Burgstaller Jakob M, Porchet François, Steurer Johann, Wertli Maria M
Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032, Zurich, Switzerland.
Department of Neurosurgery, Spine Center, Schulthess Clinic, Zürich, Switzerland.
BMC Musculoskelet Disord. 2015 Apr 22;16:96. doi: 10.1186/s12891-015-0548-8.
Lumbar spinal stenosis is the most common reason for spinal surgery in elderly patients. However, the surgical management of spinal stenosis is controversial. The aim of this review was to list aspects a surgeon considers when choosing a specific type of treatment.
Appraisal of arguments reported in randomized controlled trials (RCTs) included in systematic reviews published or indexed in the Cochrane library studying surgical treatments in patients with spinal stenosis.
Eight out of nine RCTs listed arguments for the choice of their treatments under investigation. The argument for decompression alone was the high success rate, the argument against was a potential increase in vertebral instability. The argument for decompression and fusion without instrumentation was that it is a well-established technique with a high fusion success rate, the argument against it was that the indication for fusion in spinal stenosis has remained unclear. The argument for decompression and fusion with instrumentation was an increased fusion rate compared to decompression and fusion without instrumentation, the argument against this was that the invasive procedure is associated with more complications.
The main argument identified in this appraisal for and against decompression alone in patient with lumbar spinal stenosis was whether or not instability should be treated with (instrumented) fusion procedures. However, there is disagreement on how instability should be defined. In a first step it is important that researchers and clinicians agree on definitions for important key concepts such as instability and reoperations.
腰椎管狭窄症是老年患者脊柱手术最常见的原因。然而，椎管狭窄症的手术治疗存在争议。本综述的目的是列出外科医生在选择特定治疗类型时所考虑的因素。
对Cochrane图书馆发表或索引的系统评价中纳入的随机对照试验（RCT）报告的论据进行评估，这些试验研究了椎管狭窄症患者的手术治疗。
九项RCT中有八项列出了其正在研究的治疗选择的论据。仅行减压的论据是成功率高，反对的论据是椎体不稳定可能增加。不行内固定的减压融合术的论据是这是一种成熟的技术，融合成功率高，反对的论据是椎管狭窄症的融合指征仍不明确。行内固定的减压融合术的论据是与不行内固定的减压融合术相比，融合率更高，反对的论据是该侵入性手术会带来更多并发症。
本评估中确定的支持和反对单纯对腰椎管狭窄症患者进行减压的主要论据是是否应采用（内固定）融合手术治疗不稳定。然而，对于如何定义不稳定存在分歧。首先，研究人员和临床医生就不稳定和再次手术等重要关键概念的定义达成一致很重要。
