Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
Spine J. 2023 Aug;23(8):1152-1160. doi: 10.1016/j.spinee.2023.04.004. Epub 2023 Apr 12.
Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression.
Retrospective cohort.
Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded.
MCID achievement in ODI (cut off 12.8).
Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early ≤3 months, late ≥6 months). Nonradiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI - Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray - spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by ≤3 months) and nonachievement of MCID (MCID not achieved at ≥6 months).
A total of 338 patients were included. At ≤3 months, patients who did not achieve MCID had significantly lower preoperative ODI (40.1 vs 48.1, p<0.001) and worse psoas Goutallier grading (p=.048). At ≥6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs 47.5, p<.001), higher age (68 vs 63 years, p=.007), worse average L1-S1 Pfirrmann grading (3.5 vs 3.2, p=.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late timepoint came out as independent predictors for MCID nonachievement.
After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For nonachievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor.
尽管先前的一些研究分析了非改善的预测因素，但这些研究大多集中在人口统计学和临床变量上，并未考虑放射学预测因素。此外，虽然有几项研究检查了减压后的改善程度，但关于改善速度的数据较少。
确定微创减压后不能达到最小临床重要差异（MCID）的风险因素和预测因素（包括放射学和非放射学）。
回顾性队列研究。
接受微创减压治疗退行性腰椎疾病并至少随访 1 年的患者纳入研究。术前 Oswestry 残疾指数（ODI）<20 的患者被排除在外。
ODI 中 MCID 的实现（截止值 12.8）。
患者在两个时间点（早期≤3 个月，晚期≥6 个月）分为两组（达到 MCID，未达到 MCID）。评估非放射学（年龄、性别、BMI、合并症、焦虑、抑郁、手术节段数、术前 ODI、术前腰痛）和放射学（MRI-Schizas 分级狭窄、硬脑膜囊横截面积、Pfirrmann 分级椎间盘退变、腰大肌横截面积和 Goutallier 分级、小关节囊肿/渗出；X 射线-脊椎滑脱、腰椎前凸、脊柱骨盆参数）变量，进行比较分析以确定危险因素，并进行多元回归模型分析以确定较慢达到 MCID（≤3 个月未达到 MCID）和未达到 MCID（≥6 个月未达到 MCID）的预测因素。
共纳入 338 例患者。在≤3 个月时，未达到 MCID 的患者术前 ODI 明显较低（40.1 对 48.1，p<0.001），腰大肌 Goutallier 分级较差（p=.048）。在≥6 个月时，未达到 MCID 的患者术前 ODI 明显较低（38 对 47.5，p<.001），年龄较大（68 对 63 岁，p=.007），L1-S1 平均 Pfirrmann 分级较差（3.5 对 3.2，p=.035），以及手术水平的原有脊椎滑脱发生率较高（p=.047）。当将这些和其他可能的危险因素纳入回归模型时，早期低术前 ODI（p=.002）和差的 Goutallier 分级（p=.042）以及晚期低术前 ODI（p<.001）是 MCID 无法实现的独立预测因素。
微创减压后，术前 ODI 较低和肌肉健康状况较差是较慢达到 MCID 的危险因素和预测因素。对于未达到 MCID，术前 ODI 较低、年龄较大、椎间盘退变较大和脊椎滑脱是危险因素，而术前 ODI 较低是唯一的独立预测因素。
