Singh Sumedha, Shahi Pratyush, Song Junho, Subramanian Tejas, Morse Kyle, Maayan Omri, Araghi Kasra, Singh Nishtha, Tuma Olivia, Asada Tomoyuki, Korsun Maximilian, Mai Eric, Dowdell James, Sheha Evan, Sandhu Harvinder, Albert Todd, Qureshi Sheeraz, Iyer Sravisht
Hospital for Special Surgery.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2025 Feb 1;50(3):187-195. doi: 10.1097/BRS.0000000000005019. Epub 2024 Apr 29.
Retrospective cohort.
To identify the predictors of slower and nonimprovement after surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).
There is limited evidence regarding clinical and radiologic predictors of slower and nonimprovement following surgery for L4-5 DLS.
Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiologic variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.
Two hundred thirty-three patients (37% decompression and 63% fusion) were included. At less than three months, high pelvic tilt (PT) (OR: 0.92, P= 0.02) and depression (OR: 0.28, P= 0.02) were predictors of MCID nonachievement and GRC nonbetterment, respectively. Neither retained significance at above six months and hence, were identified as predictors of slower improvement. At above six months, low preoperative VAS leg (OR: 1.26, P= 0.01) and high facet orientation (OR: 0.95, P= 0.03) were predictors of MCID nonachievement, high L4-5 slip percentage (OR: 0.86, P= 0.03) and L5-S1 angular motion (OR: 0.78, P= 0.01) were predictors of GRC nonbetterment, and high preoperative ODI (OR: 0.96, P= 0.04) was a predictor of PASS nonachievement.
High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of nonimprovement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.
回顾性队列研究。
确定L4 - 5节段退变性腰椎滑脱症（DLS）手术治疗后恢复缓慢及未改善的预测因素。
关于L4 - 5 DLS手术后恢复缓慢及未改善的临床和放射学预测因素的证据有限。
纳入接受L4 - 5 DLS微创减压或融合手术且随访至少1年的患者。结局指标包括：（1）最小临床重要差异（MCID），（2）患者可接受症状状态（PASS），（3）整体评分变化（GRC）。分析的预测因素的临床变量有年龄、性别、体重指数（BMI）、手术类型、合并症、焦虑、抑郁、吸烟、骨质疏松症以及术前患者报告结局指标（PROMs）（Oswestry功能障碍指数，ODI；视觉模拟量表，腰背痛和腿痛VAS；12项简明健康调查躯体成分评分，SF - 12 PCS）。分析的放射学变量有滑脱百分比、平移和角运动、关节突间隙/囊肿/方向、侧方滑脱、椎间盘高度、脊柱侧弯、主曲线和分曲线Cobb角以及脊柱骨盆参数。
纳入233例患者（37%为减压手术，63%为融合手术）。在术后不到三个月时，高骨盆倾斜度（PT）（比值比：0.92，P = 0.02）和抑郁（比值比：0.28，P = 0.02）分别是未达到MCID和GRC未改善的预测因素。在术后六个月以上时，二者均无统计学意义，因此被确定为恢复缓慢的预测因素。在术后六个月以上时，术前腿痛VAS评分低（比值比：1.26，P = 0.01）和关节突方向高（比值比：0.95，P = 0.03）是未达到MCID的预测因素，高L4 - 5滑脱百分比（比值比：0.86，P = 0.03）和L5 - S1角运动（比值比：0.78，P = 0.01）是GRC未改善的预测因素，术前ODI评分高（比值比：0.96，P = 0.04）是未达到PASS的预测因素。
高PT和抑郁是恢复缓慢的预测因素，术前腿痛评分低、残疾程度高、关节突方向高、滑脱百分比高以及L5 - S1角运动是未改善的预测因素。然而，这些是初步研究结果，需要进一步对同质队列进行研究以证实这些发现。
