Staats Peter S, Dorsi Michael J, Reece David E, Strand Natalie H, Poree Lawrence, Hagedorn Jonathan M
National Spine and Pain Centers, Atlantic Beach, FL, USA.
UCLA, Westlake Village Primary & Specialty Care, 1250 La Venta Drive, Westlake Village, CA, 91361, USA.
Interv Pain Med. 2024 Apr 22;3(2):100412. doi: 10.1016/j.inpm.2024.100412. eCollection 2024 Jun.
This prospective longitudinal study compares outcomes for Medicare beneficiaries receiving outpatient percutaneous image-guided lumbar decompression (PILD) using the ® procedure to patients undergoing outpatient laminectomy. All patients were diagnosed with lumbar spinal stenosis (LSS) with neurogenic claudication (NC).
All medical claims for 100 % of Medicare beneficiaries were reviewed, with study subjects identified using Centers for Medicare and Medicaid Research Identifiable Files. Baseline data were extracted individually to allow for longitudinal analysis through two-year follow-up. The index procedure was defined as the first or outpatient laminectomy during the enrollment period. The rate of subsequent surgical procedures and incidence of harms were used as study outcomes.
Cohorts included 2197 and 7416 laminectomy patients. patients were significantly older (76.7 years versus 73.4 years, respectively; p < 0.0001), and 57.4 % of were female, compared to 43.3 % of laminectomy (p < 0.0001). patients presented with significantly more baseline comorbidities compared to laminectomy patients (mean of 5.7 versus 4.8, respectively; p < 0.0001). Subsequent surgical procedure rate of 9.0 % for was significantly higher than 5.5 % for laminectomy (p < 0.0001). experienced harms at a significantly lower rate than laminectomy (1.9 % versus 5.8 %, respectively; p < 0.0001). The composite rate of subsequent surgical procedures and harms was similar between groups at 10.8 % for and 11.0 % for laminectomy.
can be considered a viable option for treatment of LSS with NC as evidenced by real-world data in this study. At two-years, patients experienced fewer harms and underwent more subsequent surgical procedures than laminectomy patients. The higher rate of subsequent surgical procedures for may be attributable to its position earlier in the LSS treatment algorithm. The overall rate of harms and subsequent surgical procedures was similar between groups, suggesting that should be considered as a treatment option, particularly for older patients with multiple comorbidities.
这项前瞻性纵向研究比较了接受门诊经皮影像引导下腰椎减压术（PILD）（使用®程序）的医疗保险受益人与接受门诊椎板切除术的患者的治疗结果。所有患者均被诊断为伴有神经源性间歇性跛行（NC）的腰椎管狭窄症（LSS）。
对100%医疗保险受益人的所有医疗索赔进行了审查，使用医疗保险和医疗补助研究中心的可识别文件确定研究对象。单独提取基线数据，以便进行为期两年的随访纵向分析。索引程序定义为入组期间的首次门诊经皮影像引导下腰椎减压术或门诊椎板切除术。后续手术程序的发生率和伤害发生率用作研究结果。
队列包括2197例接受门诊经皮影像引导下腰椎减压术的患者和7416例接受椎板切除术的患者。接受门诊经皮影像引导下腰椎减压术的患者年龄显著更大（分别为76.7岁和73.4岁；p<0.0001），接受门诊经皮影像引导下腰椎减压术的患者中57.4%为女性，而接受椎板切除术的患者中这一比例为43.3%（p<0.0001）。与接受椎板切除术的患者相比，接受门诊经皮影像引导下腰椎减压术的患者基线合并症显著更多（平均分别为5.7种和4.8种；p<0.0001）。接受门诊经皮影像引导下腰椎减压术的患者后续手术程序发生率为9.0%，显著高于接受椎板切除术的患者的5.5%（p<0.0001）。接受门诊经皮影像引导下腰椎减压术的患者发生伤害的比率显著低于接受椎板切除术的患者（分别为1.9%和5.8%；p<0.0001）。两组之间后续手术程序和伤害的综合发生率相似，接受门诊经皮影像引导下腰椎减压术的患者为10.8%，接受椎板切除术为11.0%。
本研究的真实世界数据表明，门诊经皮影像引导下腰椎减压术可被视为治疗伴有神经源性间歇性跛行的腰椎管狭窄症的可行选择。在两年时，接受门诊经皮影像引导下腰椎减压术的患者比接受椎板切除术的患者经历的伤害更少，接受的后续手术程序更多。接受门诊经皮影像引导下腰椎减压术的患者后续手术程序发生率较高可能归因于其在腰椎管狭窄症治疗算法中处于较早位置。两组之间伤害和后续手术程序的总体发生率相似，这表明门诊经皮影像引导下腰椎减压术应被视为一种治疗选择，特别是对于患有多种合并症的老年患者。
