1Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
J Neurosurg Spine. 2023 Jun 9;39(3):394-403. doi: 10.3171/2023.4.SPINE221047. Print 2023 Sep 1.
Patients with degenerative lumbar scoliosis (DLS) and neurogenic pain may be candidates for decompression alone or short-segment fusion. In this study, minimally invasive surgery (MIS) decompression (MIS-D) and MIS short-segment fusion (MIS-SF) in patients with DLS were compared in a propensity score-matched analysis.
The propensity score was calculated using 13 variables: sex, age, BMI, Charlson Comorbidity Index, smoking status, leg pain, back pain, grade 1 spondylolisthesis, lateral spondylolisthesis, multilevel spondylolisthesis, lumbar Cobb angle, pelvic incidence minus lumbar lordosis, and pelvic tilt in a logistic regression model. One-to-one matching was performed to compare perioperative morbidity and patient-reported outcome measures (PROMs). The minimal clinically important difference (MCID) for patients was calculated based on cutoffs of percentage change from baseline: 42.4% for Oswestry Disability Index (ODI), 25.0% for visual analog scale (VAS) low-back pain, and 55.6% for VAS leg pain.
A total of 113 patients were included in the propensity score calculation, resulting in 31 matched pairs. Perioperative morbidity was significantly reduced for the MIS-D group, including shorter operative duration (91 vs 204 minutes, p < 0.0001), decreased blood loss (22 vs 116 mL, p = 0.0005), and reduced length of stay (2.6 vs 5.1 days, p = 0.0004). Discharge status (home vs rehabilitation), complications, and reoperation rates were similar. Preoperative PROMs were similar, but after 3 months, improvement was significantly higher for the MIS-SF group in the VAS back pain score (-3.4 vs -1.2, p = 0.044) and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) score (+10.3 vs +1.9, p = 0.009), and after 1 year the MIS-SF group continued to have significantly greater improvement in the VAS back pain score (-3.9 vs -1.2, p = 0.026), ODI score (-23.1 vs -7.4, p = 0.037), 12-Item Short-Form Health Survey MCS score (+6.5 vs -6.5, p = 0.0374), and VR-12 MCS score (+7.6 vs -5.1, p = 0.047). MCID did not differ significantly between the matched groups for VAS back pain, VAS leg pain, or ODI scores (p = 0.38, 0.055, and 0.072, respectively).
Patients with DLS undergoing surgery had similar rates of significant improvement after both MIS-D and MIS-SF. For matched patients, tradeoffs were seen for reduced perioperative morbidity for MIS-D versus greater magnitudes of improvement in back pain, disability, and mental health for patients 1 year after MIS-SF. However, rates of MCID were similar, and the small sample size among the matched patients may be subject to patient outliers, limiting generalizability of these results.
患有退行性腰椎侧凸（DLS）和神经性疼痛的患者可能是接受减压或短节段融合的候选者。在这项研究中，对 DLS 患者进行了微创减压（MIS-D）和微创短节段融合（MIS-SF）的倾向性评分匹配分析。
使用 13 个变量：性别、年龄、BMI、Charlson 合并症指数、吸烟状况、腿部疼痛、背部疼痛、I 度脊椎滑脱、侧位脊椎滑脱、多节段脊椎滑脱、腰椎 Cobb 角、骨盆入射角减腰椎前凸、骨盆倾斜，在逻辑回归模型中计算倾向评分。进行一对一匹配以比较围手术期发病率和患者报告的结果测量（PROMs）。根据从基线变化的百分比计算患者的最小临床重要差异（MCID）：Oswestry 残疾指数（ODI）为 42.4%，视觉模拟量表（VAS）腰痛为 25.0%，VAS 腿痛为 55.6%。
共有 113 名患者纳入倾向评分计算，得出 31 对匹配。MIS-D 组的围手术期发病率显著降低，包括手术时间缩短（91 分钟对 204 分钟，p <0.0001），失血量减少（22 毫升对 116 毫升，p = 0.0005）和住院时间缩短（2.6 天对 5.1 天，p = 0.0004）。出院状态（家庭对康复）、并发症和再手术率相似。术前 PROMs 相似，但在 3 个月时，MIS-SF 组在 VAS 腰痛评分（-3.4 对-1.2，p = 0.044）和退伍军人 RAND 12 项健康调查（VR-12）心理成分综合评分（MCS）（+10.3 对+1.9，p = 0.009）方面的改善明显更高，在 1 年时，MIS-SF 组在 VAS 腰痛评分（-3.9 对-1.2，p = 0.026）、ODI 评分（-23.1 对-7.4，p = 0.037）、12 项简明健康调查 MCS 评分（+6.5 对-6.5，p = 0.0374）和 VR-12 MCS 评分（+7.6 对-5.1，p = 0.047）方面的改善继续显著更高。MIS-D 和 MIS-SF 之间的匹配组之间 VAS 腰痛、VAS 腿痛或 ODI 评分的 MCID 无显著差异（p = 0.38、0.055 和 0.072）。
接受手术治疗的 DLS 患者在接受 MIS-D 和 MIS-SF 治疗后均有相似的显著改善率。对于匹配的患者，MIS-D 具有降低围手术期发病率的优势，而 MIS-SF 在 1 年后在腰痛、残疾和心理健康方面的改善幅度更大。然而，MCID 的比率相似，并且匹配患者的样本量较小可能会受到患者异常值的影响，限制了这些结果的普遍性。
