Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA.
Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 USA.
Spine J. 2022 Oct;22(10):1651-1659. doi: 10.1016/j.spinee.2022.06.013. Epub 2022 Jul 6.
The indications for surgical intervention of axial back pain without leg pain for degenerative lumbar disorders have been limited in the literature, as most study designs allow some degree of leg symptoms in the inclusion criteria.
To determine the outcome of surgery (decompression only vs. fusion) for pure axial back pain without leg pain.
STUDY DESIGN/SETTING: Prospectively collected data in the Michigan Spine Surgery Improvement Collaborative (MSSIC).
Patients with pure axial back pain without leg pain underwent lumbar spine surgery for primary diagnoses of lumbar disc herniation, lumbar stenosis, and isthmic or degenerative spondylolisthesis ≤ grade II.
Minimally clinically important difference (MCID) for back pain, Numeric Rating Scale of back pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), MCID of PROMIS-PF, and patient satisfaction on the North American Spine Surgery Patient Satisfaction Index were collected at 90 days, 1 year, and 2 years after surgery.
Log-Poisson generalized estimating equation models were constructed with patient-reported outcomes as the independent variable, reporting adjusted risk ratios (RR).
Of the 388 patients at 90 days, multi-level versus single level lumbar surgery decreased the likelihood of obtaining a MCID in back pain by 15% (RR=0.85, p=.038). For every one-unit increase in preoperative back pain, the likelihood for a favorable outcome increased by 8% (RR=1.08, p<.001). Of the 326 patients at 1 year, symptom duration > 1 year decreased the likelihood of a MCID in back pain by 16% (RR=0.84, p=.041). The probability of obtaining a MCID in back pain increased by 9% (RR=1.09, p<.001) for every 1-unit increase in baseline back pain score and by 14% for fusions versus decompression alone (RR=1.14, p=.0362). Of the 283 patients at 2 years, the likelihood of obtaining MCID in back pain decreased by 30% for patients with depression (RR=0.70, p<.001) and increased by 8% with every one-unit increase in baseline back pain score (RR=1.08, p<.001).
Only the severity of preoperative back pain was associated with improvement in MCID in back pain at all time points, suggesting that surgery should be considered for selected patients with severe axial pain without leg pain. Fusion surgery versus decompression alone was associated with improved patient-reported outcomes at 1 year only, but not at the other time points.
对于没有下肢疼痛的退行性腰椎疾病的轴向腰痛，手术干预的适应证在文献中受到限制，因为大多数研究设计在纳入标准中允许存在一定程度的下肢症状。
确定仅行减压术与融合术治疗单纯轴向腰痛的手术结果。
研究设计/设置：密歇根脊柱外科学改进合作组织（MSSIC）前瞻性收集的数据。
单纯轴向腰痛且无下肢疼痛的患者因原发性腰椎间盘突出症、腰椎管狭窄症和峡部或退行性脊椎滑脱症（≤Ⅱ级）行腰椎手术。
腰痛的最小临床重要差异（MCID）、腰痛数字评分量表、患者报告的结局测量信息系统身体功能量表（PROMIS-PF）、PROMIS-PF 的 MCID 和北美脊柱外科患者满意度指数（North American Spine Surgery Patient Satisfaction Index）在术后 90 天、1 年和 2 年进行评估。
采用对数泊松广义估计方程模型，以患者报告的结局为自变量，报告调整后的风险比（RR）。
在 90 天时的 388 例患者中，与单节段相比，多节段腰椎手术使腰痛获得 MCID 的可能性降低了 15%（RR=0.85，p=.038）。术前腰痛每增加 1 个单位，获得良好结局的可能性增加 8%（RR=1.08，p<.001）。在 1 年时的 326 例患者中，症状持续时间>1 年使腰痛获得 MCID 的可能性降低了 16%（RR=0.84，p=.041）。腰痛基线评分每增加 1 个单位，获得腰痛 MCID 的可能性增加 9%（RR=1.09，p<.001），融合术与单纯减压术相比增加 14%（RR=1.14，p=.0362）。在 2 年时的 283 例患者中，患有抑郁症的患者获得腰痛 MCID 的可能性降低了 30%（RR=0.70，p<.001），而腰痛基线评分每增加 1 个单位，获得腰痛 MCID 的可能性增加 8%（RR=1.08，p<.001）。
仅术前腰痛的严重程度与腰痛 MCID 的改善相关，这表明对于有严重轴向疼痛且无下肢疼痛的患者，应考虑手术治疗。与单纯减压术相比，融合术在 1 年时患者报告的结局改善，但在其他时间点没有改善。
