Fekete Tamas F, Loibl M, Jeszenszky D, Haschtmann D, Banczerowski P, Kleinstück F S, Becker H J, Porchet F, Mannion A F
Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
National Institute of Clinical Neurosciences, Budapest, Hungary.
Eur Spine J. 2018 Mar;27(3):700-708. doi: 10.1007/s00586-017-5358-2. Epub 2017 Oct 27.
Patient-rated measures are considered the gold standard for assessing the outcome of spine surgery, but there is no consensus on the appropriate timing of follow-up. Journals often demand a minimum 2-year follow-up, but the indiscriminate application of this principle may not be warranted. We examined the course of change in patient outcomes up to 5 years after surgery for degenerative spinal disorders.
The data were evaluated from 4287 consecutive patients (2287 women, 2000 men; aged 62 ± 15 years) with degenerative disorders of the thoracolumbar spine, undergoing first-time surgery at the given level between 01/01/2005 and 31/12/2011. The Core Outcome Measures Index (COMI; scored 0-10) was completed by 4012 (94%) patients preoperatively, 4008 (93%) at 3-month follow-up, 3897 (91%) at 1-year follow-up, 3736 (87%) at 2-year follow-up, and 3387 (79%) at 5-year follow-up. 2959 (69%) completed the COMI at all five time-points.
The individual COMI change scores from preoperatively to the various follow-up time-points showed significant correlations ranging from r = 0.50 (for change scores at the earliest vs the latest follow-up) to r = 0.75 (for change scores after 12- vs 24-month follow-up). Concordance with respect to whether the minimum clinically important change score was achieved at consecutive time-points was also good (70-82%). COMI decreased significantly (p < 0.05) from preop to 3 months (by 3.6 ± 2.8 points) and from 3 to 12 months (by 0.3 ± 2.4 points), then levelled off up to 5 years (0.04-0.05 point change; p > 0.05). The course of change up to 12 months differed slightly (p < 0.05) depending on pathology/whether fusion was carried out. For patients undergoing simple decompression, 3-month follow-up was sufficient; those undergoing fusion continued to show further slight but significant change up to 12 months.
Stable group mean COMI scores were observed for all patients from 12 months postoperatively onwards. The early postoperative results appeared to herald the longer term outcome. As such, a 'wait and see policy' in patients with a poor initial outcome at 3 months is not advocated. The insistence on a 2-year follow-up could result in a failure to intervene early to achieve better long-term outcomes.
患者自评指标被视为评估脊柱手术疗效的金标准，但对于合适的随访时机尚无共识。期刊通常要求至少2年的随访，但不加区分地应用这一原则可能并不合理。我们研究了退行性脊柱疾病患者术后长达5年的疗效变化过程。
对4287例连续患者（2287例女性，2000例男性；年龄62±15岁）的数据进行评估，这些患者患有胸腰椎退行性疾病，于2005年1月1日至2011年12月31日在特定节段接受首次手术。4012例（94%）患者在术前完成了核心结局指标指数（COMI；评分0 - 10），3个月随访时为4008例（93%），1年随访时为3897例（91%），2年随访时为3736例（87%），5年随访时为3387例（79%）。2959例（69%）在所有五个时间点均完成了COMI。
从术前到各个随访时间点的个体COMI变化评分显示出显著相关性，范围从r = 0.50（最早与最晚随访时的变化评分）到r = 0.75（12个月与24个月随访后的变化评分）。在连续时间点是否达到最小临床重要变化评分方面的一致性也良好（70 - 82%）。COMI从术前到3个月显著降低（p < 0.05）（降低3.6±2.8分），从3个月到12个月降低（0.3±2.4分），然后直至5年保持平稳（变化0.04 - 0.05分；p > 0.05）。根据病理情况/是否进行融合，长达12个月的变化过程略有不同（p < 0.05）。对于接受单纯减压的患者，3个月随访就足够了；接受融合手术的患者在长达12个月时仍继续显示出进一步的轻微但显著的变化。
术后12个月起观察到所有患者的组平均COMI评分稳定。术后早期结果似乎预示着长期结局。因此，不提倡对3个月时初始结局较差的患者采取“观望政策”。坚持2年随访可能导致无法早期干预以获得更好的长期结局。
