Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
Clin Neurol Neurosurg. 2020 Sep;196:105952. doi: 10.1016/j.clineuro.2020.105952. Epub 2020 May 26.
Decompression surgery is a mainstay of surgical treatment for lumbar spinal stenosis (LSS). However, up to 30% of patients have low satisfaction due to residual symptoms. In the clinical setting, improvements in leg pain are more significant than those in leg numbness. Residual numbness could be related to the relatively low satisfaction rate. However, few studies have focused on numbness; thus, elucidating the risk factors and rate of residual numbness would benefit surgeons and patients. This study aimed to clarify the risk factors for and rate of residual numbness after decompression surgery.
We retrospectively reviewed prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between January 2014 and March 2016. Patients were included if preoperative and final follow-up questionnaires and radiographs were available. A minimum one-year follow-up was required. We evaluated the Numeric Rating Scale (NRS) scores of low back pain, leg pain, and leg numbness preoperatively and at the final follow-up visit. Residual numbness was defined as a postoperative NRS ≥ 1, whereas persistent numbness was defined as a postoperative NRS ≥ 5. We compared the clinical data of patients with or without residual numbness to those of patients with or without persistent numbness. Multivariate logistic regression analysis was performed to identify risk factors for residual and persistent numbness.
A total of 116 patients (73 men, 43 women) were included. Of them, 60% had residual numbness with a mean follow-up period of 25 months. Only durotomy differed significantly between patients with and those without residual numbness. However, the significance did not persist after logistic regression analysis. A total of 16% had persistent numbness. Diabetes mellitus, intraoperative durotomy, and preoperative NRS of numbness were identified as risk factors. There were no differences in smoking status, presence of spondylolisthesis or scoliosis, or severity of stenosis.
We found three risk factors for persistent numbness following decompression surgery for LSS; diabetes mellitus and durotomy were modifiable, whereas preoperative numbness was not. Our findings would help surgeons minimize the incidence of persistent numbness by adequately controlling diabetes and avoiding durotomy during surgery. Providing information about the potential for residual numbness during the informed consent process is important to ensuring realistic patient expectations.
减压手术是治疗腰椎管狭窄症（LSS）的主要手术方法。然而，多达 30%的患者由于残留症状而满意度较低。在临床实践中，腿部疼痛的改善比腿部麻木更为显著。残留麻木可能与相对较低的满意度有关。然而，很少有研究关注麻木问题，因此，阐明残留麻木的风险因素和发生率将使外科医生和患者受益。本研究旨在阐明减压手术后残留麻木的风险因素和发生率。
我们回顾性分析了 2014 年 1 月至 2016 年 3 月期间在一家机构接受单纯减压而未行融合术治疗 LSS 的连续患者的前瞻性收集数据。如果术前和最终随访问卷和 X 线片可用，则纳入患者。需要至少一年的随访。我们评估了术前和最终随访时的下腰痛、腿痛和腿部麻木的数字评分量表（NRS）评分。术后 NRS≥1 定义为残留麻木，术后 NRS≥5 定义为持续麻木。我们比较了有或无残留麻木的患者与有或无持续麻木的患者的临床资料。采用多变量逻辑回归分析确定残留和持续麻木的风险因素。
共纳入 116 例患者（73 名男性，43 名女性），其中 60%的患者有残留麻木，平均随访时间为 25 个月。只有硬脊膜切开术在有和无残留麻木的患者之间有显著差异。然而，在逻辑回归分析后，这种差异并不显著。16%的患者有持续麻木。糖尿病、术中硬脊膜切开术和术前麻木 NRS 被确定为风险因素。吸烟状况、脊柱滑脱或脊柱侧凸的存在以及狭窄的严重程度均无差异。
我们发现减压手术治疗 LSS 后持续麻木的三个风险因素；糖尿病和硬脊膜切开术是可以改变的，而术前麻木则无法改变。我们的发现将通过充分控制糖尿病和避免手术中硬脊膜切开术来帮助外科医生尽量减少持续麻木的发生率。在知情同意过程中提供有关残留麻木可能性的信息对于确保患者的现实期望非常重要。
