Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea.
Medicine (Baltimore). 2024 Jan 12;103(2):e36874. doi: 10.1097/MD.0000000000036874.
Disability and pain associated with lumbar degenerative spondylolisthesis (LDS) result in a significant burden on both the healthcare costs and patients' quality of life. Currently, there exists controversy regarding employment of either nonsurgical management (NSM) or surgical management (SM) in a clinical setting. Spinal canal cross-sectional area (SCA) has been an important morphological parameter for the analysis of LDS. However, there is lack of research about the comparative value of NSM and SM according to SCA. Moreover, previous research have not yet evaluated the clinical most suitable cutoff values of SCA. The objective of this research was to evaluate the effective of NSM and SM for LDS using SCA as an objective morphological parameter. The axial T2 magnetic resonance imaging images were obtained from each patient. We collected SCA samples from 149 patients with LDS. 72 patients underwent SM and the rest did NSM. We measured SCA at the L4/5 LDS on magnetic resonance imaging using a picture archiving and communications system. We measured SCA at the intervertebral disk posterior border, turning down to reach the facet joint side on the opposite edge at the L4/5 level. The average SCA value was 114.34 ± 48.11 mm2 in the NSM group and 69.88 ± 27.87 mm2 in the SM group. Therefore, the SM group had considerably lower SCA (P < .001). In view of the effectiveness of SCA as a prediction factor of surgical option, Receiver Operating Characteristic curve analysis show the optimal cutoff value for SCA as 83.21 mm2, with 70.8% sensitivity, 71.4% specificity, and an area under the curve of 0.80 (95% CI, 0.73-0.87). The narrower the SCA, the higher the probability of SM. Thus, it is proposed that to evaluate surgical decision making, the pain physician should carefully inspect the SCA.
腰椎退行性滑脱症（LDS）引起的残疾和疼痛给医疗保健成本和患者生活质量带来了巨大负担。目前，对于临床中采用非手术治疗（NSM）还是手术治疗（SM）存在争议。椎管横截面积（SCA）一直是分析 LDS 的一个重要形态学参数。然而，关于根据 SCA 比较 NSM 和 SM 的价值的研究还很少。此外，先前的研究尚未评估 SCA 的临床最适截止值。本研究旨在评估 SCA 作为客观形态学参数对 LDS 的 NSM 和 SM 的疗效。从每位患者获得轴向 T2 磁共振成像图像。我们从 149 例 LDS 患者中收集了 SCA 样本。72 例患者接受了 SM，其余患者接受了 NSM。我们使用图像存档和通信系统在磁共振成像上测量 L4/5 LDS 的 SCA。我们在 L4/5 水平，在椎间盘后缘测量，向下转弯到达对面边缘的关节突关节侧。NSM 组的平均 SCA 值为 114.34±48.11mm2，SM 组为 69.88±27.87mm2。因此，SM 组的 SCA 明显较低（P<.001）。鉴于 SCA 作为手术选择预测因素的有效性，接收器操作特征曲线分析显示 SCA 的最佳截止值为 83.21mm2，具有 70.8%的敏感性、71.4%的特异性和 0.80 的曲线下面积（95%CI，0.73-0.87）。SCA 越窄，SM 的可能性越高。因此，建议疼痛医师在评估手术决策时仔细检查 SCA。
