Hospital Universitario Clínico San Carlos. Madrid, España.
Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 May-Jun;64(3):177-184. doi: 10.1016/j.recot.2019.12.003. Epub 2020 Mar 11.
Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation.
An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery.
A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator.
The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist.
下腰痛仍然是西方人群中的一种常见病理实体。我们在文献中没有发现任何数据评估，通过正确的体格检查和脊柱简单 X 光片的评估，是否可以诊断出极有可能成为腰椎手术候选者的患者，从而减少这种疾病带来的护理负担和资源消耗。本研究的目的是开发一个用户友好的计算器，仅允许极有可能接受手术治疗的患者转诊接受脊柱手术咨询。
这是一项观察性和回顾性研究，纳入了来自西班牙托莱多省塔拉拉弗拉雷纳（Talavera de la Reina）医疗保健区的所有成年患者，这些患者在经过一年的日历时间后，因临床和/或放射学诊断为退行性腰椎疾病而被其他专家转诊至脊柱外科病房，以评估在不成功的保守治疗后是否需要手术。所有患者均按照相同的方案进行评估，随访 6 年，在随访结束时对接受过腰椎手术的患者进行检查。
共研究了 201 例患者，在 6 年随访结束时，共有 77 例患者接受了手术。手术治疗的指征与随访结束时接受的治疗之间的一致性为 70%。因此，进行了逻辑回归以试图预测可以转诊到脊柱外科病房的患者，并由此生成了一个计算器，其中包括平片变量作为一个基本项目，并且显示出统计学意义（P<.05）：年龄、Waddell 的非器质性体征、Lasegue 征和平片评估。获得该工具后，计算了所有拟行手术治疗患者的手术可能性，当使用计算器时，超过 62%的结果作为截止点。
计算器的使用可以可靠地预测成为手术治疗候选者的可能性为 70%。因此，计算器结果大于 62%的患者应转诊接受脊柱外科评估。
