Masuda Soichiro, Fukasawa Toshiki, Fujibayashi Shunsuke, Otsuki Bungo, Murata Koichi, Shimizu Takayoshi, Matsuda Shuichi, Kawakami Koji
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Ann Clin Epidemiol. 2024 Oct 31;7(1):1-9. doi: 10.37737/ace.25001. eCollection 2025 Jan 1.
Reoperation after lumbar spine surgery is a major issue for both patients and physicians. It is uncertain whether fusion is superior to decompression alone for lumbar degenerative disease regarding reoperation rate. We aim to evaluate the reoperation rate after fusion surgery for lumbar degenerative disease compared with decompression alone.
This study was conducted under a retrospective cohort design in patients undergoing fusion or decompression alone in one or two levels for lumbar degenerative disease using a Japanese claims-based database. Primary outcome was reoperation incidence during the follow-up period, and secondary outcome was reoperation incidence within 90 days postoperatively. Confounding factors were handled using propensity score overlap weighting. Cumulative incidence of reoperation was calculated from the Kaplan-Meier curve and hazard ratios (HRs) and 95% confidence intervals (CIs) for reoperation were estimated using Cox proportional hazards regression models.
8497 patients (2051 patients in the fusion group and 6446 in the decompression alone group) were included in the study. There was no difference in reoperation rate between fusion and decompression alone (weighted HR 0.85 [95% CI 0.69 to 1.04]; p = 0.11).
Among patients with lumbar degenerative disease who underwent fusion or decompression alone, no significant difference was observed between the two groups.
腰椎手术后再次手术对患者和医生来说都是一个重大问题。就再次手术率而言，对于腰椎退行性疾病，融合手术是否优于单纯减压手术尚不确定。我们旨在评估与单纯减压手术相比，腰椎退行性疾病融合手术后的再次手术率。
本研究采用回顾性队列设计，使用日本基于索赔的数据库，纳入因腰椎退行性疾病接受单节段或双节段融合或单纯减压手术的患者。主要结局是随访期间的再次手术发生率，次要结局是术后90天内的再次手术发生率。使用倾向评分重叠加权处理混杂因素。根据Kaplan-Meier曲线计算再次手术的累积发生率，并使用Cox比例风险回归模型估计再次手术的风险比（HR）和95%置信区间（CI）。
本研究共纳入8497例患者（融合组2051例，单纯减压组6446例）。融合手术和单纯减压手术的再次手术率没有差异（加权HR 0.85 [95%CI 0.69至1.04]；p = 0.11）。
在接受融合或单纯减压手术的腰椎退行性疾病患者中，两组之间未观察到显著差异。
