Shabat Shay, Arinzon Zeev, Folman Yoram, Leitner Josef, David Rami, Pevzner Evgeny, Gepstein Reuven, Pekarsky Ilya, Shuval Ishay
Spinal Care Unit, Sapir Medical Center, 48 Tchernichovsky Street, Kfar-Saba, 44281, Israel.
Eur Spine J. 2008 Feb;17(2):193-8. doi: 10.1007/s00586-007-0514-8. Epub 2007 Oct 17.
The purpose of our prospective study is to evaluate the surgical outcome among patients aged 80 years and above, who underwent surgery for lumbar spinal stenosis. We assessed patients' clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients' satisfaction, the need for repeated surgery, and overall mortality. Thirty-nine patients more than 80 years of age were operated in our institution in the last decade. Twenty-five of them were followed-up with a mean 36.8 months after the operation. The Barthel index was used to evaluate pre and postsurgery ADL, and the visual analogue scale (VAS) was used to evaluate pain. The satisfaction rate of the patients before and after the operation and the complication rate were also evaluated. A significant reduction in VAS (P < 0.001) and a significant increase in the Barthel index (P < 0.001) were recorded. Seventy-six percent of the patients were very satisfied or somewhat satisfied with the operative results. Fifty-two percent of the patients had complications (0.9 complications per patients), however, about half of them were minor. No operative or perioperative mortality was noticed and the overall hospital stay for these elderly patients was 3.6 days on average. Surgery in very old elderly patients is safe and effective in the treatment of spinal stenosis, who did not respond well to the conservative treatment. The surgery did not increase the associated morbidity and mortality and most of the patients benefited from the surgery in terms of reduction in pain, increase in ADL and walking ability and overall increase in the satisfaction rate.
我们前瞻性研究的目的是评估80岁及以上接受腰椎管狭窄手术患者的手术效果。我们评估了患者的临床和人口统计学数据、手术过程、围手术期并发症、术前和术后疼痛强度、基本日常生活活动(BADL)、患者满意度、再次手术需求以及总体死亡率。在过去十年中,我们机构为39名80岁以上的患者实施了手术。其中25名患者在术后平均36.8个月进行了随访。采用Barthel指数评估手术前后的日常生活活动能力,采用视觉模拟量表(VAS)评估疼痛程度。同时还评估了患者手术前后的满意度和并发症发生率。结果显示VAS显著降低(P < 0.001),Barthel指数显著升高(P < 0.001)。76%的患者对手术结果非常满意或较为满意。52%的患者出现并发症(每位患者平均0.9次并发症),不过其中约一半为轻微并发症。未观察到手术或围手术期死亡情况,这些老年患者的平均住院时间为3.6天。对于保守治疗效果不佳的高龄老年患者,手术治疗腰椎管狭窄是安全有效的。手术并未增加相关的发病率和死亡率,大多数患者在疼痛减轻、日常生活活动能力和行走能力提高以及满意度总体提升方面均从手术中获益。