Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada.
School of Psychology and Exercise Science, Murdoch University, Australia.
Spine (Phila Pa 1976). 2020 Nov 1;45(21):E1421-E1430. doi: 10.1097/BRS.0000000000003587.
STUDY DESIGN: Longitudinal analysis of prospectively collected data. OBJECTIVE: Investigate potential predictors of poor outcome following surgery for degenerative lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: LSS is the most common reason for an older person to undergo spinal surgery, yet little information is available to inform patient selection. METHODS: We recruited LSS surgical candidates from 13 orthopedic and neurological surgery centers. Potential outcome predictors included demographic, health, clinical, and surgery-related variables. Outcome measures were leg and back numeric pain rating scales and Oswestry disability index scores obtained before surgery and after 3, 12, and 24 postoperative months. We classified surgical outcomes based on trajectories of leg pain and a composite measure of overall outcome (leg pain, back pain, and disability). RESULTS: Data from 529 patients (mean [SD] age = 66.5 [9.1] yrs; 46% female) were included. In total, 36.1% and 27.6% of patients were classified as experiencing a poor leg pain outcome and overall outcome, respectively. For both outcomes, patients receiving compensation or with depression/depression risk were more likely, and patients participating in regular exercise were less likely to have poor outcomes. Lower health-related quality of life, previous spine surgery, and preoperative anticonvulsant medication use were associated with poor leg pain outcome. Patients with ASA scores more than two, greater preoperative disability, and longer pain duration or surgical waits were more likely to have a poor overall outcome. Patients who received preoperative chiropractic or physiotherapy treatment were less likely to report a poor overall outcome. Multivariable models demonstrated poor-to acceptable (leg pain) and excellent (overall outcome) discrimination. CONCLUSION: Approximately one in three patients with LSS experience a poor clinical outcome consistent with surgical non-response. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. These predictors may assist surgeons with patient selection and inform shared decision-making for patients with symptomatic LSS. LEVEL OF EVIDENCE: 2.
研究设计：前瞻性收集数据的纵向分析。
目的：调查退行性腰椎管狭窄症（LSS）手术后不良结局的潜在预测因素。
背景资料概要：LSS 是老年人接受脊柱手术最常见的原因，但可供患者选择的信息很少。
方法：我们从 13 个骨科和神经外科中心招募了 LSS 手术候选者。潜在的结局预测因素包括人口统计学、健康、临床和手术相关变量。结局测量包括手术前和术后 3、12 和 24 个月的腿部和背部数字疼痛评分量表以及 Oswestry 残疾指数评分。我们根据腿部疼痛轨迹和总体结局（腿部疼痛、背部疼痛和残疾）的综合测量对手术结局进行分类。
结果：共纳入 529 例患者（平均[标准差]年龄为 66.5[9.1]岁；46%为女性）的数据。在腿部疼痛结局和总体结局方面，分别有 36.1%和 27.6%的患者被归类为预后不良。对于这两种结局，接受赔偿或有抑郁/抑郁风险的患者更有可能，而定期锻炼的患者不太可能出现不良结局。健康相关生活质量较低、既往脊柱手术和术前抗惊厥药物使用与腿部疼痛结局不良相关。ASA 评分大于 2 分、术前残疾程度较高、疼痛持续时间或手术等待时间较长的患者更有可能出现总体结局不良。接受术前整脊或物理治疗的患者不太可能报告总体结局不良。多变量模型显示出较差至可接受（腿部疼痛）和极好（总体结局）的区分度。
结论：大约三分之一的 LSS 患者出现与手术无反应一致的不良临床结局。人口统计学、健康和临床因素比手术相关因素更能预测临床结局。这些预测因素可能有助于外科医生选择患者，并为有症状的 LSS 患者提供知情决策。
证据等级：2。
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