G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
W.-M. Yue, The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore.
Clin Orthop Relat Res. 2020 Aug;478(8):1880-1888. doi: 10.1097/CORR.0000000000001252.
The number of young patients with degenerative lumbar spondylosis is expected to increase, and with it, the number of younger patients seeking surgical treatment is likely to rise. The goals of young patients with degenerative spondylolisthesis may differ from those of older patients, but little is known about the levels of pain and function, complication rates, or radiographic union that young patients achieve after interbody fusion.
QUESTIONS/PURPOSES: (1) How likely were patients younger than 50 years to achieve a minimal clinically important difference (MCID) in improvement on any of several validated patient-reported outcomes scores after transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a minimum of 2 years after surgery? (2) What proportion developed complications or underwent reoperations? (3) What proportion achieved radiographic fusion or developed adjacent-segment degeneration?
Longitudinally maintained institutional registry data of patients undergoing primary, single-level, transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a single institution from 2006 to 2013 were studied in this retrospective case series. Of the 96 patients who met inclusion criteria, 14% (13 of 96) were missing follow-up data, leaving 83 patients younger than 50 years with complete clinical and radiological data at a minimum of 2 years (97%, 93 of 96 had sufficient data to assess complications and radiographic fusion). The mean age of the cohort was 44 ± 7 years. Radiological parameters for each patient with spondylolisthesis were recorded. Clinical outcomes such as the numeric rating scale for back pain and leg pain, Oswestry Disability Index (ODI) and SF-36 were assessed preoperatively and postoperatively at 1, 3, 6 months and 2 years. The proportion of patients who had an improvement greater than the MCID of each outcome instrument was then calculated. The occurrence of any medical, surgical or wound complications, and reoperations for any reason were recorded. Radiographic fusion using Bridwell grading and adjacent-segment degeneration were assessed by an independent observer not involved in clinical care. The mean follow-up was 5 ± 3 years.
The proportions of patients younger than 50 years who achieved the MCID for the various patient-reported outcomes were 82% (68 of 83) for leg pain, 75% (62 of 83) for back pain, 87% (72 of 83) for ODI and 71% (59 of 83) for SF-36 physical component summary at 2 years. Two perioperative complications occurred, and two reoperations were performed for implant-related complications. A total of 85% (79 of 93) of young patients achieved stable fusion, 8% (seven of 93) had radiologic adjacent-segment degeneration, and one patient underwent a revision procedure.
Young patients with lumbar degenerative spondylolisthesis commonly, but do not always, experience clinically meaningful gains in pain relief, function, and quality of life after transforaminal lumbar interbody fusion. A low risk of complications, reoperations, nonunion and adjacent-segment degeneration were also noted in this population.
Level III, therapeutic study.
预计患有退行性腰椎滑脱症的年轻患者人数将会增加，因此寻求手术治疗的年轻患者数量可能会上升。与老年患者相比，年轻退行性脊椎滑脱症患者的治疗目标可能有所不同，但对于接受椎间融合术后年轻患者的疼痛和功能水平、并发症发生率或影像学融合率知之甚少。
问题/目的：（1）在接受经椎间孔腰椎体间融合术（TLIF）治疗退行性脊椎滑脱症的患者中，年龄小于 50 岁的患者在手术后至少 2 年，在任何几种经过验证的患者报告结局评分中达到最小临床重要差异（MCID）改善的可能性有多大？（2）有多少患者发生并发症或需要再次手术？（3）有多少患者达到影像学融合或发生邻近节段退变？
本回顾性病例系列研究对 2006 年至 2013 年在一家机构接受初次、单节段、经椎间孔腰椎体间融合术治疗退行性脊椎滑脱症的患者进行了长期的机构注册数据研究。在符合纳入标准的 96 名患者中，14%（13/96）的患者缺失随访数据，83 名年龄小于 50 岁的患者在手术后至少 2 年（97%，96 例中有 93 例有足够的数据评估并发症和影像学融合）时，具有完整的临床和影像学数据。队列的平均年龄为 44±7 岁。记录每位脊椎滑脱症患者的影像学参数。评估术前和术后 1、3、6 个月和 2 年的患者的数字评定量表（NRS）腰痛和腿痛、Oswestry 功能障碍指数（ODI）和 SF-36 等临床结果。然后计算出每种患者报告结局工具中达到 MCID 的患者比例。记录任何医疗、手术或伤口并发症的发生情况，以及任何原因的再次手术。由一位未参与临床护理的独立观察者评估影像学融合（Bridwell 分级）和邻近节段退变。平均随访时间为 5±3 年。
年龄小于 50 岁的患者在术后 2 年时，在各种患者报告结局中达到 MCID 的比例分别为：腿痛 82%（68/83）、腰痛 75%（62/83）、ODI 87%（72/83）和 SF-36 身体成分 71%（59/83）。发生了 2 例围手术期并发症，因植入物相关并发症进行了 2 例再次手术。93%（79/85）的年轻患者达到稳定融合，8%（7/93）发生影像学邻近节段退变，1 例患者行翻修手术。
接受经椎间孔腰椎体间融合术治疗的腰椎退行性脊椎滑脱症年轻患者通常会在疼痛缓解、功能和生活质量方面获得有临床意义的改善，但并非总是如此。在该人群中还观察到并发症、再次手术、不愈合和邻近节段退变的风险较低。
III 级，治疗性研究。
