Norton Leatherman Spine Center, Suite 900, Louisville, KY 40202, USA.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:77-84. doi: 10.2106/JBJS.I.01300.
The value of lumbar spine arthrodesis in older patients is not well documented. As most of the literature regarding lumbar arthrodesis in older patients has focused on the prevalence of complications, the purpose of this study was to determine the clinical outcomes for older compared with younger patients undergoing lumbar arthrodesis.
We studied 224 patients who underwent a single-level posterolateral lumbar arthrodesis with an iliac crest bone graft. Outcome measures included the Oswestry Disability Index, the Medical Outcomes Study Short Form-36 and numeric rating scales for back and leg pain, as well as a radiographic assessment of fusion. Outcome measures were evaluated on the basis of the mean change and the percentage of patients reaching a minimum clinically important difference threshold. For comparison, the patients were divided into two groups: 174 patients who were younger than sixty-five years and fifty patients who were sixty-five years of age or older.
Substantial improvements from baseline were noted in all of the clinical and health-related quality-of-life measures at the six-month, one-year, and two-year intervals. The mean improvements in the Oswestry Disability Index score at two years postoperatively were 28.5 points for the older patients and 24.5 points for the younger patients. For Short Form-36 physical component summary scores, the mean improvement from baseline was 14.2 points for the older group and 11.7 points for the younger group at two years. The older patients also demonstrated a similar or greater improvement in the numeric rating scale back and leg pain scores at all time intervals, with a significant difference in leg pain scores at two years postoperatively (10.4 points for the older patients and 6.4 points for the younger patients; p=0.002). Perioperative complications, although an obvious concern, did not appear to adversely affect clinical and health-related quality-of-life outcomes at two years postoperatively.
This study demonstrates a substantial benefit for patients sixty-five years of age or older with degenerative disc disease who are treated with a single-level lumbar decompression and instrumented arthrodesis, and we conclude that lumbar arthrodesis is a viable and reasonable treatment option for appropriately selected patients sixty-five years of age or older.
老年人腰椎融合术的价值尚未得到充分证实。由于大多数关于老年患者腰椎融合术的文献都集中在并发症的发生率上，因此本研究的目的是确定与年轻患者相比，老年患者接受腰椎融合术的临床结果。
我们研究了 224 例接受单节段后路腰椎融合术伴髂嵴骨移植的患者。结果测量包括 Oswestry 功能障碍指数、医疗结果研究 36 项简明健康状况调查问卷和腰背腿痛数字评分量表，以及融合的放射学评估。根据平均变化和达到最小临床重要差异阈值的患者比例来评估结果测量。为了进行比较，将患者分为两组：174 例年龄小于 65 岁，50 例年龄为 65 岁或以上。
所有临床和健康相关生活质量指标在术后 6 个月、1 年和 2 年均有显著改善。术后 2 年时，老年患者 Oswestry 功能障碍指数评分的平均改善为 28.5 分，年轻患者为 24.5 分。对于健康调查简表生理成分总分，老年组从基线的平均改善为 14.2 分，年轻组为 11.7 分，在 2 年时。老年患者在所有时间间隔的腰背腿痛数字评分量表评分也表现出类似或更大的改善，术后 2 年时腿痛评分差异有统计学意义（老年患者 10.4 分，年轻患者 6.4 分；p=0.002）。虽然围手术期并发症是一个明显的关注点，但它们似乎并没有对术后 2 年的临床和健康相关生活质量结果产生不利影响。
本研究表明，对于患有退行性椎间盘疾病且接受单节段腰椎减压和器械融合术治疗的 65 岁或以上患者，有显著的获益，我们得出结论，腰椎融合术是一种可行且合理的治疗选择，适用于适当选择的 65 岁或以上患者。
