Fukushima Masayoshi, Oka Hiroyuki, Hara Nobuhiro, Oshima Yasushi, Chikuda Hirotaka, Tanaka Sakae, Takeshita Katsushi, Matsudaira Ko
Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Orthop Sci. 2017 May;22(3):411-414. doi: 10.1016/j.jos.2017.01.021. Epub 2017 Feb 20.
A few cohort studies have determined which patients with lumbar spinal stenosis are likely to need surgery because of the deterioration of symptoms. However, there are still insufficient data regarding the management of lumbar spinal stenosis due to lack of prognostic factors associated with the need for surgery. The purpose of this study was to identify the prognostic factors associated with the need for surgical treatment in patients with lumbar spinal stenosis.
Patients with lumbar spinal stenosis from our hospital and related facilities were enrolled. Eligibility criteria were as follows: age 50-85 years and the patient's conditions met the definition of lumbar spinal stenosis; the presence of neurogenic intermittent claudication caused by numbness and/or pain in the lower limbs; and magnetic resonance imaging-confirmed symptomatic LSS. We followed 274 patients (151 men; mean age, 71 ± 7.4 years) for 3 years to identify prognostic factors. We used a multivariate logistic regression model to investigate the association between the indication for surgical treatment (within 3 years) and age, sex, complications, depression, illness duration, the presence of cauda equina symptoms, and the presence of degenerative spondylolisthesis/scoliosis.
In the survey conducted 3 years after treatment, 185 patients responded (follow-up rate 67.5%). In 82 patients, surgery was performed during the follow-up period. The multivariate logistic regression model showed that the presence of cauda equina symptoms and the presence of degenerative spondylolisthesis/scoliosis were significantly associated with the indication for surgical treatment within 3 years.
This study showed that the presence of cauda equina symptoms and degenerative spondylolisthesis/scoliosis were prognostic factors associated with the indication for surgery in patients with lumbar spinal stenosis.
一些队列研究已确定哪些腰椎管狭窄症患者可能因症状恶化而需要手术。然而，由于缺乏与手术需求相关的预后因素，关于腰椎管狭窄症的治疗仍数据不足。本研究的目的是确定腰椎管狭窄症患者手术治疗需求的预后因素。
纳入我院及相关机构的腰椎管狭窄症患者。纳入标准如下：年龄50 - 85岁且患者病情符合腰椎管狭窄症的定义；存在由下肢麻木和/或疼痛引起的神经源性间歇性跛行；磁共振成像确诊为有症状的腰椎管狭窄症。我们对274例患者（151例男性；平均年龄71±7.4岁）进行了3年的随访以确定预后因素。我们使用多因素逻辑回归模型研究手术治疗指征（3年内）与年龄、性别、并发症、抑郁、病程、马尾神经症状的存在以及退行性椎体滑脱/脊柱侧凸的存在之间的关联。
在治疗3年后进行的调查中，185例患者回复（随访率67.5%）。在82例患者中，随访期间进行了手术。多因素逻辑回归模型显示，马尾神经症状的存在以及退行性椎体滑脱/脊柱侧凸的存在与3年内手术治疗指征显著相关。
本研究表明，马尾神经症状的存在以及退行性椎体滑脱/脊柱侧凸是腰椎管狭窄症患者手术指征的预后因素。
