Nolte Michael T, Cha Elliot D K, Lynch Conor P, Jacob Kevin C, Patel Madhav R, Geoghegan Cara E, Jadczak Caroline N, Mohan Shruthi, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Neurospine. 2021 Dec;18(4):863-870. doi: 10.14245/ns.2142230.115. Epub 2021 Dec 31.
To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).
Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.
The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).
LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.
评估患者报告结局量表（PROM）的变化作为翻修性腰椎减压术（LD）的预测指标。
对接受初次单节段或多节段LD的患者进行回顾性研究。根据患者在初次手术后2年内是否接受翻修性LD进行分类。记录视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、12项简明健康调查和12项退伍军人兰德身体成分评分（SF - 12 PCS和VR - 12 PCS）以及患者报告结局测量信息系统身体功能（PROMIS - PF）。评估PROM得分的变化以比较组间差异，并作为翻修性LD的危险因素。
该研究纳入135例患者，其中91例仅接受初次手术，44例接受初次手术及翻修手术。匹配的患者在人口统计学或围手术期特征方面无显著差异。接受翻修手术的患者平均翻修时间为7.4±5.7个月。初次手术队列的所有PROM均显著改善（均p<0.05），而初次手术加翻修手术队列的VAS背部疼痛、ODI和PROMIS - PF显著改善（均p<0.05）。然而，两组在VAS背部疼痛和PROMIS - PF方面存在差异（p<0.05）。除了PROMIS - PF在6个月时（p = 0.024），PROM得分的变化不是翻修的显著危险因素。
LD已被证明具有可靠的疗效，但早期识别有翻修风险的患者至关重要。本研究表明，PROMIS - PF等工具可能有助于预测哪些患者有风险，6个月的随访期对于咨询未改善的患者可能有价值。
