Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis
Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis
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DOI：
10.1007/s00586-010-1374-1
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发表时间：
2010-11-01
影响因子：
2.8
通讯作者：
Matsudaira, Ko
中科院分区：
文献类型：
--
作者：
Hara, Nobuhiro;Oka, Hiroyuki;Matsudaira, Ko
下肢疼痛/麻木和步态障碍是腰椎管狭窄症（LSS）下肢的两个主要症状，通常预期通过减压手术缓解。然而，术前患者可获得的关于特定预测因素的信息缺乏，导致其中一些患者在术后主要症状仍然存在时对手术结果不满意。观察性研究试图确定减压手术改良开窗术与恢复性脊柱成形术的结果的预测因子。在109名接受减压手术的连续LSS患者中，89（56名男性和33名女性）完成了2年随访。与术前相比，术后2年日本骨科协会评分系统确定的麻木和步态障碍显著改善，无论性别、术前下肢静息麻木、马尾下垂综合征、退行性脊柱畸形或脊髓造影充盈缺损、减压节段数目等潜在预测因素如何，27例（30.3%）和13例（14.6%）患者出现残余下肢疼痛/麻木和步态障碍，在检查的变量中，术前静息麻木与残余下肢疼痛/麻木和步态障碍相关，术前足下垂与残余步态障碍相关，这是第一个研究，以确定具体的预测因素，这两个剩余的主要减压手术后LSS症状，可考虑将其纳入知情同意书中
Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery modified fenestration with restorative spinoplasty Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender preoperative presence of resting numbness in the leg, drop foot cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels However, 27 (30 3%) and 13 (14 6%) patients showed residual leg pain/numbness and gait disturbance, respectively Among the variables examined, the preoperative resting numbness was associated with residual leg pain/numbness and gait disturbance and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent