Ulrich Nils H, Gravestock Isaac, Held Ulrike, Schawkat Khoschy, Pichierri Giuseppe, Wertli Maria M, Winklhofer Sebastian, Farshad Mazda, Porchet Francois, Steurer Johann, Burgstaller Jakob M
Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland; Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
World Neurosurg. 2018 Jun;114:e1275-e1283. doi: 10.1016/j.wneu.2018.03.196. Epub 2018 Apr 5.
Decompression alone to treat degenerative lumbar stenosis with and without concomitant degenerative spondylolisthesis (DS; non-DS) has shown ambiguous results in the literature.
The aim is to compare clinical outcomes in DS and non-DS patients with lumbar stenosis who underwent decompression alone surgery without fusion on 1-3 adjacent levels after 6-month, 12-month, 24-month, and 36-month follow-up.
We conducted a prospective cohort study at 8 medical centers. The main outcomes of this study are changes in Spinal Stenosis Measure (SSM) symptoms score, SSM function score, and quality of life (EQ-5D-3L sum score) over time. Propensity score matching for DS versus non-DS was applied.
One hundred seventy-seven patients met the inclusion criteria, 68 of whom had DS. In the matched cohort (n = 136), the estimated difference in SSM symptoms score of DS versus non-DS for changes from baseline to 36 months was 0.21 (95% CI, -0.15 to 0.57). For SSM function score, the estimated difference from baseline to 36 months was 0.05 (-0.21 to 0.31). Differences in changes between groups in EQ-5D-3L sum score were estimated to be -3.66 (-10.63 to 3.31) from baseline to 36 months. None of the group differences between the non-DS and the DS group was statistically significant. All matched patients improved over time in all additional outcomes.
Even after 3 years of follow-up, we show that among patients with degenerative lumbar spinal stenosis, both groups (DS and non-DS) distinctively take advantage of decompression alone without fusion.
在有或没有伴发退行性椎体滑脱（DS；无DS）的情况下，单纯减压治疗退行性腰椎管狭窄症在文献中的结果并不明确。
旨在比较腰椎管狭窄症的DS患者和无DS患者在接受1 - 3个相邻节段单纯减压未融合手术，在6个月、12个月、24个月和36个月随访后的临床结局。
我们在8个医疗中心进行了一项前瞻性队列研究。本研究的主要结局是随时间变化的椎管狭窄测量（SSM）症状评分、SSM功能评分和生活质量（EQ - 5D - 3L总分）。对DS与无DS进行倾向评分匹配。
177例患者符合纳入标准，其中68例有DS。在匹配队列（n = 136）中，从基线到36个月时，DS与无DS的SSM症状评分估计差异为0.21（95%CI，-0.15至0.57）。对于SSM功能评分，从基线到36个月的估计差异为0.05（-0.21至0.31）。从基线到36个月，EQ - 5D - 3L总分的组间变化差异估计为-3.66（-10.63至3.31）。无DS组和DS组之间的组间差异均无统计学意义。所有匹配患者在所有其他结局方面均随时间改善。
即使经过3年的随访，我们发现，在退行性腰椎管狭窄症患者中，两组（DS和无DS）均能明显从单纯减压未融合手术中获益。
