硬膜外类固醇注射对腰椎管狭窄症疗效研究中患者术后结局的影响。
The Effect of Epidural Steroid Injection on Postoperative Outcome in Patients From the Lumbar Spinal Stenosis Outcome Study.
作者信息
Fekete Tamas, Woernle Christoph, Mannion Anne F, Held Ulrike, Min Kan, Kleinstück Frank, Ulrich Nils, Haschtmann Daniel, Becker Hans-Juergen, Porchet Francois, Theiler Robert, Steurer J
机构信息
*Schulthess Clinic, Spine Center Division, Zürich, Switzerland †Balgrist University Hospital, Department of Orthopedics, University of Zürich, Zürich, Switzerland ‡Schulthess Clinic, Department Research and Development, Spine Center Division, Zürich, Switzerland §Horten Centre for Patient Oriented Research and Knowledge Transfer, University Zürich, Zürich, Switzerland; and ¶Triemli City Hospital, Zürich, Switzerland.
出版信息
Spine (Phila Pa 1976). 2015 Aug 15;40(16):1303-10. doi: 10.1097/BRS.0000000000000969.
STUDY DESIGN
Retrospective analysis of data from patients participating in the Lumbar Spinal Stenosis Outcome Study (LSOS).
OBJECTIVE
The aim of LSOS was to assess clinical outcomes after surgical or nonoperative treatment in patients with and without prior epidural steroid injections.
SUMMARY OF BACKGROUND DATA
Epidural steroid injections (ESI), a common treatment modality, reduce symptoms in the short-term, but according to a subgroup analysis from the Spine Patient Outcomes Research Trial (SPORT) they reduce the amount of improvement after subsequent surgical or nonoperative treatment.
METHODS
The data of 281 patients with lumbar spinal stenosis who had completed baseline and 6-month follow-up assessments were analyzed. Patients completed the Spinal Stenosis Measure (SSM). Changes in the SSM scores from baseline to follow-up were compared between patients with and without prior ESI, for the surgical and nonsurgical treatment groups.
RESULTS
The mean (SD) age of the patients was 75 (8.7) years. 229 patients underwent surgery and 111 of these had received an ESI in the 12 months before surgery. Of the 52 patients treated nonoperatively, 29 had received a prior ESI. The unadjusted changes (improvement) in the SSM-symptom scores between baseline and 6 months' follow up were: surgery and prior ESI 0.95, surgery and no prior ESI 0.78 (P = 0.15); no surgery and prior ESI 0.28, no surgery and no prior ESI 0.29 (P = 0.85). When adjusted for confounding factors, the reduction in SSM-symptom score was greater for surgery than for nonoperative treatment by 0.41 points (P < 0.001); the effect of having had an ESI prior to study entry was -0.08 (P = 0.40).
CONCLUSION
The analysis of outcomes in the LSOS cohort provided no evidence that ESIs have a negative effect on the short-term outcome of surgery or nonoperative treatment in patients with lumbar spinal stenosis.
LEVEL OF EVIDENCE
研究设计
对参与腰椎管狭窄症结局研究（LSOS）的患者数据进行回顾性分析。
目的
LSOS的目的是评估接受或未接受过硬膜外类固醇注射的患者在手术或非手术治疗后的临床结局。
背景数据总结
硬膜外类固醇注射（ESI）是一种常见的治疗方式，可在短期内减轻症状，但根据脊柱患者结局研究试验（SPORT）的亚组分析，它会降低后续手术或非手术治疗后的改善程度。
方法
分析了281例完成基线和6个月随访评估的腰椎管狭窄症患者的数据。患者完成了椎管狭窄测量（SSM）。比较了手术组和非手术组中接受过和未接受过ESI的患者从基线到随访时SSM评分的变化。
结果
患者的平均（标准差）年龄为75（8.7）岁。229例患者接受了手术，其中111例在手术前12个月接受了ESI。在52例接受非手术治疗的患者中，29例接受过ESI。基线至6个月随访期间SSM症状评分的未调整变化（改善情况）为：手术且术前接受过ESI为0.95，手术且术前未接受过ESI为0.78（P = 0.15）；非手术且术前接受过ESI为0.28，非手术且术前未接受过ESI为0.29（P = 0.85）。在对混杂因素进行调整后，手术组SSM症状评分的降低幅度比非手术治疗组大0.41分（P < 0.001）；研究入组前接受过ESI的影响为-0.08（P = 0.40）。
结论
对LSOS队列结局的分析未提供证据表明ESI对腰椎管狭窄症患者手术或非手术治疗的短期结局有负面影响。
证据级别
3级。
Zotero 插件