Clinical Significance of Facet Cysts in Patients Undergoing Lumbar Decompression for Degenerative Spine: A Propensity-score Matched Multicenter Analysis.
Karim Rizwan Nathani, Miles A Hudson, Aleeza Safdar, William Krauss, Maziyar Kalani, Selby G Chen, Kingsley Abode-Iyamah, Mohamad Bydon, Joshua Bakhsheshian
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引用次数: 0
Abstract
Study design: Cohort study.
Objective: This study aimed to evaluate influence of facet cysts on outcomes in patients undergoing lumbar decompression, and the influence of spinal fusion in patients undergoing decompression for facet cysts.
Summary of background data: The impact of facet cysts on outcomes following lumbar spine surgery for degenerative spine disease remains unclear.
Methods: Our multicenter institutional Neurosurgery Enterprise Registry was queried for patients who underwent lumbar decompression for degenerative spine conditions. Patients were divided into 2 cohorts: those with lumbar spine facet cysts and those without. Retrospective propensity-score matching was performed using 13 baseline variables to adjust for potential confounding factors, including age, sex, race, body mass index, and comorbidities. Secondary analysis comparing outcomes in patients with facet cysts cases undergoing decompression only versus those undergoing decompression and fusion was conducted.
Results: A total of 6768 patients were reviewed, of which 188 (2.8%) had facet cysts, which underwent lumbar decompression during 2019-2023. After 3:1 matching, patients with facet cysts were compared with 564 patients without it. We found no significant differences in LOS, nonroutine discharge, postoperative complications, readmissions, and reoperations. In addition, in cases with facet cysts, decompression reported no increased risk for discharge opioids, readmissions, and reoperations, whereas fusion (in a separate cohort of 127 patients with facet cysts) was associated with an increased risk for nonroutine discharge (3.7% vs. 10.2%, P=0.021), complications (2.1% vs. 7.1%, P=0.042), and longer LOS (0.89±1.69 vs. 3.74±2.03 d, P<0.001) and operative time (138.78±62.99 vs. 273.07±111.51 min, P <0.001).
Conclusions: The presence of facet cysts does not significantly affect outcomes of lumbar decompression for degenerative spine disease. Decompression alone for facet cysts can have better outcomes than decompression and fusion. The need for fusion should be weighted with its higher risks of complications, longer hospital stays, and nonroutine discharges.
研究设计：队列研究。目的：本研究旨在评估小关节突囊肿对腰椎减压患者预后的影响，以及脊柱融合对小关节突囊肿减压患者预后的影响。背景资料总结：小关节突囊肿对退行性脊柱疾病腰椎手术后预后的影响尚不清楚。方法：我们的多中心机构神经外科企业登记处查询了因脊柱退行性疾病行腰椎减压术的患者。患者被分为2组：有腰椎关节突囊肿和无腰椎关节突囊肿。使用13个基线变量进行回顾性倾向评分匹配，以调整潜在的混杂因素，包括年龄、性别、种族、体重指数和合并症。对单纯行减压与行减压融合的小关节突囊肿患者进行二次分析，比较其预后。结果：共回顾6768例患者，其中188例（2.8%）患有小关节突囊肿，于2019-2023年期间行腰椎减压术。3:1匹配后，将有关节突囊肿的患者与无关节突囊肿的564例患者进行比较。我们发现在LOS、非常规出院、术后并发症、再入院和再手术方面没有显著差异。此外，在关节突囊肿病例中，减压术没有增加阿片类药物出院、再入院和再手术的风险，而融合术（在127例关节突囊肿患者的单独队列中）与非常规出院风险增加（3.7% vs. 10.2%， P=0.021）、并发症（2.1% vs. 7.1%， P=0.042）和更长的LOS（0.89±1.69 vs. 3.74±2.03 d）相关。关节突囊肿的存在对退行性脊柱疾病腰椎减压的结果没有显著影响。单纯减压治疗小关节突囊肿比减压融合治疗效果更好。需要融合应权衡其并发症的高风险，较长的住院时间和非常规出院。
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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