Impact of Severe Hip and Knee Osteoarthritis on Patient-Reported Outcomes and Global Alignment Following Lumbar Spinal Stenosis Surgery.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-03-25 DOI:10.1097/BRS.0000000000005340

Shota Tamagawa, Hidetoshi Nojiri, Juri Teramoto, Arihisa Shimura, Hiromitsu Takano, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Muneaki Ishijima

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Abstract

Study design: Retrospective cohort study.

Objective: To evaluate the impact of concomitant severe hip or knee osteoarthritis (OA) on patient-reported outcome measures (PROMs) and global alignment in patients undergoing surgery for lumbar spinal stenosis (LSS).

Summary of background data: Hip and knee OA frequently coexist with LSS, contributing to diagnostic and therapeutic complexities. Limited evidence exists regarding the impact of severe lower extremity OA on baseline and postoperative outcomes in patients with LSS.

Methods: A total of 121 patients with LSS who underwent decompression surgery with or without interbody fusion and completed 1-year follow-up were included. Patients were divided into severe OA and non-severe OA groups based on the Kellgren-Lawrence (KL) classification, with grades 3-4 classified as severe OA. We compared radiographic parameters and PROMs, including the Visual Analog Scale (VAS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Oswestry Disability Index (ODI), at baseline and 1-year follow-up. Multivariable linear regression was used to assess the effect of severe OA on 1-year postoperative PROMs.

Results: Sixty-seven patients (55.4%) had severe hip or knee OA. Severe OA was independently associated with higher VAS scores for low back pain (β=0.234, P=0.030) and leg pain (β=0.272, P=0.012), poorer JOABPEQ scores across multiple domains, and higher ODI scores (β=0.269, P=0.008) at 1-year follow-up. Patients with severe OA exhibited greater sagittal vertical axis and coronal imbalance postoperatively despite comparable spinopelvic mismatch. Additionally, the severe OA group experienced a higher rate of implant-related complications (10.5% vs. 1.9%, P=0.043).

Conclusion: Concomitant severe lower extremity OA was associated with worse PROMs, sagittal and coronal alignment following LSS surgery. These findings underscore the importance of recognizing and addressing severe lower extremity OA during preoperative planning for LSS to optimize surgical outcomes.

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研究设计回顾性队列研究：评估腰椎管狭窄症（LSS）手术患者同时合并严重髋关节或膝关节骨关节炎（OA）对患者报告结果指标（PROMs）和整体对位的影响：背景数据摘要：髋关节和膝关节OA经常与腰椎管狭窄症并存，导致诊断和治疗的复杂性。关于严重下肢 OA 对 LSS 患者基线和术后结果的影响，目前证据有限：方法：共纳入了121例接受减压手术并进行或不进行椎间融合术、随访1年的LSS患者。根据凯尔格伦-劳伦斯（Kellgren-Lawrence，KL）分类法将患者分为严重 OA 组和非严重 OA 组，其中 3-4 级为严重 OA。我们比较了基线和随访1年时的放射学参数和PROM，包括视觉模拟量表（VAS）、日本骨科协会背痛评估问卷（JOABPEQ）和Oswestry残疾指数（ODI）。采用多变量线性回归评估严重 OA 对术后 1 年 PROMs 的影响：67名患者（55.4%）患有严重的髋关节或膝关节OA。随访1年时，严重OA与较高的腰痛（β=0.234，P=0.030）和腿痛（β=0.272，P=0.012）VAS评分、较差的JOABPEQ多领域评分和较高的ODI评分（β=0.269，P=0.008）独立相关。尽管脊柱骨盆不匹配程度相当，但严重OA患者术后表现出更大的矢状垂直轴和冠状不平衡。此外，严重OA组的植入相关并发症发生率更高（10.5%对1.9%，P=0.043）：结论：伴有严重下肢OA与LSS手术后较差的PROMs、矢状位和冠状位对位有关。这些发现强调了在LSS术前规划中识别和处理严重下肢OA以优化手术效果的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.