Robertson Peter A, Plank Lindsay D
Auckland City Hospital, New Zealand.
J Spinal Disord Tech. 2008 Jun;21(4):235-40. doi: 10.1097/BSD.0b013e3180ca712c.
Prospective cohort study of lumbar spinal fusion.
To examine the functional changes subsequent to lumbar spinal fusion in a total procedure audit in a community spinal surgery practice.
Several randomized controlled trials have demonstrated efficacy of spinal fusion procedures across diagnoses, but demonstrating effectiveness in community practice has been more difficult. Hospital database studies demonstrate incidence, reoperation rates, and complications of spinal fusions, yet cannot demonstrate outcomes consistently. The challenge is to demonstrate functional benefits from spinal fusion in a community setting.
Over a 5-year period all patients in a community practice who underwent lumbar spinal fusion procedures with additional pedicle screw stabilization for degenerative, spondylolytic and spondylolisthetic conditions, were evaluated with application of the Modified Rowland 23 point Questionnaire of Disability preoperatively, and at 1-year postoperative assessment. Statistical analysis was performed.
A median 10-point improvement in the Modified Roland Questionnaire score was achieved across 160 patients, and the improvement was highly statistically significant for the major diagnoses--degenerative spondylolisthesis, discogenic low back pain, and spondylolysis and isthmic spondylolisthesis. Greater reduction of disability was seen in primary procedures when compared with revision surgery, and in noncompensation patients when compared with compensation patients, although in neither case was the difference statistically significant.
This study has demonstrated that consistent functional improvements can be achieved across a total population of lumbar spinal fusions in a nonacademic setting. It also demonstrated that use of prospective cohort analysis techniques, with adequate follow up, and minimal increased costs to patients and practice, is a sustainable prospective audit technique.
腰椎融合术的前瞻性队列研究。
在社区脊柱外科实践的全面手术审计中，检查腰椎融合术后的功能变化。
多项随机对照试验已证明脊柱融合手术在各种诊断中的疗效，但在社区实践中证明其有效性则更具难度。医院数据库研究显示了脊柱融合术的发病率、再次手术率和并发症，但无法始终如一地证明其结果。挑战在于在社区环境中证明脊柱融合术的功能益处。
在5年期间，对社区实践中所有因退行性、峡部裂性和峡部裂滑脱性疾病接受腰椎融合术并附加椎弓根螺钉固定的患者，术前及术后1年应用改良罗兰23点残疾问卷进行评估。进行了统计分析。
160例患者的改良罗兰问卷评分中位数提高了10分，对于主要诊断——退行性滑脱、椎间盘源性下腰痛、峡部裂和峡部裂滑脱，这种改善具有高度统计学意义。与翻修手术相比，初次手术患者的残疾程度降低更大；与有补偿患者相比，无补偿患者的残疾程度降低更大，尽管在这两种情况下差异均无统计学意义。
本研究表明，在非学术环境下，整个腰椎融合患者群体均可实现持续的功能改善。研究还表明，采用前瞻性队列分析技术，进行充分随访，且对患者和医疗机构的成本增加最小，是一种可持续的前瞻性审计技术。
