Department of Neurosurgery, Spine Center, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2020 Sep 15;45(18):1277-1284. doi: 10.1097/BRS.0000000000003515.
Retrospective cohort study of a nationwide sample database.
The objective of the present study was to compare the long-term incidence of reoperation for lumbar spinal stenosis (LSS) after anterior fusion, posterior fusion, and decompression.
Surgical treatment for LSS can be largely divided into 2 categories: decompression only and decompression with fusion. A previous nationwide study reported that fusion surgery was performed in 10% of patients with LSS, and the 10-year reoperation rate was approximately 17%. However, with the development of surgical techniques and changes in surgical trends, these results should be reassessed.
The National Health Insurance Service-National Sample Cohort of the Republic of Korea was utilized to establish a cohort of adult patients (N = 1400) who first underwent surgery for LSS during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using a Fine and Gray regression model after adjustment for sex, age, diabetes, osteoporosis, Charlson comorbidity index, severity of disability, type of medical coverage, and type of hospital.
The overall cumulative incidence of reoperation was 6.2% at 2 years, 10.8% at 5 years, and 18.4% at 10 years. The cumulative incidence of reoperation was 20.6%, 12.6%, and 18.6% after anterior fusion, posterior fusion, and decompression, respectively, at 10 years postoperatively (P = 0.44). The first surgical technique did not affect the reoperation type (P = 0.27). Decompression was selected as the surgical technique for reoperation in 83.5% of patients after decompression, in 72.7% of patients after anterior fusion, and in 64.3% of patients after posterior fusion.
The initial surgical technique did not affect reoperation during the 10-year follow-up period. Decompression was the most commonly used technique for reoperation.
一项全国性样本数据库的回顾性队列研究。
本研究旨在比较前路融合、后路融合和减压治疗腰椎管狭窄症（LSS）后长期再手术的发生率。
LSS 的手术治疗可大致分为两类：仅减压和减压融合。一项先前的全国性研究报告称，LSS 患者中有 10%接受了融合手术，10 年再手术率约为 17%。然而，随着手术技术的发展和手术趋势的变化，这些结果应该重新评估。
利用韩国国家健康保险服务-全国抽样队列，建立了一个 2005 年至 2007 年期间首次接受 LSS 手术的成年患者队列（N=1400）。患者随访 8 至 10 年。考虑到再手术前死亡是竞争事件，使用 Fine 和 Gray 回归模型在调整性别、年龄、糖尿病、骨质疏松症、Charlson 合并症指数、残疾严重程度、医疗保险类型和医院类型后，比较了不同手术技术之间的再手术风险。
总体再手术累积发生率为 2 年时 6.2%，5 年时 10.8%，10 年时 18.4%。10 年后，前路融合、后路融合和减压的再手术累积发生率分别为 20.6%、12.6%和 18.6%（P=0.44）。初次手术技术并不影响再手术类型（P=0.27）。在减压后，83.5%的患者选择减压作为再手术技术，在前路融合后为 72.7%，后路融合后为 64.3%。
在 10 年的随访期间，初始手术技术并不影响再手术。减压是最常用于再手术的技术。
4 级
