Khechen Benjamin, Haws Brittany E, Patel Dil V, Cardinal Kaitlyn L, Guntin Jordan A, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Clin Spine Surg. 2019 Mar;32(2):E107-E111. doi: 10.1097/BSD.0000000000000735.
Retrospective cohort.
The objective of this study was to determine if an association exists between gender and postoperative improvements in patient-reported outcomes (PRO) measures following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Current spine literature presents conflicting findings regarding the influence of gender on clinical outcomes.
Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. PRO measures including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain scores were collected preoperatively and 6-week, 12-week, and 6-month postoperatively. Rates of minimum clinically important difference (MCID) achievement were determined at 6-months postoperative. Statistical analysis was performed using Pearson χ analysis or Student t test.
In total, 169 patients, 40.83% females and 59.17% males, were included. Females experienced greater inpatient pain scores than males (POD 0: 5.30 vs. 4.69, P=0.041; POD 1: 4.80 vs. 4.13, P=0.019). Females demonstrated significantly greater ODI (43.77 vs. 36.22; P=0.002) and VAS leg (6.20 vs. 5.27; P=0.039) scores than males. No differences in postoperative improvements in ODI, VAS back or VAS leg pain scores were identified between genders, with exception to females demonstrating greater improvement in VAS leg pain at 6 months postoperatively (female: -4.40 vs. male: -3.32; P=0.033). Furthermore, no differences in MCID achievement for PROs were identified between cohorts.
Females demonstrated greater preoperative pain and disability as well as inpatient VAS pain scores compared to males. Furthermore, gender was not associated with differences in length of stay, perioperative complication rates, or narcotics consumption. Improvements in pain and disability, as well as rates of MCID achievement were similar between genders. These findings suggest that gender is not associated with surgical or clinical outcomes and should not be used as a predictor of outcomes following MIS TLIF.
Level III.
回顾性队列研究。
本研究的目的是确定性别与微创经椎间孔腰椎椎间融合术（MIS TLIF）后患者报告结局（PRO）测量指标的术后改善之间是否存在关联。
目前的脊柱文献对于性别对临床结局的影响呈现出相互矛盾的研究结果。
对接受初次单节段MIS TLIF手术的患者进行回顾性分析。收集术前以及术后6周、12周和6个月的PRO测量指标，包括奥斯维斯特残疾指数（ODI）以及视觉模拟评分（VAS）的腰背痛和腿痛评分。在术后6个月确定达到最小临床重要差异（MCID）的比例。使用Pearson χ分析或Student t检验进行统计分析。
总共纳入了169例患者，其中女性占40.83%，男性占59.17%。女性患者住院期间的疼痛评分高于男性（术后第0天：5.30对4.69，P = 0.041；术后第1天：4.80对4.13，P = 0.019）。女性患者的ODI评分（43.77对36.22；P = 0.002）和VAS腿痛评分（6.20对5.27；P = 0.039）显著高于男性。除女性在术后6个月时VAS腿痛改善程度更大外（女性：-4.40对男性：-3.32；P = 0.033），未发现性别之间在ODI、VAS腰背痛或VAS腿痛评分的术后改善方面存在差异。此外，各队列之间在PRO达到MCID方面未发现差异。
与男性相比，女性术前疼痛和残疾程度更高，住院期间的VAS疼痛评分也更高。此外，性别与住院时间、围手术期并发症发生率或麻醉药物消耗量的差异无关。性别之间在疼痛和残疾改善以及达到MCID的比例方面相似。这些发现表明，性别与MIS TLIF术后的手术或临床结局无关，不应作为MIS TLIF术后结局的预测指标。
三级。
