Department of orthopedics, Peking University Third Hospital, No 49. North Garden Street, Beijing, China.
Spine (Phila Pa 1976). 2020 Dec 15;45(24):E1669-E1676. doi: 10.1097/BRS.0000000000003713.
A retrospective study.
The aim of this study was to evaluate the factors affecting health-related quality of life (HRQOL) after surgery in patients with degenerative lumbar scoliosis (DLS) by minimum clinically important difference (MCID).
MCID has been introduced in the adult spinal deformity to quantify the absolute minimum change that can be considered a success. There are limited data available to identify factors affecting reaching MCID after DLS surgery.
This study reviewed a cohort of 123 DLS patients after correction surgery and with a minimum 2-year follow-up (FU). Inclusion criteria included age ≥40 and minimum five vertebrae fused and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and FU. Using a multivariate analysis, two groups were compared to identify possible risk factors: those who reached MCID in the all four SRS domains (N = 65) at the last FU and those who missed MCID (N = 58).
At baseline, patients differed significantly from matched normative data in all SRS-22 domains. The baseline HRQOL was comparable in reached MCID and missed MCID group patients (P > 0.05). The HRQOL scores at FU were significantly higher than those at baseline. Of 123 included patients, 77.2% (N = 95), 72.4% (N = 89), 76.4% (N = 94), and 89.4% (N = 110) reached MCID in SRS pain, activity, appearance, and mental domain, respectively. Pelvic incidence (PI) >55°, lumbar lordosis (LL) loss >4.65°, coronal imbalance at FU, sagittal vertical axis (SVA) at FU >80 mm, and presence of proximal junctional kyphosis (PJK) and distal junctional problem (DJP) had negative effects on the recovery process.
Factors affecting reaching MCID after surgery for DLS were higher PI, LL loss, coronal imbalance, severe sagittal imbalance, and the occurrence of PJK and DJP.
回顾性研究。
本研究旨在通过最小临床重要差异（MCID）评估退行性腰椎侧凸（DLS）患者手术后健康相关生活质量（HRQOL）的影响因素。
MCID 已被引入成人脊柱畸形领域，以量化可被视为成功的绝对最小变化。目前，只有有限的数据可以确定 DLS 手术后影响达到 MCID 的因素。
本研究回顾了 123 例 DLS 患者的队列，这些患者在接受矫正手术后至少有 2 年的随访（FU）。纳入标准包括年龄≥40 岁，至少融合 5 个椎体，且在基线（BL）和 FU 时具备 Scoliosis Research Society（SRS）-22 评分和影像学数据。通过多变量分析，比较两组以确定可能的危险因素：在最后一次 FU 时在所有四个 SRS 领域达到 MCID 的患者（N=65）和未达到 MCID 的患者（N=58）。
在基线时，所有 SRS-22 领域的患者与匹配的正态数据相比均有显著差异。达到 MCID 和未达到 MCID 组患者的基线 HRQOL 相当（P＞0.05）。FU 时的 HRQOL 评分明显高于基线时。在纳入的 123 例患者中，分别有 77.2%（N=95）、72.4%（N=89）、76.4%（N=94）和 89.4%（N=110）在 SRS 疼痛、活动、外观和精神领域达到 MCID。骨盆入射角（PI）＞55°、腰椎前凸（LL）丢失＞4.65°、FU 时冠状面失衡、FU 时矢状垂直轴（SVA）＞80mm 以及近端交界性后凸（PJK）和远端交界性问题（DJP）的存在对恢复过程有负面影响。
影响 DLS 手术后达到 MCID 的因素包括较高的 PI、LL 丢失、冠状面失衡、严重的矢状面失衡以及 PJK 和 DJP 的发生。
4 级。
