Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
London Health Sciences Center, London, Ontario, Canada.
Spine (Phila Pa 1976). 2018 May 15;43(10):E574-E579. doi: 10.1097/BRS.0000000000002429.
A prospective cohort study of consecutive patients.
Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively.
Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively.
Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage.
Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group.
The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression.
一项连续患者的前瞻性队列研究。
确定退行性腰椎滑脱症患者非手术治疗的生活质量（QoL）和滑脱进展的发生率。
继发于退行性腰椎滑脱症的腰椎管狭窄症是一种常见的放射学诊断，与慢性腰痛和神经根症状有关。在经过验证的 QoL 测量方面，关于这种疾病的临床病程以及非手术治疗患者的滑脱进展程度，证据有限。
评估了经过验证的疾病特异性和通用 QoL 指标，包括 SF12 身体和心理评分[SF12 身体成分综合评分（PCS）和 SF12 心理成分综合评分（MCS）]、Oswestry 残疾指数（ODI）以及背部和腿部疼痛的数字评分，以及滑脱程度的放射学评估，在初始就诊（基线）和基线评估后至少 5 年进行评估。滑脱进展定义为滑脱百分比增加超过 5%。
尽管术前 X 线片未见滑脱进展，但160 名患者中有 39 名（24.4%）选择转为手术治疗。66 名参与者中有 70 个滑脱水平在非手术治疗至少 5 年后进行了评估。21 名参与者（31.8%）出现了滑脱进展。两组患者的 SF12-PCS、ODI 和腿部疼痛均有类似改善（P<0.05）。两组的 SF12-MCS 均无显著变化。只有在未进展组中背部疼痛有所改善。
大多数低等级滑脱症病例在 5 年内通过非手术治疗不会进展。无论是否有进展，无论是否有进展，PCL、ODI 和腿部疼痛均从基线水平改善，尽管症状仍然存在，且在 5 年内有相当数量的患者选择转为手术治疗。只有在没有进展的情况下，非手术治疗才能改善背部疼痛。
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