Department of Neurological Surgery, University of California San Diego, San Diego, CA.
Spine (Phila Pa 1976). 2019 Dec 1;44(23):E1369-E1378. doi: 10.1097/BRS.0000000000003155.
This is a retrospective analysis of national administrative hospital data.
This study examines national trends in the surgical management of lumbar spinal stenosis (LSS) in patients with and without coexisting scoliosis between 2010 and 2014. The study also examines revision rates for LSS procedures.
There is wide variability in the surgical management of patients with LSS, with and without coexisting spinal deformity.
Data were obtained from the Healthcare Cost and Utilization Project's National Inpatient Sample Database. International Classification of Diseases 9th revision- Clinical Modification codes were used to identify all patients with a primary diagnosis of lumbar spinal stenosis. These patients were divided into two groups: 1) LSS alone and 2) LSS with coexisting scoliosis. The two groups were examined for one of three surgical outcomes: 1) decompression alone (discectomy, laminectomy), 2) simple fusion, and 3) complex fusion (>three vertebrae or 360° fusion). The groups were then further examined for revision operations. National Inpatient Sample discharge weights were applied where relevant.
In 2014 national estimates of discharged patients indicated 76,275 patients with a primary diagnosis of LSS (population rate, 23.9; in the elderly (65+) the age-adjusted population rate was 95.4). Of these patients, 88.5% were managed through primary surgery (34.6% decompression, 47.2% simple fusion, 5.7% complex fusion). Between 2010 and 2014, the percentage of decompression decreased from 47.5% to 34.6%, the percent of simple fusion increased from 35.3% to 47.2%, and the percent of complex fusion increased from 5.7% to 7.1% (P < 0.01). In patients with coexisting scoliosis, lumbar spinal stenosis was predominantly managed by simple fusion and complex fusion (15.5% decompression, 51.9% simple fusion, 27.3% complex fusion, in 2014). Revision rates were highest among patients without scoliosis managed with complex fusion (15.8% in 2014) compared with patients with scoliosis (8.8% in 2014). Patients with scoliosis who underwent decompression only had revision rates of 1.7% and 0.62% in 2010 and 2014, respectively.
We observed a leveling-off of the rate of operation for patients with a primary diagnosis of LSS at around 88%. There was an increase in the rate of fusion and a decrease in the rate of decompression across all patient groups. We report no difference in revision rates between patients with and without scoliosis, except in those undergoing a complex fusion.
这是一项对国家行政医院数据的回顾性分析。
本研究旨在检查 2010 年至 2014 年间，伴或不伴脊柱侧凸的腰椎管狭窄症（LSS）患者的手术治疗的全国趋势。本研究还检查了 LSS 手术的翻修率。
伴或不伴脊柱畸形的 LSS 患者的手术治疗存在很大差异。
数据来自医疗保健成本和利用项目的国家住院患者样本数据库。使用国际疾病分类第 9 版临床修正版代码来确定所有原发性腰椎管狭窄症患者。这些患者被分为两组：1）单纯 LSS 和 2）伴脊柱侧凸的 LSS。两组患者接受了三种手术治疗结果之一的检查：1）单纯减压（椎间盘切除术、椎板切除术），2）单纯融合，3）复杂融合（>3 个椎体或 360°融合）。然后进一步检查两组患者的翻修手术。在相关情况下应用国家住院患者样本出院权重。
2014 年全国出院患者的估计表明，有 76275 名患者被诊断为原发性 LSS（人口比例为 23.9%；在老年人（65 岁以上）中，年龄调整后的人口比例为 95.4%）。这些患者中，88.5%通过初次手术治疗（34.6%减压，47.2%单纯融合，5.7%复杂融合）。2010 年至 2014 年间，减压的比例从 47.5%降至 34.6%，单纯融合的比例从 35.3%增至 47.2%，复杂融合的比例从 5.7%增至 7.1%（P<0.01）。在伴脊柱侧凸的患者中，腰椎管狭窄症主要通过单纯融合和复杂融合治疗（2014 年分别为 15.5%减压，51.9%单纯融合，27.3%复杂融合）。在未伴脊柱侧凸的患者中，接受复杂融合治疗的患者翻修率最高（2014 年为 15.8%），而伴脊柱侧凸的患者翻修率为 8.8%（2014 年）。在 2010 年和 2014 年，仅接受减压治疗的伴脊柱侧凸患者的翻修率分别为 1.7%和 0.62%。
我们观察到原发性 LSS 患者的手术率约为 88%，达到了稳定水平。所有患者组的融合率都有所增加，减压率则有所下降。我们报告脊柱侧凸患者与无脊柱侧凸患者的翻修率没有差异，除了接受复杂融合治疗的患者。
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