Inculet Clayton, Urquhart Jennifer C, Rasoulinejad Parham, Hall Hamilton, Fisher Charles, Attabib Najmedden, Thomas Kenneth, Ahn Henry, Johnson Michael, Glennie Andrew, Nataraj Andrew, Christie Sean D, Stratton Alexandra, Yee Albert, Manson Neil, Paquet Jérôme, Rampersaud Y Raja, Bailey Christopher S
1Division of Orthopaedics, Department of Surgery, Western University/London Health Sciences Centre, London, Ontario.
2Lawson Health Research Institute, London, Ontario.
J Neurosurg Spine. 2021 Jul 2;35(3):299-307. doi: 10.3171/2020.11.SPINE201261. Print 2021 Sep 1.
Many studies have utilized a combined cohort of patients with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) to evaluate indications and outcomes. Intuitively, these are very different populations, and rates, indications, and outcomes may differ. The goal of this study was to compare specific patient characteristics associated with the utilization of a posterior lumbar interbody device between cohorts of patients with DS and IS, as well as to compare rates of interbody device use and patient-rated outcomes at 1 year after surgical treatment.
The authors included patients who underwent posterior lumbar interbody fusion or instrumented posterolateral fusion for grade I or II DS or IS and had been enrolled in the Canadian Spine Outcomes and Research Network registry from 2009 to 2016. The outcome measures were score on the Oswestry Disability Index, scores for back pain and leg pain on the numeric rating scale, and mental component summary (MCS) score and physical component summary score on the 12-Item Short-Form Health Survey. Descriptive statistics were used to compare spondylolisthesis groups, logistic regression was used to compare interbody device use, and the chi-square test was used to compare the proportions of patients who achieved a minimal clinically important difference (MCID) at 1 year after surgery.
In total, 119 patients had IS and 339 had DS. Patients with DS were more commonly women, older, less likely to smoke, and more likely to have neurogenic claudication and comorbidities, whereas patients with IS more commonly had radicular pain, neurological deficits, and worse back pain. Spondylolisthesis was more common at the L4-5 level in patients with DS and at the L5-S1 level in patients with IS. Similar proportions of patients had an interbody device (78.6% of patients with DS vs 82.4% of patients with IS, p = 0.429). Among patients with IS, factors associated with interbody device utilization were BMI ≥ 30 kg/m2 and increased baseline leg pain intensity. Factors associated with interbody device utilization in patients with DS were younger age, increased number of total comorbidities, and lower baseline MCS score. For each outcome measure, similar proportions of patients in the surgical treatment and spondylolisthesis groups achieved the MCID at 1 year after surgery.
Although the demographic and patient characteristics associated with interbody device utilization differed between cohorts, similar proportions of patients attained clinically meaningful improvement at 1 year after surgery.
许多研究采用了退行性腰椎滑脱（DS）和峡部裂性腰椎滑脱（IS）患者的联合队列来评估手术指征和疗效。直观地说，这是两个截然不同的人群，其发病率、手术指征和疗效可能存在差异。本研究的目的是比较DS和IS患者队列中与使用后路腰椎椎间融合器相关的特定患者特征，以及比较手术治疗后1年时椎间融合器的使用比例和患者自评疗效。
作者纳入了2009年至2016年期间因I级或II级DS或IS接受后路腰椎椎间融合术或器械辅助后外侧融合术且已纳入加拿大脊柱疗效与研究网络登记系统的患者。疗效指标包括Oswestry功能障碍指数评分、数字评分量表上的背痛和腿痛评分，以及12项简短健康调查问卷中的精神健康综合评分（MCS）和身体健康综合评分。采用描述性统计比较腰椎滑脱组，采用逻辑回归比较椎间融合器的使用情况，采用卡方检验比较术后1年达到最小临床重要差异（MCID）的患者比例。
共有119例患者患有IS，339例患有DS。DS患者中女性更为常见，年龄较大，吸烟可能性较小，更易出现神经源性间歇性跛行和合并症，而IS患者更常出现神经根性疼痛、神经功能缺损和更严重的背痛。DS患者中腰椎滑脱在L4-5节段更为常见，IS患者中在L5-S1节段更为常见。使用椎间融合器的患者比例相似（DS患者为78.6%，IS患者为82.4%，p = 0.429）。在IS患者中，与使用椎间融合器相关的因素包括BMI≥30 kg/m2和基线腿痛强度增加。DS患者中与使用椎间融合器相关的因素包括年龄较小、合并症总数增加和基线MCS评分较低。对于每项疗效指标，手术治疗组和腰椎滑脱组中相似比例的患者在术后1年达到了MCID。
尽管不同队列中与使用椎间融合器相关的人口统计学和患者特征有所不同，但相似比例的患者在术后1年实现了有临床意义的改善。
