Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
Clin Spine Surg. 2021 Nov 1;34(9):E537-E544. doi: 10.1097/BSD.0000000000001246.
This was a prospective consecutive clinical cohort study.
The purpose of our study was to develop and provide an initial internal validation of a novel classification system that can help surgeons and patients better understand their postoperative course following the particular minimally invasive surgery (MIS) and approach that is utilized.
Surgeons and patients are often attracted to the option of minimally invasive spine surgery because of the perceived improvement in recovery time and postsurgical pain. A classification system based on the impact of the surgery and surgical approach(es) on postoperative recovery can be particularly helpful.
Six hundred thirty-one patients who underwent MIS lumbar/thoracolumbar surgery for degenerative conditions of the spine were included. Perioperative outcomes-operative time, estimated blood loss, postsurgical length of stay (LOS), 90-day complications, postoperative day zero narcotic requirement [in Morphine Milligram Equivalent (MME)], and need for intravenous patient-controlled analgesia (IV PCA).
Postoperative LOS and postoperative narcotic use were deemed most clinically relevant, thus selected as primary outcomes. Type of surgery was significantly associated with all outcomes (P<0.0001), except intraoperative complications. Number of levels for fusion was significantly associated with operative time, in-hospital complications, 24 hours oral MME, and the need for IV PCA and LOS (P<0.0001). Number of surgical approaches for lumbar fusion was significantly associated with operative time, 24 hours oral MME, need for IV PCA and LOS (P<0.001). Based on these parameters, the following classification system ("Qureshi-Louie classification" for MIS degenerative lumbar surgery) was devised: (1) Decompression-only; (2) Fusion-1 and 2 levels, 1 approach; (3) Fusion-1 level, 2 approaches; (4) Fusion-2 levels, 2 approaches; (5) Fusion-3+ levels, 2 approaches.
We present a novel classification system and initial internal validation to describe the perioperative expectations following various MIS surgeries in the degenerative lumbar spine. This initial description serves as the basis for ongoing external validation.
这是一项前瞻性连续临床队列研究。
我们研究的目的是开发并提供一种新的分类系统，该系统可以帮助外科医生和患者更好地了解他们在接受特定微创脊柱手术（MIS）和所采用手术方法后的术后过程。
外科医生和患者经常选择微创脊柱手术，因为他们认为术后恢复期和术后疼痛会有所改善。基于手术和手术方法对术后恢复的影响的分类系统可能特别有帮助。
纳入了 631 名因脊柱退行性疾病接受 MIS 腰椎/胸腰椎手术的患者。围手术期结果包括手术时间、估计失血量、术后住院时间（LOS）、90 天并发症、术后第 0 天阿片类药物需求（以吗啡毫克当量（MME）表示）和静脉自控镇痛（IV PCA）的需求。
术后 LOS 和术后阿片类药物使用被认为是最具临床意义的，因此被选为主要结果。手术类型与所有结果均显著相关（P<0.0001），但与术中并发症无关。融合的节段数与手术时间、住院并发症、24 小时口服 MME 以及 IV PCA 和 LOS 的需求显著相关（P<0.0001）。腰椎融合的手术入路数与手术时间、24 小时口服 MME、IV PCA 和 LOS 的需求显著相关（P<0.001）。基于这些参数，设计了以下分类系统（用于 MIS 退行性腰椎手术的“Qureshi-Louie 分类”）：（1）单纯减压；（2）融合 1-2 个节段，1 个入路；（3）融合 1 个节段，2 个入路；（4）融合 2 个节段，2 个入路；（5）融合 3+个节段，2 个入路。
我们提出了一种新的分类系统和初步的内部验证，以描述各种 MIS 手术在退行性腰椎中的围手术期预期。这一初步描述为正在进行的外部验证奠定了基础。
