Ferrero Emmanuelle, Lonjon Guillaume, Bouyer Benjamin, Sabourin Marc, Ould-Slimane Mourad, Guigui Pierre
Department of orthopedic surgery, hôpital européen Georges-Pompidou, Paris V university, 20, rue Leblanc, 75015 Paris, France.
Department of orthopedic surgery, hôpital européen Georges-Pompidou, Paris V university, 20, rue Leblanc, 75015 Paris, France.
Orthop Traumatol Surg Res. 2018 Nov;104(7):1031-1036. doi: 10.1016/j.otsr.2018.07.012. Epub 2018 Sep 1.
In degenerative lumbar spinal stenosis (DLSS) variability of symptoms according to the severity of stenosis is not well understood. Therefore, another factor that impacts functional outcomes of DLSS patients has been evoked: patient's comorbidities. The aim of this study was to investigate influence of comorbidities on clinical symptoms and functional outcomes in DLSS patients.
In this prospective study, patients treated for DLSS were included during 12 consecutive months. Both clinical and radiographic exams were required to confirm DLSS diagnosis. Epidemiologic, clinical and radiographic data were collected. Two questionnaires were used to assess functional outcomes: a specific score dedicated to lumbar stenosis consequences assessment (self-administered Beaujon questionnaire, SABQ) and a non-specific score (Short Form 36, SF-36). Four comorbidity scores were calculated: Cumulative Illness Rating Scale, Charlson index, Functional Comorbidity Index and Index of Co-Existent Diseases Correlations between functional and comorbidity scores were calculated.
250 patients were included (65.6±12 years). The four comorbidities scores were significantly correlated to total SABQ, as well as lumbar and radicular ischemia components. Best correlations were observed for cumulative illness rating scale and SABQ. Two factors were observed that significantly influenced the relationship between SABQ and cumulative illness rating scale: herniated disc and SF-36 general health perception.
This study highlighted that preoperative function is influenced by comorbidities in DLSS patients. Relationships existed between comorbidities and symptoms related to low back pain and neurogenic claudication, contrary to radicular pain. Therefore, comorbidities might impact the variability of patients' outcomes. This finding should be part of the patient's preoperative information. Moreover, role of comorbidities on postoperative outcomes need to be investigated.
在退变性腰椎管狭窄症（DLSS）中，根据狭窄严重程度出现的症状变异性尚未得到充分理解。因此，另一个影响DLSS患者功能结局的因素被提及：患者的合并症。本研究的目的是调查合并症对DLSS患者临床症状和功能结局的影响。
在这项前瞻性研究中，连续12个月纳入接受DLSS治疗的患者。需要进行临床和影像学检查以确诊DLSS。收集流行病学、临床和影像学数据。使用两份问卷评估功能结局：一份专门用于评估腰椎管狭窄后果的特定评分（自我管理的博若莱问卷，SABQ）和一份非特定评分（简短健康调查问卷，SF-36）。计算四个合并症评分：累积疾病评定量表、查尔森指数、功能合并症指数和共存疾病指数。计算功能评分与合并症评分之间的相关性。
纳入250例患者（65.6±12岁）。四个合并症评分与总SABQ以及腰椎和神经根缺血成分显著相关。累积疾病评定量表与SABQ的相关性最佳。观察到两个因素显著影响SABQ与累积疾病评定量表之间的关系：椎间盘突出和SF-36总体健康感知。
本研究强调，DLSS患者的术前功能受合并症影响。合并症与腰痛和神经源性间歇性跛行相关症状之间存在关联，与神经根性疼痛相反。因此，合并症可能影响患者结局的变异性。这一发现应作为患者术前信息的一部分。此外，合并症对术后结局的作用需要进一步研究。
