全国范围内腰椎管狭窄症的手术治疗趋势。
Nationwide trends in the surgical management of lumbar spinal stenosis.
机构信息
Cedars Sinai Spine Center, Los Angeles, CA, USA.
出版信息
Spine (Phila Pa 1976). 2013 May 15;38(11):916-26. doi: 10.1097/BRS.0b013e3182833e7c.
STUDY DESIGN
Retrospective analysis using national administrative data.
OBJECTIVE
This study presents US nationwide trends in the surgical management of patients with lumbar spinal stenosis (LSS) with and without coexisting spondylolisthesis and scoliosis from 2004 to 2009.
SUMMARY OF BACKGROUND DATA
Lack of consensus and wide variability exists in surgical decision making for patients with LSS.
METHODS
Data were obtained from the Nationwide Inpatient Sample, a database developed as part of the Healthcare Cost and Utilization Project. All discharged patients with a primary diagnosis of LSS were identified. Three subgroups were studied: (1) LSS alone, (2) LSS with spondylolisthesis, and (3) LSS with scoliosis. Surgical treatment was divided into 3 groups: (1) decompression only (laminectomy, discectomy), (2) simple fusion (1-2 disc levels, single approach), and (3) complex fusion (>2 disc levels or a combined posterior and anterior approach).
RESULTS
Between 2004 and 2009, national estimates for the annual number of discharged inpatients with a primary diagnosis of LSS increased from 94,011 (population rate, [the age adjusted population rate per 100,000] 32.1) to 102,107 (population rate, 33.3). The rate of decompressions decreased from 58.5% to 49.2% for discharged patients with LSS from 2004 to 2009 (P < 0.05), whereas the rate of simple fusions increased from 21.5% to 31.2% (P < 0.05) and the rate of complex fusions did not change at 6.7%. From 2004 to 2009, the use of bone morphogenetic protein more than doubled from 14.5% to 33.0% of all fusions, and the use of interbody devices increased from 28.5% to 45.1% (P < 0.05). In 2009, 26.2% of patients with LSS without instability underwent a fusion procedure, while 82.7% of patients with LSS with coexisting spondylolisthesis and 67.6% of patients with coexisting scoliosis underwent a fusion procedure.
CONCLUSION
This study demonstrates that the rate of simple fusion surgery has increased for treatment of LSS compared with decompression only.
LEVEL OF EVIDENCE
研究设计
使用国家行政数据进行回顾性分析。
目的
本研究旨在展示 2004 年至 2009 年期间，美国患有腰椎管狭窄症（LSS）伴或不伴脊椎滑脱和脊柱侧凸患者的手术治疗方式的全国趋势。
背景资料概述
对于患有 LSS 的患者，手术决策存在共识缺乏和广泛差异。
方法
数据来自全国住院患者样本，这是医疗保健成本和利用项目的一部分。确定了所有主要诊断为 LSS 的出院患者。研究了三个亚组：（1）LSS 单独，（2）LSS 伴脊椎滑脱，和（3）LSS 伴脊柱侧凸。手术治疗分为三组：（1）仅减压（椎板切除术，椎间盘切除术），（2）简单融合（1-2 个椎间盘水平，单一入路），和（3）复杂融合（>2 个椎间盘水平或联合后路和前路）。
结果
2004 年至 2009 年期间，全国每年因主要诊断为 LSS 而出院的住院患者人数从 94,011 人（人口率，[每 100,000 人的年龄调整人口率]32.1）增加到 102,107 人（人口率，33.3）。从 2004 年到 2009 年，患有 LSS 的出院患者的减压率从 58.5%下降到 49.2%（P <0.05），而简单融合的比例从 21.5%上升到 31.2%（P <0.05），而复杂融合的比例没有变化，为 6.7%。从 2004 年到 2009 年，骨形态发生蛋白的使用增加了一倍以上，从所有融合术的 14.5%增加到 33.0%，椎间植入物的使用从 28.5%增加到 45.1%（P <0.05）。2009 年，26.2%无不稳定的 LSS 患者接受了融合手术，而 82.7%的 LSS 伴脊椎滑脱患者和 67.6%的 LSS 伴脊柱侧凸患者接受了融合手术。
结论
本研究表明，与单纯减压相比，LSS 的单纯融合手术率有所增加。
证据水平
4 级。
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