Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
Spine (Phila Pa 1976). 2020 Sep 1;45(17):E1097-E1104. doi: 10.1097/BRS.0000000000003483.
A multicenter retrospective case series.
The purpose of this study was to compare the clinical outcomes of a surgical treatment for adult spinal deformity (ASD) in the United States (US) with those in Japan (JP) in a matched cohort.
Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity ASD patients who live in Asian countries are poorly understood.
A total of 300 surgically treated ASDs of age more than 50 years with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2 years (2y) were consecutively included. Patients were propensity-score matched for age, sex, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups.
A total of 186 patients were matched by propensity score and were almost identical within these parameters: age (US vs. JP: 66 ± 8 vs. 65 ± 7 yr), sex (females: 90% vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7 sagittal vertical axis (C7SVA) (5 ± 5 vs. 5 ± 4 cm), 2y Pelvic incidence minus lumbar lordosis (9 ± 15° vs. 9 ± 15°), and 2y pelvic tilt (PT) (25 ± 10° vs. 24 ± 10°). Oswestry Disability Index (ODI) scores and Scoliosis Research Society patient questionnaire ((SRS-22) function and pain scores were similar at 2y between the US and JP groups (ODI: 27 ± 19% vs. 28 ± 14%, P = 0.72; SRS-22 function: 3.6 ± 0.9 vs. 3.6 ± 0.7, P = 0.54; SRS-22 pain: 3.6 ± 1.0 vs. 3.8 ± 0.8, P = 0.11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction: 4.3 ± 0.9 vs. 4.0 ± 0.8, P < 0.01).
Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared with the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery.
多中心回顾性病例系列研究。
本研究旨在对美国（US）和日本（JP）接受成人脊柱畸形（ASD）手术治疗的患者的临床结果进行匹配队列比较。
在亚洲国家，年龄超过 50 岁、最低固定椎位于骨盆且随访时间至少 2 年（2y）的胸腰椎骶（TLS）脊柱融合术治疗成人脊柱畸形 ASD 患者的手术结果了解甚少。
共纳入 300 例年龄超过 50 岁的手术治疗 ASD 患者，最低固定椎位于骨盆，且随访时间至少 2 年（2y）。采用倾向性评分对年龄、性别、融合节段和术后 2y 矢状位脊柱排列进行匹配。比较美国和日本两组患者的人口统计学、手术和影像学参数。
通过倾向评分匹配了 186 例患者，这些参数几乎相同：年龄（美国 vs. 日本：66±8 岁 vs. 65±7 岁）、性别（女性：90% vs. 89%）、融合节段（10±3 个 vs. 10±2 个）、术后 2y 的 C7 矢状垂直轴（C7SVA）（5±5cm vs. 5±4cm）、术后 2y 的骨盆入射角减去腰椎前凸（9±15° vs. 9±15°）和术后 2y 的骨盆倾斜角（PT）（25±10° vs. 24±10°）。术后 2y 时，美国和日本两组患者的 Oswestry 功能障碍指数（ODI）评分和脊柱侧凸研究协会患者问卷（（SRS-22）功能和疼痛评分相似（ODI：27±19% vs. 28±14%，P=0.72；SRS-22 功能：3.6±0.9 vs. 3.6±0.7，P=0.54；SRS-22 疼痛：3.6±1.0 vs. 3.8±0.8，P=0.11）。然而，与美国相比，日本的满意度显著降低（SRS-22 满意度：4.3±0.9 vs. 4.0±0.8，P<0.01）。
美国和日本的 ASD 患者接受手术治疗的效果相似。然而，与美国相比，日本患者的满意度评分较低。生活方式和文化期望的差异可能会影响 ASD 手术后患者的满意度。
3。
