Kang Daniel G, Baldus Christine, Glassman Steven D, Shaffrey Christopher I, Lurie Jon D, Bridwell Keith H
Washington University in St. Louis School of Medicine, St. Louis, MO.
University of Louisville, Louisville, KY.
Spine (Phila Pa 1976). 2017 Apr 1;42(7):479-489. doi: 10.1097/BRS.0000000000001800.
A retrospective analysis of prospective, multicenter National Institute of Health clinical trial.
The aim of this study was to assess the rate of neurologic complications and impact of new neurologic deficits on 1-year postoperative patient-reported outcomes (PROs).
There are limited studies evaluating the impact of new neurologic deficits on PROs following surgery for primary presentation adult lumbar scoliosis.
Patients were divided into two groups: new postoperative neurological deficit (Def) or no deficit (NoDef). Preoperative and 1-year follow-up PROs were analyzed [Scoliosis Research Society (SRS) Questionnaire, Oswestry Disability Index (ODI), Short Form-12 Physical/Mental Health Composite Scores (PCS/MCS), and back/leg pain Numerical Rating Scale (NRS)].
One hundred forty-one patients: 14 Def (9.9%), 127 NoDef (90.1%). No differences were observed in demographic, radiographic, or PRO data between groups preoperatively. Def group had longer surgical procedures (8.3 vs. 6.9 hours, P = 0.030), greater blood loss (2832 vs. 2606 mL, P = 0.022), and longer hospitalizations (10.6 vs. 7.8 days, P = 0.004). NoDef group reported significant improvement in all PROs from preop to 1-year postoperative. Def group only had improvement in SRS Pain (2.7 preop to 3.4 postop, P = 0.037) and self-image domains (2.7 to 3.6, p = 0.004), and NRS back pain (6.6 to 3.2, P = 0.004) scores with significant worsening of NRS leg pain (4.1 to 6.1, P = 0.045). Group comparisons of 1-year postop PROs found that Def group reported more NRS leg pain (6.1 vs. 1.7, P < 0.001) and worse outcomes than NoDef group for ODI (35.7 vs. 23.1, P = 0.016) and PCS (32.6 vs. 41.9, P = 0.007).
We found a 9.9% rate of new neurologic deficits following surgery for symptomatic primary presentation adult lumbar scoliosis, much higher than previous studies. Most neurologic deficits improved by 1-year follow-up, but appeared to have a dramatic negative impact on PROs, with increased postoperative leg pain and greater patient-perceived pathology reported in patients experiencing neurological deficits compared with those who did not.
对一项前瞻性、多中心的美国国立卫生研究院临床试验进行回顾性分析。
本研究旨在评估神经并发症的发生率以及新出现的神经功能缺损对术后1年患者报告结局（PROs）的影响。
评估新出现的神经功能缺损对成人原发性腰椎侧弯手术术后PROs影响的研究有限。
患者分为两组：术后出现新的神经功能缺损（Def）组和无神经功能缺损（NoDef）组。分析术前和术后1年的PROs [脊柱侧弯研究学会（SRS）问卷、奥斯威斯利残疾指数（ODI）、简短健康调查问卷12项身体/心理健康综合评分（PCS/MCS）以及腰/腿痛数字评定量表（NRS）]。
141例患者：14例有神经功能缺损（9.9%），127例无神经功能缺损（90.1%）。术前两组在人口统计学、影像学或PROs数据方面未观察到差异。有神经功能缺损组手术时间更长（8.3小时对6.9小时，P = 0.030），失血量更大（2832毫升对2606毫升，P = 0.022），住院时间更长（10.6天对7.8天，P = 0.004）。无神经功能缺损组报告所有PROs从术前到术后1年都有显著改善。有神经功能缺损组仅在SRS疼痛（术前2.7分，术后3.4分，P = 0.037）、自我形象领域（2.7分至3.6分，P = 0.004）以及NRS腰背痛（6.6分至3.2分，P = 0.004）评分上有所改善，而NRS腿痛评分显著恶化（4.1分至6.1分，P = 0.045）。术后1年PROs的组间比较发现，有神经功能缺损组报告的NRS腿痛更多（6.1分对1.7分，P < 0.001），并且在ODI（35.7分对23.1分，P = 0.016）和PCS（32.6分对41.9分，P = 0.007）方面的结局比无神经功能缺损组更差。
我们发现，有症状的原发性成人腰椎侧弯手术后新出现神经功能缺损的发生率为9.9%，远高于先前的研究。大多数神经功能缺损在术后1年时有所改善，但似乎对PROs有显著负面影响，与未出现神经功能缺损的患者相比，出现神经功能缺损的患者术后腿痛增加，且患者感知到的病情更严重。
3级
