1Department of Orthopaedics, Hospital for Special Surgery, New York, New York.
2Department of Orthopaedics, Weill Cornell Medical College, New York, New York; and.
J Neurosurg Spine. 2023 Jul 14;39(4):576-582. doi: 10.3171/2023.5.SPINE23278. Print 2023 Oct 1.
The objective of this study was to assess the outcomes of patients with predominant back pain (pBP) undergoing minimally invasive decompression surgery compared with patients with nonpredominant back pain (npBP).
This was a retrospective cohort study. Patients were divided into two groups based on the presenting complaint: 1) pBP, defined as visual analog scale (VAS) back pain score > VAS leg pain score; and 2) npBP. Changes in patient-reported outcome measures (PROMs) were compared at the early (< 6 months) and late (≥ 6 months) postoperative time points. Outcomes measures were: 1) PROMs (Oswestry Disability Index [ODI], VAS back and leg pain scores, 12-Item Short-Form Health Survey Physical Component Score [SF-12 PCS], and Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF]), and 2) minimal clinically important difference (MCID) achievement rate and time. For the late MCID achievement point, a second analysis was conducted restricting VAS back and leg pain scores only to patients with preoperative scores ≥ 5.
Three hundred ninety patients were included (126 with pBP and 264 with npBP). There were no differences in patient demographics and operated levels. There were no differences in preoperative ODI, SF-12 PCS, and PROMIS PF scores. The pBP cohort had a significantly greater preoperative VAS back pain score than the npBP cohort, whereas the npBP cohort had a significantly greater preoperative VAS leg pain score than the pBP cohort. There were no differences in the absolute values or changes in ODI, VAS back pain, SF-12 PCS, and PROMIS PF scores at any time point. There was a significant difference in the early VAS leg pain scores (greater in npBP) that disappeared by the late postoperative time point. There was no difference in the MCID achievement rate in the ODI, SF-12 PCS, or PROMIS PF scores. By the late postoperative time point, 51.2% and 55.3% achieved an MCID on the ODI, 58.1% and 62.7% on the SF-12 PCS, 60% and 67.6% on the PROMIS PF, 81.1% and 73.2% on VAS back pain scores for those with preoperative scores ≥ 5, and 72% and 83.6% on VAS leg pain scores for those with preoperative scores ≥ 5 for the pBP and npBP cohorts, respectively. Additionally, there were no differences in time to MCID achievement for any PROMs.
The pBP and npBP cohorts showed similar improvement in PROMs and MCID achievement rates. This result shows that minimally invasive laminectomy is equally effective for patients presenting with pBP or npBP.
本研究旨在评估以腰痛为主（pBP）的患者与非腰痛为主（npBP）患者行微创减压手术后的结局。
这是一项回顾性队列研究。根据主要症状，患者被分为两组：1）pBP，定义为视觉模拟量表（VAS）腰痛评分> VAS 腿痛评分；2）npBP。比较两组患者在早期（<6 个月）和晚期（≥6 个月）术后的患者报告结局测量（PROM）变化。结局测量包括：1）PROM（Oswestry 残疾指数[ODI]、VAS 腰痛和腿痛评分、12 项简短健康调查身体成分评分[SF-12 PCS]和患者报告结局测量信息系统身体功能[PROMIS PF]）；2）最小临床重要差异（MCID）达标率和时间。对于晚期 MCID 达标点，对术前评分≥5 的患者仅进行 VAS 腰痛和腿痛评分的二次分析。
共纳入 390 例患者（pBP 组 126 例，npBP 组 264 例）。两组患者的人口统计学和手术水平无差异。术前 ODI、SF-12 PCS 和 PROMIS PF 评分无差异。pBP 组术前 VAS 腰痛评分明显高于 npBP 组，而 npBP 组术前 VAS 腿痛评分明显高于 pBP 组。任何时间点 ODI、VAS 腰痛、SF-12 PCS 和 PROMIS PF 评分的绝对值或变化均无差异。早期 VAS 腿痛评分（npBP 组更高）有显著差异，但在晚期术后时间点消失。ODI、SF-12 PCS 和 PROMIS PF 评分的 MCID 达标率无差异。晚期时，pBP 组和 npBP 组 ODI 分别有 51.2%和 55.3%、SF-12 PCS 分别有 58.1%和 62.7%、PROMIS PF 分别有 60%和 67.6%、术前评分≥5 的患者 VAS 腰痛评分分别有 81.1%和 73.2%、术前评分≥5 的患者 VAS 腿痛评分分别有 72%和 83.6%达到 MCID，pBP 组和 npBP 组的 VAS 腿痛评分均显著高于 npBP 组（P<0.001）。此外，任何 PROM 的 MCID 达标时间均无差异。
pBP 组和 npBP 组患者的 PROM 和 MCID 达标率均有相似的改善。该结果表明，微创减压术对以腰痛为主或非腰痛为主的患者同样有效。
