low back pain (LBP) in patients with LSS and DLS, and to identify the predictors of postoperative residual LBP.A total of 75 patients (33 males and 42 females) with a mean age of 71.8 years (range 53-86 years) who underwent decompression surgery for LSS with DLS (Cobb angle a parts per thousand yen 10A degrees) and had a minimum follow-up period of 1 year, were retrospectively reviewed using the Japanese Orthopaedic Association scoring system for the assessment of lumbar spinal diseases (JOA score). Radiographic measurements included coronal and sagittal Cobb angles, apical vertebral rotation (Nash-Moe method), and anteroposterior and lateral spondylolisthesis. Logistic regression analysis was performed to investigate the predictors of residual LBP after surgery.Forty-nine patients had preoperative LBP, of which 29 (59.1 %) experienced postoperative relief of LBP. Logistic regression analysis demonstrated that the degree of apical vertebral rotation on preoperative radiography was significantly associated with postoperative residual LBP (odds ratio, 8.16, 95 % confidence interval, 1.55-83.81, p = 0.011).A higher degree of apical vertebral rotation may therefore be an indicator of mechanical LBP in patients with LSS and DLS. Decompression with fusion should be recommended in these patients.