Alnaghmoosh Nabeel, Urquhart Jennifer, Raj Ruheksh, Abraham Edward, Jacobs Bradley, Phan Philippe, Johnson Michael, Paquet Jerome, Nataraj Andrew, McIntosh Greg, Fisher Charles G, Rampersaud Y Raja, Manson Neil, Hall Hamilton, Rasoulinejad Parham, Bailey Christopher S
Division of Orthopaedics, Department of Surgery, Western University /London Health Sciences Centre, London, Ontario, Canada.
Lawson Health Research Institute /London Health Sciences Centre, London, Ontario, Canada.
Global Spine J. 2022 Oct;12(8):1667-1675. doi: 10.1177/2192568220985471. Epub 2021 Jan 7.
Retrospective Cohort Study.
This study aimed to determine how the surgeon-determined and patient-rated location of predominant pain influences patient-rated outcomes at 1-year after posterior lumbar fusion in adult isthmic spondylolisthesis.
We retrospectively reviewed consecutive patients prospectively enrolled in the Canadian Spine Outcomes and Research Network national registry between 2009 and 2017 that underwent posterior lumbar fusion for isthmic spondylolisthesis. Using longitudinal mixed-model repeated-measures analysis the change from baseline in patient-reported outcome measures (PROMs) at 1 year after surgery was compared between surgeon-determined groups (back vs. radicular) and between patient-rated pain groups (back, leg, and equal) derived from preoperative pain scores on the numerical rating scale (NRS).
83/252 (33%) patients had a surgeon-determined chief complaint of back pain, while 103 (41%) patients rated their back pain as the predominant pain location, and 78 (31%) rated their back and leg pain to be equal. At baseline patients in the surgeon-determined radicular group had worse NRS-leg pain than those in the back-pain group but equal NRS-back pain. At baseline patients in the patient-rated equal pain group had similar back pain compared to the patient-rated back pain group and similar leg pain compared to the patient-rated leg pain group. All PROMs improved post-operatively and were not different between the 2 groups at 1 year.
Our study found no difference in outcome, irrespective of whether a surgeon determines the patient's primary pain complaint back or radicular dominant, or the patient rates pain in one location greater than another.
回顾性队列研究。
本研究旨在确定在成人峡部裂型腰椎滑脱症后路腰椎融合术后1年时，外科医生判定的主要疼痛部位与患者自评的疼痛部位如何影响患者自评的结果。
我们回顾性分析了2009年至2017年间前瞻性纳入加拿大脊柱结局与研究网络国家注册库的连续患者，这些患者因峡部裂型腰椎滑脱症接受了后路腰椎融合术。使用纵向混合模型重复测量分析，比较了外科医生判定的组（背痛组与神经根性痛组）之间以及根据术前数字评分量表（NRS）疼痛评分得出的患者自评疼痛组（背痛、腿痛和相等组）之间术后1年患者报告结局量表（PROMs）相对于基线的变化。
83/252（33%）例患者的主要疼痛症状经外科医生判定为背痛，而103例（41%）患者将背痛自评为主导疼痛部位，78例（31%）患者自评背痛和腿痛程度相等。在基线时，外科医生判定为神经根性痛组的患者NRS腿痛评分比背痛组患者更差，但NRS背痛评分相等。在基线时，患者自评疼痛相等组的患者与患者自评背痛组的患者背痛相似，与患者自评腿痛组的患者腿痛相似。所有PROMs术后均有改善，两组在术后1年时无差异。
我们的研究发现，无论外科医生判定患者的主要疼痛症状是背痛为主还是神经根性痛为主，或者患者自评某一部位疼痛程度高于另一部位，结局均无差异。
