Sciubba Daniel M, Scheer Justin K, Yurter Alp, Smith Justin S, Lafage Virginie, Klineberg Eric, Gupta Munish, Eastlack Robert, Mundis Gregory M, Protopsaltis Themistocles S, Blaskiewicz Donald, Kim Han Jo, Koski Tyler, Kebaish Khaled, Shaffrey Christopher I, Bess Shay, Hart Robert A, Schwab Frank, Ames Christopher P
Department of Neurosurgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 5-185, Baltimore, MD, 21287, USA.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Eur Spine J. 2016 Aug;25(8):2433-41. doi: 10.1007/s00586-015-3759-7. Epub 2015 Feb 6.
The goal of the present study was to compare the outcomes of operative and non-operative patients with adult spinal deformity (ASD) over 75 years of age.
A retrospective review of a multicenter prospective adult spinal deformity database was conducted examining patients with ASD over the age of 75 years. Demographics, comorbidities, operation-related variables, complications, radiographs, and Health-related quality of life (HRQOL) measures collected included Oswestry Disability Index, Short Form-36, and Scoliosis Research Society-22 preoperatively, and at 1 and 2 years later. Minimum clinically important difference (MCID) was calculated and also compared.
27 patients (12 operative, 15 non-operative) were studied. There were no significant differences (p > 0.05) between operative and non-operative patients for age, body mass-index, and comorbidities, but operative patients had worse baseline HRQOL than non-operative patients. Operative patients had a significant improvement in radiographic parameters in 2-year HRQOL, whereas non-operative patients did not (p > 0.05). Operative patients were significantly more likely to reach MCID (range 41.7-81.8 vs. 0-33.3 %, p < 0.05). In the surgical group, 9 (75 %) patients had at least 1 complication (24 total complications).
In the largest series to date comparing operative and non-operative management of adult spinal deformity in elderly patients greater than 75 years of age, reconstructive surgery provides significant improvements in pain and disability over a 2-year period. Furthermore, operative patients were more likely to reach MCID than non-operative patients. When counseling elderly patients with ASD, such data may be helpful in the decision-making process regarding treatment.
本研究的目的是比较75岁以上成人脊柱畸形（ASD）手术患者与非手术患者的治疗结果。
对一个多中心前瞻性成人脊柱畸形数据库进行回顾性研究，纳入年龄超过75岁的ASD患者。收集的人口统计学、合并症、手术相关变量、并发症、X线片以及健康相关生活质量（HRQOL）指标包括术前、术后1年和2年的Oswestry功能障碍指数、简明健康状况调查量表（Short Form-36）以及脊柱侧凸研究学会-22项问卷。计算并比较最小临床重要差异（MCID）。
共研究了27例患者（12例手术患者，15例非手术患者）。手术患者与非手术患者在年龄、体重指数和合并症方面无显著差异（p>0.05），但手术患者的基线HRQOL比非手术患者差。手术患者在2年的HRQOL中，影像学参数有显著改善，而非手术患者则没有（p>0.05）。手术患者达到MCID的可能性显著更高（范围为41.7-81.8%对0-33.3%，p<0.05）。在手术组中，9例（75%）患者至少发生1例并发症（共24例并发症）。
在迄今为止最大规模的比较75岁以上老年患者成人脊柱畸形手术治疗与非手术治疗的系列研究中，重建手术在2年期间能显著改善疼痛和功能障碍。此外，手术患者比非手术患者更有可能达到MCID。在为患有ASD的老年患者提供咨询时，这些数据可能有助于治疗决策过程。
