Ball Jacob R, Gallo Matthew C, Kebaish Kareem, Hang Nicole, Ton Andy, Hernandez Fergui, Abdou Marc, Karakash William J, Wang Jeffrey C, Hah Raymond J, Alluri Ram K
Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Neurospine. 2024 Dec;21(4):1068-1077. doi: 10.14245/ns.2448624.312. Epub 2024 Dec 31.
The purpose of this study is to describe utilization, demographics, complications, and revisions for patients with degenerative spondylolisthesis (DS) with stenosis undergoing decompression or decompression with fusion in the United States.
A national insurance database was used to identify patients who underwent either decompression and fusion or decompression alone for management of DS from 2010-2022. Utilization trends, demographics, and complications for each procedure were compared.
A total of 162,878 patients were identified, of which 78,043 patients underwent combined single-level lumbar decompression and fusion and 84,835 underwent single-level lumbar decompression alone. Between 2010-2021, lumbar decompression and fusion became the predominant surgical intervention for DS in 2016 and continued to account for more than half of all procedures during the remainder of the study period. Factors such as age, sex, comorbidities, geographic region, and physician specialty training were associated with procedure choice. Decompression with fusion was associated with a lower risk of revision surgery up to 5 years postoperatively and an overall lower incidence of 30-day complications.
Decompression with fusion has become the most common treatment for lumbar DS over the past decade despite a lack of compelling evidence supporting its use compared to decompression alone. A variety of patient and surgeon-specific factors is associated with procedure choice. After accounting for cofounders, we identified treatment-specific complications that may be valuable when counseling patients.
本研究旨在描述美国患有退行性腰椎滑脱（DS）并伴有椎管狭窄的患者接受减压手术或减压融合手术的使用情况、人口统计学特征、并发症及翻修情况。
利用一个全国性保险数据库来识别2010年至2022年期间因DS接受减压融合手术或单纯减压手术的患者。比较了每种手术的使用趋势、人口统计学特征和并发症。
共识别出162,878例患者，其中78,043例患者接受了单节段腰椎减压融合联合手术，84,835例患者仅接受了单节段腰椎减压手术。在2010年至2021年期间，腰椎减压融合手术在2016年成为DS的主要手术干预方式，并且在研究期的剩余时间里继续占所有手术的一半以上。年龄、性别、合并症、地理区域和医生专业培训等因素与手术选择有关。融合减压手术与术后5年内翻修手术风险较低以及30天并发症总体发生率较低相关。
尽管与单纯减压相比，缺乏支持融合减压手术使用的有力证据，但在过去十年中，融合减压手术已成为腰椎DS最常见的治疗方法。多种患者和外科医生特定因素与手术选择有关。在考虑混杂因素后，我们确定了在为患者提供咨询时可能有价值的特定治疗并发症。
