Frazier D D, Lipson S J, Fossel A H, Katz J N
Department of Orthopedic Surgery, Beth Israel Hospital, Boston, Massachusetts, USA.
Spine (Phila Pa 1976). 1997 Sep 1;22(17):2025-9. doi: 10.1097/00007632-199709010-00017.
Prospective observational study.
To examine associations between radiographic parameters (scoliosis and olisthesis) and outcomes of surgery for degenerative spinal stenosis.
Preoperative degenerative scoliosis generally is thought to be associated with an unfavorable outcome of surgery for spinal stenosis. Data on the relationship between an increase in olisthesis after laminectomy for spinal stenosis and outcomes of surgery are sparse and conflicting.
Radiographs were obtained before surgery and at least 6 months after surgery and coded for preoperative scoliosis and change in olisthesis after surgery. The reviewers of radiographs were blind to outcome information. Patients completed questionnaires on demographic and clinical data as well as on back pain, lower extremity pain, walking capacity, and satisfaction with surgery. Associations between radiographic data and patient reported outcomes were examined with the Spearman rank correlation and confirmed with multiple linear regression models that adjusted for potential confounders.
Ninety patients met eligibility criteria. Preoperative scoliosis was associated with less improvement in back pain at 6 months and at 24 months after surgery. An increase in olisthesis after surgery was associated with greater improvement in lower extremity pain at 6 months and at 24 months after surgery. An increase in olisthesis also was associated with greater improvement in walking capacity at 6 months and at 24 months after surgery. In multivariable analyses that adjusted for potential confounders, a change in olisthesis was not associated significantly with greater improvement in any of the outcomes.
The data support the widely held view that preoperative scoliosis is associated with an unfavorable outcome after decompression for degenerative lumbar spinal stenosis. Increase in olisthesis was not associated with unfavorable results. In fact, there was a weak trend toward better outcomes with greater slip. These data indicate that minor increases in olisthesis after surgery for spinal stenosis generally are tolerated well.
前瞻性观察性研究。
研究影像学参数（脊柱侧凸和椎体滑脱）与退行性腰椎管狭窄症手术结果之间的关联。
术前退行性脊柱侧凸通常被认为与腰椎管狭窄症手术的不良预后相关。关于腰椎管狭窄症椎板切除术后椎体滑脱增加与手术结果之间关系的数据稀少且相互矛盾。
在手术前和术后至少6个月获取X线片，并对术前脊柱侧凸和术后椎体滑脱的变化进行编码。X线片阅片者对结果信息不知情。患者完成关于人口统计学和临床数据以及背痛、下肢疼痛、行走能力和手术满意度的问卷调查。使用Spearman等级相关性检验影像学数据与患者报告结果之间的关联，并通过调整潜在混杂因素的多元线性回归模型进行确认。
90例患者符合纳入标准。术前脊柱侧凸与术后6个月和24个月时背痛改善较少相关。术后椎体滑脱增加与术后6个月和24个月时下肢疼痛改善更大相关。术后椎体滑脱增加还与术后6个月和24个月时行走能力改善更大相关。在调整潜在混杂因素的多变量分析中，椎体滑脱的变化与任何一项结果的更大改善均无显著关联。
数据支持广泛持有的观点，即术前脊柱侧凸与退行性腰椎管狭窄症减压术后的不良预后相关。椎体滑脱增加与不良结果无关。事实上，滑脱越大，预后有轻微改善的趋势。这些数据表明，腰椎管狭窄症手术后椎体滑脱的轻微增加通常耐受性良好。
