Department of Orthopaedics, Neurological Surgery, New York Spine Institute, NYU Langone Medical Center-Orthopaedic Hospital, 301 East 17th St, New York, NY, 10003, USA.
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, US.
Spine Deform. 2024 Sep;12(5):1431-1439. doi: 10.1007/s43390-024-00896-x. Epub 2024 Jul 31.
To assess impact of baseline disability on HRQL outcomes.
CD patients with baseline (BL) and 2 year (2Y) data included, and ranked into quartiles by baseline NDI, from lowest/best score (Q1) to highest/worst score (Q4). Means comparison tests analyzed differences between quartiles. ANCOVA and logistic regressions assessed differences in outcomes while accounting for covariates (BL deformity, comorbidities, HRQLs, surgical details and complications).
One hundred and sixteen patients met inclusion (Age:60.97 ± 10.45 years, BMI: 28.73 ± 7.59 kg/m, CCI: 0.94 ± 1.31). The cohort mean cSVA was 38.54 ± 19.43 mm and TS-CL: 37.34 ± 19.73. Mean BL NDI by quartile was: Q1: 25.04 ± 8.19, Q2: 41.61 ± 2.77, Q3: 53.31 ± 4.32, and Q4: 69.52 ± 8.35. Q2 demonstrated greatest improvement in NRS Neck at 2Y (-3.93), compared to Q3 (-1.61, p = .032) and Q4 (-1.41, p = .015). Q2 demonstrated greater improvement in NRS Back (-1.71), compared to Q4 (+ 0.84, p = .010). Q2 met MCID in NRS Neck at the highest rates (69.9%), especially compared to Q4 (30.3%), p = .039. Q2 had the greatest improvement in EQ-5D (+ 0.082), compared to Q1 (+ 0.073), Q3 (+ 0.022), and Q4 (+ 0.014), p = .034. Q2 also had the greatest mJOA improvement (+ 1.517), p = .042.
Patients in Q2, with mean BL NDI of 42, consistently demonstrated the greatest improvement in HRQLs whereas those in Q4, (NDI 70), saw the least. BL NDI between 39 and 44 may represent a disability "Sweet Spot," within which operative intervention maximizes patient-reported outcomes. Furthermore, delaying intervention until patients are severely disabled, beyond an NDI of 61, may limit the benefits of surgery.
评估基线残疾对 HRQL 结局的影响。
纳入基线（BL）和 2 年（2Y）数据的 CD 患者，并根据基线 NDI 将其分为四组，从最低/最佳分数（Q1）到最高/最差分数（Q4）。均值比较检验分析了四组之间的差异。协方差分析和逻辑回归评估了在考虑协变量（BL 畸形、合并症、HRQL、手术细节和并发症）的情况下结局的差异。
116 名患者符合纳入标准（年龄：60.97±10.45 岁，BMI：28.73±7.59kg/m，CCI：0.94±1.31）。该队列的平均 cSVA 为 38.54±19.43mm，TS-CL 为 37.34±19.73。按四分位数的 BL NDI 平均值为：Q1：25.04±8.19，Q2：41.61±2.77，Q3：53.31±4.32，Q4：69.52±8.35。与 Q3（-1.61，p=0.032）和 Q4（-1.41，p=0.015）相比，Q2 在 2Y 时在 NRS 颈部方面表现出最大的改善（-3.93）。与 Q4（+0.84，p=0.010）相比，Q2 在 NRS 背部方面表现出更大的改善（-1.71）。Q2 在 NRS 颈部方面达到 MCID 的比例最高（69.9%），尤其是与 Q4（30.3%）相比，p=0.039。与 Q1（+0.073）、Q3（+0.022）和 Q4（+0.014）相比，Q2 在 EQ-5D 方面表现出最大的改善（+0.082），p=0.034。与 Q1（+0.073）、Q3（+0.022）和 Q4（+0.014）相比，Q2 在 mJOA 方面也表现出最大的改善（+1.517），p=0.042。
BL NDI 均值为 42 的 Q2 患者的 HRQL 改善最大，而 NDI 为 70 的 Q4 患者的改善最小。BL NDI 在 39 和 44 之间可能代表残疾的“甜蜜点”，在此范围内手术干预可最大限度地提高患者报告的结果。此外，BL NDI 超过 61 时，延迟干预直到患者出现严重残疾，可能会限制手术的益处。
