Rosen David S, O'Toole John E, Eichholz Kurt M, Hrubes Melody, Huo Dezheng, Sandhu Faheem A, Fessler Richard G
Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Neurosurgery. 2007 Mar;60(3):503-9; discussion 509-10. doi: 10.1227/01.NEU.0000255332.87909.58.
Lumbar spinal stenosis and spondylosis are major causes of morbidity among the elderly. Surgical decompression is an effective treatment, but many elderly patients are not considered as candidates for surgery based on age or comorbidities. Minimally invasive surgical techniques have recently been developed and used successfully for the treatment of lumbar spinal disease. Our objective was to examine the safety and efficacy of minimally invasive lumbar spinal surgery for elderly patients.
We reviewed demographic information, pre- and postoperative Visual Analog Scale pain scores, Oswestry Disability Index scores, and Short-Form 36 scores of prospectively accrued patients who underwent minimally invasive decompression of lumbar degenerative disease at two institutions between January 2002 and December 2005. Data from patients who were at least 75 years old were selected. Statistical analysis methods included paired t test, multiple linear regression, and linear mixed effects modeling.
Fifty-seven patients with a mean age of 81 years met the study criteria (median follow-up period, 7 mo; mean follow-up period, 10 mo). No major complications or deaths occurred. Fifty patients had sufficient outcomes data for analysis. Visual Analog Scale pain scores decreased from 5.7 to 2.2 for back pain and from 5.7 to 2.3 for symptomatic leg pain (P < 0.05). Oswestry Disability Index scores decreased from 48 to 27; Short-Form 36 Body Pain and Physical Function scores also showed statistically significant improvements after surgery (P < 0.05). The longitudinal analysis demonstrated durability of the symptom relief.
Minimally invasive lumbar spine decompression is a safe and efficacious treatment for elderly patients with spinal stenosis and spondylosis. Elderly patients should be considered good candidates for lumbar surgical decompression using minimally invasive techniques.
腰椎管狭窄症和脊椎关节病是老年人发病的主要原因。手术减压是一种有效的治疗方法，但许多老年患者因年龄或合并症而不被视为手术候选人。近年来已开发出微创外科技术，并成功用于治疗腰椎疾病。我们的目的是研究老年患者微创腰椎手术的安全性和有效性。
我们回顾了2002年1月至2005年12月期间在两家机构接受腰椎退行性疾病微创减压的前瞻性累积患者的人口统计学信息、术前和术后视觉模拟量表疼痛评分、Oswestry功能障碍指数评分和简明健康调查36项评分。选择年龄至少75岁患者的数据。统计分析方法包括配对t检验、多元线性回归和线性混合效应模型。
57例平均年龄81岁的患者符合研究标准（中位随访期7个月；平均随访期10个月）。未发生重大并发症或死亡。50例患者有足够的结果数据用于分析。背痛的视觉模拟量表疼痛评分从5.7降至2.2，有症状的腿痛评分从5.7降至2.3（P<0.05）。Oswestry功能障碍指数评分从48降至27；简明健康调查36项身体疼痛和身体功能评分在术后也有统计学显著改善（P<0.05）。纵向分析表明症状缓解具有持久性。
微创腰椎减压术是治疗老年腰椎管狭窄症和脊椎关节病患者的一种安全有效的方法。老年患者应被视为使用微创技术进行腰椎手术减压的良好候选人。
