Predictive Factors for Subjective Improvement in Lumbar Spinal Stenosis Patients with Nonsurgical Treatment: A 3-Year Prospective Cohort Study.
Predictive Factors for Subjective Improvement in Lumbar Spinal Stenosis Patients with Nonsurgical Treatment: A 3-Year Prospective Cohort Study.
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DOI：
10.1371/journal.pone.0148584
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Tanaka S
中科院分区：
文献类型：
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作者：
Matsudaira K;Hara N;Oka H;Kunogi J;Yamazaki T;Takeshita K;Atsushi S;Tanaka S
评估腰椎管狭窄症（LSS）连续患者非手术治疗后主观改善的预测因素。LSS患者来自日本的17个医疗中心。我们随访了274例患者（151例男性;平均年龄71 ± 7.4岁）3年。采用多变量logistic回归模型评估非手术治疗后主观症状改善的预测因素。在30%的患者中，保守治疗导致症状的主观改善;在70%的患者中，症状保持不变，恶化或需要手术治疗。非手术治疗主观改善的预测因素的多变量分析显示，马尾症状的消失（仅神经根症状）的优势比（OR）为3.31（95%置信区间[CI]：1.50-7.31）;无退行性脊椎滑脱/脊柱侧凸的OR为2.53（95% CI：1.13-5.65）;病程<1年的OR为3.81（95% CI：1.46-9.98）;高血压的OR为2.09（95% CI：0.92-4.78）。LSS患者接受非手术治疗后主观症状改善的预测因素为仅存在神经根症状、不存在退行性脊柱滑脱/脊柱侧凸以及病程<1年。
To assess the predictive factors for subjective improvement with nonsurgical treatment in consecutive patients with lumbar spinal stenosis (LSS). Patients with LSS were enrolled from 17 medical centres in Japan. We followed up 274 patients (151 men; mean age, 71 ± 7.4 years) for 3 years. A multivariable logistic regression model was used to assess the predictive factors for subjective symptom improvement with nonsurgical treatment. In 30% of patients, conservative treatment led to a subjective improvement in the symptoms; in 70% of patients, the symptoms remained unchanged, worsened, or required surgical treatment. The multivariable analysis of predictive factors for subjective improvement with nonsurgical treatment showed that the absence of cauda equina symptoms (only radicular symptoms) had an odds ratio (OR) of 3.31 (95% confidence interval [CI]: 1.50–7.31); absence of degenerative spondylolisthesis/scoliosis had an OR of 2.53 (95% CI: 1.13–5.65); <1-year duration of illness had an OR of 3.81 (95% CI: 1.46–9.98); and hypertension had an OR of 2.09 (95% CI: 0.92–4.78). The predictive factors for subjective symptom improvement with nonsurgical treatment in LSS patients were the presence of only radicular symptoms, absence of degenerative spondylolisthesis/scoliosis, and an illness duration of <1 year.