Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
Spine (Phila Pa 1976). 2023 May 15;48(10):688-694. doi: 10.1097/BRS.0000000000004565. Epub 2023 Feb 20.
Prospective cohort study.
The aim was to investigate the association between postoperative dural sac cross-sectional area (DSCA) after decompressive surgery for lumbar spinal stenosis and clinical outcome. Furthermore, to investigate if there is a minimum threshold for how extensive a posterior decompression needs to be to achieve a satisfactory clinical result.
There is limited scientific evidence for how extensive lumbar decompression needs to be to obtain a good clinical outcome in patients with symptomatic lumbar spinal stenosis.
All patients were included in the Spinal Stenosis Trial of the NORwegian Degenerative spondylolisthesis and spinal STENosis (NORDSTEN)-study. The patients underwent decompression according to three different methods. DSCA measured on lumbar magnetic resonance imaging at baseline and at three months follow-up, and patient-reported outcome at baseline and at two-year follow-up were registered in a total of 393 patients. Mean age was 68 (SD: 8.3), proportion of males were 204/393 (52%), proportion of smokers were 80/393 (20%), and mean body mass index was 27.8 (SD: 4.2).The cohort was divided into quintiles based on the achieved DSCA postoperatively, the numeric, and relative increase of DSCA, and the association between the increase in DSCA and clinical outcome were evaluated.
At baseline, the mean DSCA in the whole cohort was 51.1 mm 2 (SD: 21.1). Postoperatively the area increased to a mean area of 120.6 mm 2 (SD: 46.9). The change in Oswestry disability index in the quintile with the largest DSCA was -22.0 (95% CI: -25.6 to -18), and in the quintile with the lowest DSCA the Oswestry disability index change was -18.9 (95% CI: -22.4 to -15.3). There were only minor differences in clinical improvement for patients in the different DSCA quintiles.
Less aggressive decompression performed similarly to wider decompression across multiple different patient-reported outcome measures at two years following surgery.
前瞻性队列研究。
旨在探讨腰椎管狭窄减压术后硬脊膜囊横截面积（DSCA）与临床结果之间的关系。此外，还探讨了后减压需要达到多大程度才能获得满意的临床效果的最小阈值。
对于有症状的腰椎管狭窄症患者，获得良好临床效果所需的腰椎减压程度，科学证据有限。
所有患者均纳入挪威退行性腰椎滑脱和腰椎狭窄症（NORDSTEN）研究的脊柱狭窄试验。根据三种不同的方法对患者进行减压。在基线和三个月随访时测量腰椎磁共振成像上的 DSCA，并在基线和两年随访时登记患者报告的结果，共有 393 例患者入组。平均年龄为 68（SD：8.3）岁，男性占 204/393（52%），吸烟者占 80/393（20%），平均体重指数为 27.8（SD：4.2）。根据术后 DSCA、DSCA 的数值和相对增加，将队列分为五组，并评估 DSCA 增加与临床结果之间的关系。
在基线时，整个队列的平均 DSCA 为 51.1mm2（SD：21.1）。术后，面积增加到 120.6mm2（SD：46.9）的平均面积。在 DSCA 最大的五组中，Oswestry 残疾指数的变化为-22.0（95%CI：-25.6 至-18），在 DSCA 最小的五组中，Oswestry 残疾指数的变化为-18.9（95%CI：-22.4 至-15.3）。不同 DSCA 五分位数的患者临床改善程度差异较小。
在术后两年的多个不同患者报告的结果测量中，较不激进的减压与更广泛的减压表现相似。
