与腰椎退行性疾病融合后获得最佳结果（最小症状状态）相关的预后因素。

Prognostic factors associated with best outcomes (minimal symptom state) following fusion for lumbar degenerative conditions.

机构信息

Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.

出版信息

Spine J. 2019 Feb;19(2):187-190. doi: 10.1016/j.spinee.2018.06.348. Epub 2018 Jun 28.

DOI:10.1016/j.spinee.2018.06.348

Abstract

BACKGROUND CONTEXT: Previous studies suggest that a postoperative symptom state with Oswestry Disability Index (ODI)≤20 and pain Numeric Rating Scales (NRS)≤2 following surgery for lumbar degenerative conditions are reasonable thresholds for best outcomes in which patients will be unlikely to seek additional medical care or require additional health-care resources. PURPOSE: To identify prognostic factors that predict a "best outcome," defined as postoperative ODI≤20 and pain NRS≤2 following fusion for lumbar degenerative conditions. STUDY DESIGN: Longitudinal observational cohort. PATIENT SAMPLE: A total of 396 patients from a single site enrolled in the Quality Outcomes Database who underwent fusion for lumbar degenerative conditions. OUTCOME MEASURES: Oswestry Disability Index, Back and Leg Pain NRS (0-10). METHODS: Collected and analyzed variables included age, sex, body mass index, American Society of Anesthesia grade, number of surgical levels, surgical time, preoperative ODI, preoperative back pain, preoperative leg pain, workmen compensation status, surgical approach, smoking status, and principal diagnosis. RESULTS: A total of 74 patients (19%) reported a minimal symptom state at 1-year postoperative (ODI≤20, back pain NRS≤2, and leg pain NRS≤2) and were included in the best outcomes group. Patients in the best outcomes group were older (62 vs. 57 years, p=.001), had lower preoperative ODI (43 vs. 56, p=.000), lower preoperative back pain (6.5 vs. 7.5, p=.000). They had fewer surgical levels (1.25 vs. 1.47, p=.005) and shorter operative times [OR] times (208 vs. 241 minutes, p=.002). They were more likely to have a preoperative diagnosis of spondylolisthesis or disc herniation and less likely to have a diagnosis of adjacent segment disease or mechanical disc collapse (p=.001). Stepwise forward regression analysis revealed diagnosis (p=.023, OR=0.75), age (p=.000, OR=1.04), baseline ODI (p=.000, OR=0.96), and number of levels (p=.019, OR=0.53) as predictive variables. CONCLUSION: Achieving a minimal symptom state, defined here as a postoperative ODI≤20 and pain NRS≤2, following fusion for lumbar degenerative conditions is more likely in an older patient with a lower baseline ODI undergoing a single level lumbar fusion for spondylolisthesis.

摘要

背景：先前的研究表明，腰椎退行性疾病手术后 Oswestry 功能障碍指数（ODI）≤20 和疼痛数字评分量表（NRS）≤2 是获得最佳结果的合理阈值，在此情况下，患者不太可能寻求额外的医疗护理或需要额外的医疗保健资源。

目的：确定预测因素，以预测腰椎退行性疾病融合术后 ODI≤20 和疼痛 NRS≤2 的“最佳结果”。

研究设计：纵向观察队列。

患者样本：来自单个地点的 Quality Outcomes Database 中登记的 396 名接受腰椎退行性疾病融合术的患者。

结局测量：Oswestry 功能障碍指数、腰背疼痛 NRS（0-10）。

方法：收集和分析的变量包括年龄、性别、体重指数、美国麻醉医师协会分级、手术节段数、手术时间、术前 ODI、术前腰背疼痛、术前下肢疼痛、工人赔偿状况、手术入路、吸烟状况和主要诊断。

结果：共有 74 例患者（19%）在术后 1 年时报告了最小症状状态（ODI≤20、腰背疼痛 NRS≤2 和下肢疼痛 NRS≤2），并被纳入最佳结果组。最佳结果组的患者年龄更大（62 岁比 57 岁，p=.001），术前 ODI 更低（43 比 56，p=.000），术前腰背疼痛更低（6.5 比 7.5，p=.000）。他们的手术节段数更少（1.25 比 1.47，p=.005），手术时间更短[OR]时间（208 比 241 分钟，p=.002）。他们更有可能患有脊椎滑脱或椎间盘突出的术前诊断，而不太可能患有相邻节段疾病或机械性椎间盘塌陷的术前诊断（p=.001）。逐步向前回归分析显示诊断（p=.023，OR=0.75）、年龄（p=.000，OR=1.04）、基线 ODI（p=.000，OR=0.96）和手术节段数（p=.019，OR=0.53）是预测变量。

结论：在接受腰椎退行性疾病融合术的患者中，年龄较大、基线 ODI 较低、接受单节段腰椎融合术治疗脊椎滑脱的患者，术后 ODI≤20 和疼痛 NRS≤2 的最小症状状态更有可能达到。