退行性腰椎滑脱症后路手术围手术期影响术后满意度的因素
Perioperative Factors Influencing Postoperative Satisfaction After Lateral Access Surgery for Degenerative Lumbar Spondylolisthesis.
作者信息
Xu Sheng, Liow Ming Han Lincoln, Goh Keng Meng Jeremy, Yeo William, Ling Zhixing Marcus, Soh Chee Cheong Reuben, Tan Seang Beng, Chen Li Tat John, Guo Chang Ming
机构信息
Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4. Singapore.
出版信息
Int J Spine Surg. 2019 Oct 31;13(5):415-422. doi: 10.14444/6056. eCollection 2019 Oct.
BACKGROUND
Lateral access surgery (LAS) for lumbar degenerative spondylolisthesis is a minimally invasive lumbar fusion technique which has been gaining increasing popularity in the recent years. This study aims to identify perioperative factors that influence postoperative satisfaction after LAS for lumbar degenerative spondylolisthesis.
METHODS
From August 2010 to November 2014, 52 patients with lumbar degenerative conditions (16 male: 36 female, mean age 64.0 ± 8.7 years) were prospectively recruited and underwent LAS by a single surgeon. All patients were assessed preoperatively and 2 years postoperatively with Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, Short-Form 36 (SF-36) scores, North American Spine Society score for neurogenic symptoms, patient satisfaction, and expectation fulfillment. Cobb angles, global lumbar lordosis, disc heights, adjacent disc heights, fusion, and subsidence were rates assessed. Multiple linear regression performed with satisfaction as dependent variable to identify predictive independent variables.
RESULTS
Lower preoperative SF-36 general health scores ( = .03), higher NPRS leg pain scores ( = .04), and longer surgical duration ( = .02) were significant predictors of lower satisfaction ( < .05). NPRS back and leg pain decreased by 80.3 and 83.0%, respectively. Oswestry Disability Index and North American Spine Society score for neurogenic symptoms improved by 76.2 and 75.9%, respectively. Ninety percent of patients reported excellent/good satisfaction. Significant correction and maintenance of Cobb and global lumbar lordosis angles were achieved. There was significant increase in disc heights postoperatively ( = .05) and no significant difference in adjacent disc heights at 2 years ( > .05). Ninety-eight percent of patients achieved Bridwell Fusion Grade 1, and 5.8% had Marchi Grade 3 subsidence.
CONCLUSIONS
Lower preoperative SF-36 general health, higher NPRS leg pain, and longer surgical duration are predictors of lower satisfaction in patients undergoing LAS for lumbar degenerative spondylolisthesis.
LEVEL OF EVIDENCE
III.
CLINICAL RELEVANCE
Identifying preoperative predictors for postoperative clinical outcome can assist clinicians in patient education prior to operation.
背景
腰椎退行性滑脱的外侧入路手术（LAS）是一种微创腰椎融合技术，近年来越来越受欢迎。本研究旨在确定影响腰椎退行性滑脱LAS术后满意度的围手术期因素。
方法
2010年8月至2014年11月，前瞻性招募了52例腰椎退行性疾病患者（男16例，女36例，平均年龄64.0±8.7岁），由一名外科医生进行LAS手术。所有患者在术前和术后2年采用数字疼痛评分量表（NPRS）、Oswestry功能障碍指数、简明健康状况调查量表（SF-36）评分、北美脊柱协会神经源性症状评分、患者满意度和期望达成情况进行评估。评估Cobb角、腰椎整体前凸、椎间盘高度、相邻椎间盘高度、融合情况和沉降率。以满意度为因变量进行多元线性回归，以确定预测性独立变量。
结果
术前SF-36总体健康评分较低（P = 0.03）、NPRS腿痛评分较高（P = 0.04）和手术时间较长（P = 0.02）是满意度较低的显著预测因素（P < 0.05）。NPRS背痛和腿痛分别下降了80.3%和83.0%。Oswestry功能障碍指数和北美脊柱协会神经源性症状评分分别改善了76.2%和75.9%。90%的患者报告满意度为优/良。实现了Cobb角和腰椎整体前凸角的显著矫正和维持。术后椎间盘高度显著增加（P = 0.05），2年时相邻椎间盘高度无显著差异（P > 0.05）。98%的患者达到Bridwell融合1级，5.8%有Marchi 3级沉降。
结论
术前SF-36总体健康状况较差、NPRS腿痛较高和手术时间较长是腰椎退行性滑脱LAS患者满意度较低的预测因素。
证据级别
III。
临床意义
确定术后临床结果的术前预测因素可帮助临床医生在手术前对患者进行教育。
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