Alentado Vincent J, Caldwell Stephanie, Gould Heath P, Steinmetz Michael P, Benzel Edward C, Mroz Thomas E
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA.
Spine J. 2017 Feb;17(2):236-243. doi: 10.1016/j.spinee.2016.09.011. Epub 2016 Sep 21.
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.
This is a retrospective review of patients who underwent instrumented lumbar fusion.
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.
Outcome measures included preoperative and postoperative EQ-5D Index scores.
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively.
多项研究已确定腰椎融合患者欧洲五维健康量表（EQ-5D）评分的最小临床重要差异（MCID）阈值。然而，对于术后临床显著改善（CSI）的预测因素尚无全面了解。
确定腰椎融合手术后获得临床显著改善的医学、影像学和手术预测因素。
这是一项对接受器械辅助腰椎融合术患者的回顾性研究。
我们纳入了2008年至2013年间因任何适应证接受腰椎融合术的患者。
结局指标包括术前和术后EQ-5D指数评分。
回顾性分析因任何适应证接受腰椎融合术患者的病历，以确定患者的医学和手术特征。一名盲法评估者对每位患者的X线片进行评估，以检查融合后的矢状位对线情况。基于两个常用的MCID值，使用多变量逻辑回归对实现临床显著改善进行建模。
共有231例患者符合纳入标准；58%的患者EQ-5D评分超过MCID值0.100，16%的患者超过MCID值0.390。对于MCID阈值为0.100未实现临床显著改善的统计学显著独立预测因素包括术前EQ-5D评分较高（比值比[OR]=44.8）和L5-S1融合（OR=3.3）。对于MCID值0.390，术前EQ-5D评分较高（OR=2080.8）和抑郁症诊断（OR=7.1）可预测未实现临床显著改善，而腰椎滑脱（OR=4.1）可预测术后实现临床显著改善。对于两个MCID值，实现临床显著改善的患者在所有测量指标上的术后生活质量（QOL）评分均更好，尽管术前QOL评分较差。
本研究首次将医学、手术和术后矢状位平衡变量结合起来，作为腰椎融合术后实现临床显著改善的决定因素。了解这些预测因素可能有助于更好地选择患者和手术方式，以降低术后不良结局的可能性。
