Elsayed Galal, Erwood Matthew S, Davis Matthew C, Dupépé Esther C, McClugage Samuel G, Szerlip Paul, Walters Beverly C, Hadley Mark N
1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and.
2Department of Computer Science, University of Central Florida, Orlando, Florida.
J Neurosurg Spine. 2018 Oct;29(4):388-396. doi: 10.3171/2018.2.SPINE171028. Epub 2018 Jul 6.
This study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis.
Data were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders.
Ninety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients.
Sedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.
本研究确定腰椎管狭窄症手术减压后3个月和12个月时术前身体活动水平与功能结局之间的关联。
数据收集于2012年至2015年在单一机构进行的前瞻性观察登记，并采用回顾性队列设计进行分析。将术前能够参与户外活动的患者与未参与此类活动的患者在干预后3个月和12个月的功能结局方面进行比较，并对相关混杂因素进行调整。
纳入99例患者。在基线时，久坐/不活动的患者（n = 55）报告的背痛更严重、生活质量更低、残疾程度更高，相比术前活跃的接受类似治疗的患者。两个队列在腰椎减压手术后3个月和12个月时，背痛、腿痛、残疾程度和生活质量均较基线有显著改善。干预后3个月，久坐/不活动的患者报告的腿痛更多，残疾程度比术前参与户外活动的患者更差。然而，干预后12个月，两个队列在背痛、腿痛、生活质量或残疾程度方面无统计学显著差异。多变量分析显示，与基线相比，久坐/不活动的患者术后残疾程度改善，生活质量提高。活跃患者与不活动患者相比，残疾程度总体改善更大。
久坐/不活动的患者在腰椎管狭窄症减压手术后恢复时间更长，但在干预后12个月时，预期可达到与术前活跃/参与户外活动的患者相似的长期结局。
