Shahi Pratyush, Dalal Sidhant, Shinn Daniel, Song Junho, Araghi Kasra, Melissaridou Dimitra, Sheha Evan, Dowdell James, Iyer Sravisht, Qureshi Sheeraz A
1Department of Spine Surgery, Hospital for Special Surgery, New York; and.
2Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York.
Neurosurg Focus. 2023 Jan;54(1):E4. doi: 10.3171/2022.10.FOCUS22604.
The goal of this study was to assess the outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients ≥ 70 years old and compare them to younger age groups.
This was a retrospective study of data that were collected prospectively. Patients who underwent primary single-level MI-TLIF were included and divided into 3 groups: age < 60, 60-69, and ≥ 70 years. The outcome measures were as follows: 1) patient-reported outcome measures (PROMs) (i.e., visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]); 2) minimum clinically important difference (MCID) achievement; 3) return to activities; 4) opioid discontinuation; 5) fusion rates; and 6) complications/reoperations.
A total of 147 patients (age < 60 years, 62; 60-69 years, 47; ≥ 70 years, 38) were included. All the groups showed significant improvements in all PROMs at the early (< 6 months) and late (≥ 6 months) time points and there was no significant difference between the groups. Although MCID achievement rates for VAS leg and ODI were similar, they were lower in the ≥ 70-year-old patient group for VAS back and SF-12 PCS. Although the time to MCID achievement for ODI and SF-12 PCS was similar, it was greater in the ≥ 70-year-old patient group for VAS back and leg. There was no significant difference between the groups in terms of return to activities, opioid discontinuation, fusion rates, and complication/reoperation rates.
Although patients > 70 years of age may be less likely and/or take longer to achieve MCID compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.
本研究的目的是评估70岁及以上患者行微创经椎间孔腰椎椎间融合术（MI-TLIF）的疗效，并与较年轻年龄组进行比较。
这是一项对前瞻性收集的数据进行的回顾性研究。纳入接受初次单节段MI-TLIF的患者，并将其分为3组：年龄<60岁、60 - 69岁和≥70岁。结局指标如下：1）患者报告的结局指标（PROMs）（即背部和腿部疼痛的视觉模拟量表[VAS]、Oswestry功能障碍指数[ODI]、12项简短健康调查问卷身体成分总结[SF-12 PCS]）；2）最小临床重要差异（MCID）达成情况；3）恢复活动情况；4）停用阿片类药物情况；5）融合率；6）并发症/再次手术情况。
共纳入147例患者（年龄<60岁，62例；60 - 69岁，47例；≥70岁，38例）。所有组在早期（<6个月）和晚期（≥6个月）时间点的所有PROMs均有显著改善，且组间无显著差异。虽然VAS腿部疼痛和ODI的MCID达成率相似，但≥70岁患者组的VAS背部疼痛和SF-12 PCS的MCID达成率较低。虽然ODI和SF-12 PCS达到MCID的时间相似，但≥70岁患者组的VAS背部和腿部疼痛达到MCID的时间更长。各组在恢复活动、停用阿片类药物、融合率以及并发症/再次手术率方面无显著差异。
尽管70岁以上患者与较年轻患者相比可能较难且/或需要更长时间达到MCID，但他们在PROMs方面总体有显著改善，恢复活动和停用阿片类药物的可能性相似，且MI-TLIF术后的融合率以及并发症/再次手术率相当。
