Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Bone Joint J. 2019 Feb;101-B(2):154-161. doi: 10.1302/0301-620X.101B2.BJJ-2018-1136.R2.
The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level.
This was a retrospective study of 235 consecutive patients who had undergone decompression-only surgery for lumbar spinal stenosis and had a minimum five-year follow-up. There were 106 female patients (45.1%) and 129 male patients (54.9%), with a mean age at surgery of 66.8 years (sd 11.3). We excluded those with adult deformity and spondylolisthesis. Presenting symptoms, levels operated on initially and at re-operation were studied. MRI measurements included the anteroposterior diameter of the bony spinal canal, the degree of disc degeneration, and the thickness of the ligamentum flavum. DSS was defined by comparative measurements of the bony spinal canal. Risk factors for re-operation at the adjacent level were determined and included in a multivariate stepwise logistic regression for prediction modelling. Odds ratios (ORs) with 95% confidence intervals were calculated.
Of the 235 patients, 21.7% required re-operation at an adjacent segment. Re-operation at an adjacent segment was associated with DSS (p = 0.026), the number of levels decompressed (p = 0.008), and age at surgery (p = 0.013). Multivariate regression model (p < 0.001) controlled for other confounders showed that DSS was a significant predictor of re-operation at an adjacent segment, with an adjusted OR of 3.93.
Patients with DSS who have undergone lumbar spinal decompression are 3.9 times more likely to undergo future surgery at an adjacent level. This is a poor prognostic indicator that can be identified prior to index decompression surgery.
本研究旨在确定发育性椎管狭窄（DSS）对邻近节段再手术风险的影响。
这是一项回顾性研究，纳入了 235 例连续接受单纯减压手术治疗腰椎管狭窄症且随访时间至少 5 年的患者。其中女性 106 例（45.1%），男性 129 例（54.9%），手术时的平均年龄为 66.8 岁（标准差 11.3）。我们排除了成人畸形和脊椎滑脱患者。研究了患者的首发症状、初次手术和再次手术的节段。磁共振成像（MRI）测量包括骨性椎管的前后径、椎间盘退变程度和黄韧带厚度。通过比较骨性椎管的测量值来定义 DSS。确定了邻近节段再手术的危险因素，并纳入多变量逐步逻辑回归模型进行预测建模。计算了优势比（OR）及其 95%置信区间。
在 235 例患者中，21.7%需要在邻近节段再次手术。邻近节段再次手术与 DSS（p = 0.026）、减压节段数量（p = 0.008）和手术时年龄（p = 0.013）相关。多变量回归模型（p < 0.001）控制了其他混杂因素，结果表明 DSS 是邻近节段再手术的显著预测因素，调整后的 OR 为 3.93。
接受过腰椎减压手术的 DSS 患者，再次在邻近节段接受手术的可能性增加 3.9 倍。这是一个预后不良的指标，可以在指数减压手术之前识别。
