Jakola Asgeir S, Sørlie Andreas, Gulati Sasha, Nygaard Oystein P, Lydersen Stian, Solberg Tore
Department of Neurosurgery, St. Olavs Hospital HF, Trondheim, Norway.
BMC Surg. 2010 Nov 22;10:34. doi: 10.1186/1471-2482-10-34.
To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.
A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.
The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.
Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.
评估老年椎管狭窄患者减压性椎板切除术后的安全性、危险因素及临床结局。
从常规临床实践中连续纳入101例70岁及以上接受传统非融合椎板切除术的椎管狭窄患者，在3个月和12个月时进行重新评估。主要结局是用欧洲五维健康量表（EQ - 5D）测量的健康相关生活质量变化。次要结局包括安全性评估、Oswestry功能障碍指数（ODI）变化、自我报告健康状况的视觉模拟量表（EQ - VAS）评分、腿部和背部疼痛的VAS评分以及患者满意度。我们使用回归分析来评估改善较少的危险因素。
EQ - 5D总分在基线、3个月和12个月时分别为0.32、0.63和0.60，显示出具有统计学意义（P < 0.001）的改善。效应量> 0.8。基线时ODI平均评分为44.2，3个月时为25.6，12个月时为27.9。所有术后评分均有改善。共记录到18例（18.0%）并发症，其中6例（6.0%）为严重并发症，包括1例围手术期死亡。表示手术在3个月时有益的患者有82例（89.1%），在12个月时为73例（86.9%）。唯一发现的预测因素是腿痛持续时间较长的患者ODI改善较少（P < 0.001）。年龄增加或有并发症在任何结局变量中均未预测更差的结局。
经过适当选择的70岁及以上患者在接受非融合开放性椎板切除术后，健康相关生活质量、功能状态和疼痛有望得到具有临床意义的改善。该治疗似乎是安全的。然而，术前有长期腿痛的患者术后一年改善的可能性较小。
