Brisby Helena, Myklebust Tor Åge, Banitalebi Hasan, Austevoll Ivar, Aaen Jorn, Storheim Kjersti, Hellum Christian, Franssen Eric, Indrekvam Kari, Hermansen Erland
Spine Surgery Team, Department of Orthopedics, Sahlgrenska University Hospital, Gothenborg, Sweden.
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Spine (Phila Pa 1976). 2025 Apr 1;50(7):429-436. doi: 10.1097/BRS.0000000000005247. Epub 2024 Dec 25.
A secondary analysis of data from the NORDSTEN-spinal stenosis trial (SST).
The aim of the present study was to investigate whether the dural sac cross-sectional area (DSCA) on magnetic resonance imaging (MRI) of adjacent segments decreases after decompressive surgery due to lumbar spinal stenosis (LSS) up to 2 years postoperatively and to investigate possible associations with baseline variables, including preoperative patient and radiological characteristics, and surgical method used.
Decompressive surgery for LSS is currently the most common spinal surgery procedure; however, there is limited knowledge of changes in the DSCA over time adjacent to a decompressed segment.
In the NORDSTEN-SST, 437 patients were randomized to decompression with one of three minimally invasive surgical methods for LSS. The patients underwent an MRI of the lumbar spine (L2-L5) before surgery and at 3 and 24 months postoperatively. Descriptive statistics of adjacent DSCA and changes in adjacent DSCA are presented. Possible prognostic factors (preoperative factors, radiologic measures, and surgical method) for changes in the adjacent DSCA were examined using multivariate regression analyses.
Three hundred twenty-two patients (74%) in the original NORDSTEN-SST had undergone MRI at both 3 and 24 months postoperatively and were included (360 adjacent levels, 263 cranial, and 97 caudal to a decompressed level). Up to two years postoperatively, no decrease in adjacent DSCA was observed. No associations were found between the investigated baseline variables and DSCA change from zero to two years, except for a weak association with baseline adjacent DSCA.
Up to two years postoperatively, the DSCA did not decrease at adjacent levels after decompressive surgery. None of the investigated baseline variables showed any clinically meaningful prognostic value regarding adjacent DSCA changes two years postoperatively. The findings support previous reports that decompression of adjacent levels is not required to prevent subsequent stenosis.
对NORDSTEN腰椎管狭窄症试验（SST）的数据进行二次分析。
本研究旨在调查因腰椎管狭窄症（LSS）行减压手术后，直至术后2年，相邻节段磁共振成像（MRI）上的硬脊膜囊横截面积（DSCA）是否减小，并调查其与基线变量（包括术前患者和影像学特征以及所采用的手术方法）之间的可能关联。
LSS减压手术是目前最常见的脊柱外科手术；然而，对于减压节段相邻部位DSCA随时间的变化了解有限。
在NORDSTEN-SST中，437例患者被随机分配接受三种LSS微创外科手术方法之一进行减压。患者在手术前以及术后3个月和24个月接受腰椎（L2-L5）MRI检查。呈现相邻DSCA的描述性统计数据以及相邻DSCA的变化情况。使用多变量回归分析检查相邻DSCA变化的可能预后因素（术前因素、影像学测量指标和手术方法）。
原始NORDSTEN-SST中的322例患者（74%）在术后3个月和24个月均接受了MRI检查并被纳入研究（360个相邻节段，减压节段上方263个，下方97个）。术后长达两年，未观察到相邻DSCA减小。在所研究的基线变量与DSCA从0至2年的变化之间未发现关联，除了与基线相邻DSCA有微弱关联。
术后长达两年，减压手术后相邻节段的DSCA未减小。在所研究的基线变量中，没有一个显示出对术后两年相邻DSCA变化有任何具有临床意义的预后价值。这些发现支持了先前的报道，即无需对相邻节段进行减压以预防后续狭窄。
