*Department of Orthopaedics, University of Utah, Salt Lake City, UT; and †Division of Orthopaedic Surgery, Department of Surgery, University of Nevada, Las Vegas, NV.
Spine (Phila Pa 1976). 2013 Dec 15;38(26):2287-94. doi: 10.1097/BRS.0000000000000068.
Retrospective cohort analysis.
To compare early treatment failures, survivorship, and clinical outcomes of 3 procedures used to treat symptomatic lumbar spinal stenosis and degenerative deformity.
Symptomatic lumbar stenosis is commonly seen in association with degenerative deformity, often leading to more complex surgical treatment, with laminectomy and fusion, supplanting laminectomy alone. More recently, the interspinous process spacer (ISP), developed to treat straightforward spinal stenosis, has been used in patients with spinal deformity to limit morbidity, although no studies have compared outcomes in this patient population.
A retrospective cohort analysis of 90 consecutive patients, mean age 70 years, with 5-year mean follow-up (minimum, 2 yr), treated for stenosis with associated deformity with ISP device placement, laminectomy alone, or laminectomy and short-segment fusion. Early failure was defined as return to the operating room for revision of the index level or adjacent segment within 2 years. A Kaplan-Meier survival analysis was performed, and clinical outcomes and patient satisfaction was assessed.
Reoperation within 2 years was noted in 16.7% of patients treated for spinal stenosis and mild deformity. There was a significantly higher rate of same-level recurrence in the ISP group (33.3%), than the laminectomy (8.3%) and lami/fusion groups (0%) (P< 0.0001). Early reoperation due to adjacent segment pathology (ASP) was most common in the lami/fusion group (13.3%). Kaplan-Meier analysis revealed lowest survival for the ISP group and highest survival in the laminectomy-alone group at 2 years (P= 0.043) and 5 years (P= 0.007).
Early failure was significantly more common in patients treated with an ISP device for spinal stenosis and lumbar deformity, whereas reoperation due to symptomatic adjacent segment pathology was most common in patients treated with laminectomy and fusion. Laminectomy alone had the highest rate of survival.
回顾性队列分析。
比较三种治疗症状性腰椎椎管狭窄症和退行性变形的方法的早期治疗失败率、生存率和临床结果。
症状性腰椎狭窄症常与退行性变形有关，通常导致更复杂的手术治疗，即单纯椎板切除术被椎板切除术加融合术取代。最近，为治疗单纯性椎管狭窄症而开发的棘突间撑开器（ISP）已用于脊柱畸形患者，以降低发病率，尽管尚无研究比较该患者人群的结果。
对 90 例连续患者进行回顾性队列分析，平均年龄 70 岁，平均随访 5 年（最短随访 2 年），采用 ISP 装置、单纯椎板切除术或椎板切除术加短节段融合术治疗伴有畸形的狭窄症。早期失败定义为术后 2 年内返回手术室对索引水平或相邻节段进行翻修。进行 Kaplan-Meier 生存分析，并评估临床结果和患者满意度。
在治疗轻度脊柱畸形和狭窄症的患者中，有 16.7%的患者在术后 2 年内再次手术。在 ISP 组（33.3%）中，同水平复发率明显高于单纯椎板切除术组（8.3%）和椎板切除加融合组（0%）（P<0.0001）。由于相邻节段病变（ASP）导致早期再次手术最常见于椎板切除加融合组（13.3%）。Kaplan-Meier 分析显示，ISP 组的生存率最低，单纯椎板切除术组的生存率最高，在 2 年（P=0.043）和 5 年（P=0.007）时。
对于患有脊柱狭窄症和腰椎畸形的患者，使用 ISP 装置治疗的早期失败率明显更高，而由于症状性相邻节段病变导致再次手术的患者最常见于接受椎板切除术加融合术的患者。单纯椎板切除术的生存率最高。
3 级。
