Hathi Kalpesh, Bigney Erin, Richardson Eden, Alugo Tolu, El-Mughayyar Dana, Vandewint Amanda, Manson Neil, Abraham Edward, Small Chris, Thomas Kenneth, Fisher Charles G, Rampersaud Y Raja, Hall Hamilton, McIntosh Greg, Johnson Michael G, Bailey Christopher S, Weber Michael H, Paquet Jerome, Kingwell Stephen, Nataraj Andrew, Finkelstein Joel, Kelly Adrienne, Attabib Najmedden
Dalhousie Medicine New Brunswick, Saint John, NB, Canada.
Canada East Spine Centre, Saint John, NB, Canada.
Global Spine J. 2023 Jul;13(6):1602-1611. doi: 10.1177/21925682211042576. Epub 2021 Aug 31.
Retrospective cohort.
To compare outcomes of minimally invasive surgery (MIS) vs open surgery (OPEN) for lumbar spinal stenosis (LSS) in patients with diabetes.
Patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database were included. MIS vs OPEN outcomes were compared for 2 cohorts: (1) patients with diabetes who underwent decompression alone (N = 116; MIS n = 58 and OPEN n = 58), (2) patients with diabetes who underwent decompression with fusion (N = 108; MIS n = 54 and OPEN n = 54). Modified Oswestry Disability Index (mODI) and back and leg pain were compared at baseline, 6-18 weeks, and 1-year post-operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at 1-year was compared.
MIS approaches had less blood loss (decompression alone difference 100 mL, = .002; with fusion difference 244 mL, < .001) and shorter length of stay (LOS) (decompression alone difference 1.2 days, = .008; with fusion difference 1.2 days, = .026). MIS compared to OPEN decompression with fusion had less patients experiencing adverse events (AEs) (difference 13 patients, = .007). The MIS decompression with fusion group had lower 1-year mODI (difference 14.5, 95% CI [7.5, 21.0], < .001) and back pain (difference 1.6, 95% CI [.6, 2.7], = .002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at 1-year for mODI (MIS 75.9% vs OPEN 53.7%, = .028) and back pain (MIS 85.2% vs OPEN 70.4%, = .017).
MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.
回顾性队列研究。
比较糖尿病患者腰椎管狭窄症（LSS）行微创手术（MIS）与开放手术（OPEN）的疗效。
纳入加拿大脊柱结局与研究网络（CSORN）数据库中因LSS单独接受脊柱减压或减压融合手术的糖尿病患者。比较两个队列的MIS与OPEN疗效：（1）单独接受减压手术的糖尿病患者（N = 116；MIS组n = 58，OPEN组n = 58），（2）接受减压融合手术的糖尿病患者（N = 108；MIS组n = 54，OPEN组n = 54）。在基线、术后6 - 18周和1年时比较改良Oswestry功能障碍指数（mODI）、背痛和腿痛情况。比较1年时达到最小临床重要差异（MCID）或最小疼痛/功能障碍的患者数量。
MIS手术出血量更少（单独减压差异100 mL，P = .002；融合手术差异244 mL，P < .001），住院时间更短（单独减压差异1.2天，P = .008；融合手术差异1.2天，P = .026）。与OPEN减压融合手术相比，MIS手术发生不良事件（AE）的患者更少（差异13例患者，P = .007）。与OPEN组相比，MIS减压融合手术组1年时mODI更低（差异14.5，95%可信区间[7.5, 21.0]，P < .001），背痛更轻（差异1.6，95%可信区间[.6, 2.7]，P = .002）。MIS减压融合手术组更多患者在1年时mODI超过MCID（MIS组75.9% vs OPEN组53.7%，P = .028），背痛方面也是如此（MIS组85.2% vs OPEN组70.4%，P = .017）。
对于因LSS接受减压融合手术的糖尿病患者，MIS手术疗效更佳。
