Chan Andrew K, Bisson Erica F, Bydon Mohamad, Glassman Steven D, Foley Kevin T, Potts Eric A, Shaffrey Christopher I, Shaffrey Mark E, Coric Domagoj, Knightly John J, Park Paul, Wang Michael Y, Fu Kai-Ming, Slotkin Jonathan R, Asher Anthony L, Virk Michael S, Kerezoudis Panagiotis, Chotai Silky, DiGiorgio Anthony M, Haid Regis W, Mummaneni Praveen V
1Department of Neurological Surgery, University of California, San Francisco, California.
2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
J Neurosurg Spine. 2018 Nov 30;30(2):234-241. doi: 10.3171/2018.8.SPINE17913. Print 2019 Feb 1.
OBJECTIVEThe AANS launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the safety and quality of spine surgery. Registry data offer "real-world" insights into the utility of spinal fusion and decompression surgery for lumbar spondylolisthesis. Using the QOD, the authors compared the initial 12-month outcome data for patients undergoing fusion and those undergoing laminectomy alone for grade 1 degenerative lumbar spondylolisthesis.METHODSData from 12 top enrolling sites were analyzed and 426 patients undergoing elective single-level spine surgery for degenerative grade 1 lumbar spondylolisthesis were found. Baseline, 3-month, and 12-month follow-up data were collected and compared, including baseline clinical characteristics, readmission rates, reoperation rates, and PROs. The PROs included Oswestry Disability Index (ODI), back and leg pain numeric rating scale (NRS) scores, and EuroQol-5 Dimensions health survey (EQ-5D) results.RESULTSA total of 342 (80.3%) patients underwent fusion, with the remaining 84 (19.7%) undergoing decompression alone. The fusion cohort was younger (60.7 vs 69.9 years, p < 0.001), had a higher mean body mass index (31.0 vs 28.4, p < 0.001), and had a greater proportion of patients with back pain as a major component of their initial presentation (88.0% vs 60.7%, p < 0.001). There were no differences in 12-month reoperation rate (4.4% vs 6.0%, p = 0.93) and 3-month readmission rates (3.5% vs 1.2%, p = 0.45). At 12 months, both cohorts improved significantly with regard to ODI, NRS back and leg pain, and EQ-5D (p < 0.001, all comparisons). In adjusted analysis, fusion procedures were associated with superior 12-month ODI (β -4.79, 95% CI -9.28 to -0.31; p = 0.04).CONCLUSIONSSurgery for grade 1 lumbar spondylolisthesis-regardless of treatment strategy-was associated with significant improvements in disability, back and leg pain, and quality of life at 12 months. When adjusting for covariates, fusion surgery was associated with superior ODI at 12 months. Although fusion procedures were associated with a lower rate of reoperation, there was no statistically significant difference at 12 months. Further study must be undertaken to assess the durability of either surgical strategy in longer-term follow-up.
目的
美国神经外科医师协会（AANS）推出了质量结果数据库（QOD），这是一个前瞻性纵向登记系统，包含人口统计学、临床和患者报告结局（PRO）数据，用于衡量脊柱手术的安全性和质量。登记数据为腰椎滑脱的脊柱融合术和减压手术的效用提供了“真实世界”的见解。作者使用QOD比较了1级退变性腰椎滑脱患者接受融合手术和单纯椎板切除术患者的初始12个月结局数据。
方法
分析了12个顶级入组地点的数据，发现426例接受1级退变性腰椎滑脱择期单节段脊柱手术的患者。收集并比较了基线、3个月和12个月的随访数据，包括基线临床特征、再入院率、再次手术率和PRO。PRO包括奥斯威斯功能障碍指数（ODI）、腰腿痛数字评定量表（NRS）评分和欧洲五维健康量表（EQ-5D）结果。
结果
共有342例（80.3%）患者接受了融合手术，其余84例（19.7%）仅接受了减压手术。融合组患者更年轻（60.7岁对69.9岁，p<0.001），平均体重指数更高（31.0对28.4，p<0.001），且以腰痛为初始表现主要组成部分的患者比例更大（88.0%对60.7%，p<0.001）。12个月再次手术率（4.4%对6.0%，p=0.93）和3个月再入院率（3.5%对1.2%，p=0.45）无差异。在12个月时，两组在ODI、NRS腰腿痛和EQ-5D方面均有显著改善（所有比较，p<0.001）。在调整分析中，融合手术与12个月时更好的ODI相关（β-4.79，95%CI-9.28至-0.31；p=0.04）。
结论
1级腰椎滑脱手术——无论治疗策略如何——在12个月时均与残疾、腰腿痛和生活质量的显著改善相关。在调整协变量后，融合手术在12个月时与更好的ODI相关。尽管融合手术的再次手术率较低，但在12个月时无统计学显著差异。必须进行进一步研究以评估两种手术策略在长期随访中的耐久性。
