Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
Spine (Phila Pa 1976). 2019 Mar 1;44(5):346-354. doi: 10.1097/BRS.0000000000002805.
A retrospective cohort study.
The objectives of the present study were to examine the changes in the number of surgeries, surgical methods selected, and reoperation rates between the years 2003 and 2008.
The selection of the appropriate surgical method between decompression-only (D) and decompression plus fusion (DF) represents a challenging clinical dilemma in patients with degenerative lumbar spinal spondylolisthesis. DF is selected in greater than 90% of patients, mostly due to the associated low reoperation rate. However, the outcomes of D have been improved with minimally invasive decompression surgery techniques.
The Health Insurance Review and Assessment Service database was used to create cohorts of all Korean patients who underwent surgery for degenerative lumbar spinal spondylolisthesis in 2003 (2003 cohort, n = 5624) and 2008 (2008 cohort, n = 11,706). All patients were followed up for at least 5 years. Reoperation was defined as the occurrence of any type of second lumbar surgery during the follow-up period. The probabilities of reoperation were calculated using the Kaplan-Meier method.
The number of surgeries increased 2.08-fold in 2008. Patients older than 60 years comprised 38.6% of the 2003 cohort and 52.4% of the 2008 cohort. The proportion of DF surgery was 31.13% in the 2003 cohort but 91.54% in the 2008 cohort. However, the high proportion of fusion surgery failed to reduce the reoperation probability in the 2008 cohort (8.1%) compared with that in the 2003 cohort (6.2%). The cost of DF was US$5264 and that of D was $2719 in 2008. DF decreased the reoperation probability by 1% at the cost of $421/patient in the 2008 cohort.
The increased proportion of fusion surgery without improvement in reoperation probability in an aging society may be cautiously addressed in deciding future health policies.
回顾性队列研究。
本研究旨在探讨 2003 年至 2008 年间手术数量、手术方法选择和再次手术率的变化。
在退行性腰椎脊柱滑脱症患者中，选择单纯减压（D）与减压加融合（DF）的合适手术方法是一个具有挑战性的临床难题。DF 方法在超过 90%的患者中被选择，主要是因为其相关的低再次手术率。然而，D 的结果已经通过微创减压手术技术得到了改善。
使用健康保险审查和评估服务数据库创建了 2003 年（2003 队列，n=5624）和 2008 年（2008 队列，n=11706）接受退行性腰椎脊柱滑脱症手术的所有韩国患者队列。所有患者的随访时间均至少为 5 年。再次手术定义为随访期间发生任何类型的第二次腰椎手术。使用 Kaplan-Meier 方法计算再次手术的概率。
2008 年手术数量增加了 2.08 倍。2003 队列中年龄大于 60 岁的患者占 38.6%，而 2008 队列中这一比例为 52.4%。2003 队列中 DF 手术的比例为 31.13%，而 2008 队列中这一比例为 91.54%。然而，在 2008 队列中，高比例的融合手术并未降低再次手术的概率（8.1%），而在 2003 队列中，这一概率为 6.2%。2008 年 DF 的费用为 5264 美元，D 的费用为 2719 美元。在 2008 队列中，DF 每例患者降低 1%的再次手术概率，费用为 421 美元。
在老龄化社会中，融合手术比例的增加而没有改善再次手术的概率，这可能需要在制定未来的卫生政策时谨慎考虑。
4 级。
