Hoffman Haydn, Bennett Shelley S, Li Charles H, Haakana Piia, Lu Daniel C
Department of Neurosurgery, University of California Los Angeles.
Department of Physical Therapy, University of California, Los Angeles.
Cureus. 2018 Jun 11;10(6):e2785. doi: 10.7759/cureus.2785.
Background Lumbar spinal stenosis (LSS) is the most common indication for spine surgery among the geriatric population. Although decompressive surgery is effective, older patients do not benefit as much as younger patients, and they are frequently excluded from studies assessing postoperative physiotherapy. We sought to evaluate the long-term outcomes after surgery when a novel postoperative physiotherapy regimen was included. Methods We performed a retrospective review of patients with LSS greater than 70 years old who underwent lumbar decompressive surgery by the senior author over the past five years. We evaluated patients who participated in a novel postoperative physiotherapy regimen involving four phases of rehabilitation aimed at progressively independent ambulation. The visual analog scale (VAS), lower extremity motor strength, and functional independence measure (FIM) were collected preoperatively and after physiotherapy to measure outcomes. Results Ten consecutive patients with an average age of 83 years (range: 71 - 96) met the inclusion criteria. Nine patients underwent minimally invasive laminotomies at L4-L5 and one underwent a laminotomy at L3-L4. The average follow-up time was 41.9 months. The preoperative mean VAS was 7.35, and at the end of the study, it was 1.7 (p = 0.005). Three of the four patients with preoperative motor deficits improved. The median transfer and locomotion subscores of the FIM were six preoperatively and increased to seven postoperatively. Neither of these improvements was significant. Conclusions Patients older than 70 years undergoing decompressive surgery and a novel postoperative physiotherapy regimen experienced significant reductions in pain. Independence also increased; however, this did not reach statistical significance.
背景 腰椎管狭窄症（LSS）是老年人群中脊柱手术最常见的适应症。尽管减压手术有效，但老年患者获益程度不如年轻患者，并且他们经常被排除在评估术后物理治疗的研究之外。我们试图评估纳入一种新型术后物理治疗方案后的手术长期疗效。方法 我们对过去五年中由资深作者为年龄大于70岁的腰椎管狭窄症患者进行腰椎减压手术的情况进行了回顾性研究。我们评估了参与一种新型术后物理治疗方案的患者，该方案包括四个康复阶段，旨在逐步实现独立行走。术前和物理治疗后收集视觉模拟量表（VAS）、下肢肌力和功能独立性测量（FIM）以评估疗效。结果 连续10例平均年龄83岁（范围：71 - 96岁）的患者符合纳入标准。9例患者在L4 - L5行微创椎板切开术，1例在L3 - L4行椎板切开术。平均随访时间为41.9个月。术前平均VAS为7.35，研究结束时为1.7（p = 0.005）。术前有运动功能障碍的4例患者中有3例有所改善。FIM的转移和移动亚评分中位数术前为6分，术后增至7分。这些改善均无统计学意义。结论 年龄大于70岁的患者接受减压手术和新型术后物理治疗方案后疼痛明显减轻。独立性也有所提高；然而，这未达到统计学意义。
