老年患者微创治疗脊柱狭窄术后的结局与年轻患者相似。
Elderly patients have similar outcomes compared to younger patients after minimally invasive surgery for spinal stenosis.
机构信息
Department of Surgery, University of Toronto, Toronto, ON, Canada.
出版信息
Clin Orthop Relat Res. 2014 Jun;472(6):1824-30. doi: 10.1007/s11999-013-3411-y.
BACKGROUND
Older patients undergo surgery for lumbar spinal stenosis in great numbers, but as a result of substantial diagnostic and surgical heterogeneity, the impact of age on results after surgery is poorly defined.
QUESTIONS/PURPOSES: We compared groups of patients younger and older than 70 years with relative clinical and surgical homogeneity to determine differences in (1) interval improvement in Oswestry Disability Index (ODI) at 6 weeks, 6 months, and 12 months postoperatively and (2) perioperative adverse events.
METHODS
We performed a subgroup analysis of an ongoing prospective observational study. Patients were divided based primarily on age (younger than 70 years [n = 68] and 70 years or older [n = 41]) and secondarily on procedure (minimally invasive decompression alone or decompression and instrumented fusion). With the exception of age and American Society of Anesthesiologists status, the two age groups were similar (p > 0.3) in baseline demographics and ODI. Mean pre- and postoperative ODI were compared between groups at 6 weeks, 6 months, and 12 months. Perioperative adverse events were also compared.
RESULTS
At all time intervals, both younger and older patients demonstrated (p = 0.05 to < 0.001) improvements in ODI. At the 1-year mark, no differences in ODI were demonstrated between the younger and older patients for decompression only (21 versus 26 [p = 0.29]) or decompression and fusion (19 versus 18 [p = 0.97]). Interval improvement in ODI was not different between younger and older patients at any time point for decompression only (6 weeks: -18 versus -20 [p = 0.66]; 6 months: -21 versus -17 [p = 0.41]; 12 months: -21 versus -15 [p = 0.29]) or decompression and fusion (6 weeks: -11 versus -12 [p = 0.58]; 6 months: -21 versus -22 [p = 0.69]; 12 months: -23 versus -27 [p = 0.97]). There were no differences in perioperative adverse events between groups (p = 0.67).
CONCLUSIONS
When clinical and surgical heterogeneity is minimized, improvements in terms of disability as measured by the ODI and the frequency of adverse events after surgery in elderly patients with lumbar spinal stenosis are comparable to those of younger patients. For patients with focal lumbar spinal stenosis, age alone should not dissuade us from considering surgical intervention if otherwise indicated.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
背景
大量老年患者接受腰椎椎管狭窄症手术，但由于诊断和手术存在很大的异质性，因此年龄对术后结果的影响尚不清楚。
问题/目的：我们比较了年龄小于 70 岁和大于或等于 70 岁的患者组，这些患者具有相对的临床和手术同质性，以确定（1）术后 6 周、6 个月和 12 个月时 Oswestry 残疾指数（ODI）的间隔改善情况，以及（2）围手术期不良事件的差异。
方法
我们对一项正在进行的前瞻性观察性研究进行了亚组分析。患者主要根据年龄（小于 70 岁[n = 68]和 70 岁或以上[n = 41]）和其次根据手术方式（单纯微创减压或减压和器械融合）进行分组。除年龄和美国麻醉医师协会状态外，两个年龄组在基线人口统计学和 ODI 方面相似（p > 0.3）。在术后 6 周、6 个月和 12 个月时，比较两组之间的术前和术后平均 ODI。还比较了围手术期不良事件。
结果
在所有时间间隔内，年龄较小和较大的患者的 ODI 均有（p = 0.05 至 < 0.001）改善。在 1 年时，单纯减压的年轻患者和老年患者之间的 ODI 无差异（21 对 26 [p = 0.29]）或减压和融合（19 对 18 [p = 0.97]）。在任何时间点，单纯减压的年轻患者和老年患者之间的 ODI 间隔改善均无差异（6 周：-18 对-20 [p = 0.66]；6 个月：-21 对-17 [p = 0.41]；12 个月：-21 对-15 [p = 0.29]）或减压和融合（6 周：-11 对-12 [p = 0.58]；6 个月：-21 对-22 [p = 0.69]；12 个月：-23 对-27 [p = 0.97]）。两组之间围手术期不良事件无差异（p = 0.67）。
结论
当临床和手术异质性最小化时，腰椎管狭窄症老年患者术后残疾程度（以 ODI 衡量）和不良事件发生率的改善与年轻患者相当。对于有局灶性腰椎管狭窄症的患者，如果有其他指征，年龄不应成为我们不考虑手术干预的原因。
证据水平
III 级，治疗性研究。有关证据水平的完整描述，请参见作者说明。
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