低度退行性脊柱滑脱症和脊柱狭窄症患者的减压而非融合术:患者报告的长期疗效。

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
World neurosurgery Pub Date : 2025-01-01 Epub Date: 2024-11-22 DOI:10.1016/j.wneu.2024.10.123
Judith M P van Grafhorst, Wilco C Peul, Carmen L A Vleggeert-Lankamp
{"title":"低度退行性脊柱滑脱症和脊柱狭窄症患者的减压而非融合术:患者报告的长期疗效。","authors":"Judith M P van Grafhorst, Wilco C Peul, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.wneu.2024.10.123","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>One-third of patients with neurogenic claudication caused by lumbar spinal stenosis have low-grade degenerative spondylolisthesis. Decompression in these patients is considered a risk factor for instability, and it remains unclear whether instrumented fusion should be added. This study aims to assess the long-term clinical outcomes of decompressive surgery without instrumented fusion in patients with symptomatic spinal stenosis regardless of low-grade degenerative spondylolisthesis.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients with lumbar spinal stenosis with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 patients with spondylolisthesis and 200 randomly selected patients with stenosis. Demographic characteristics, surgical technique, reoperation indication and incidence, and patient-reported outcome measures were assessed.</p><p><strong>Results: </strong>At long-term follow-up, the mean Oswestry Disability Index was 23.6 ± 20.15 in the spondylolisthesis group and 23.4 ± 20.9 (P = 0.957) in the stenosis group. The EuroQol-5D was 0.74 ± 0.28 and 0.75 ± 0.24 (P = 0.793), respectively. The Zurich Claudication Questionnaire score was 48.2% ± 18.8 and 49.6% ± 18.5 (P = 0.646), respectively. After 9 years of follow-up, comparable satisfaction rates were reported (69% of patients with spondylolisthesis and 68% of patients with stenosis; P = 0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7% vs. 6%).</p><p><strong>Conclusions: </strong>This cohort study showed comparable satisfaction and clinical outcomes after decompressive surgery for symptomatic spinal stenosis in patients with and without grade 1 degenerative spondylolisthesis. Decompressive surgery can, therefore, be considered an effective treatment for symptomatic lumbar spinal stenosis, even if it is accompanied by degenerative spondylolisthesis. Therefore, routinely adding instrumented spondylodesis is not deemed necessary.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"893-902"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Decompression without Fusion in Patients with Low-Grade Degenerative Spondylolisthesis and Stenosis: Long-Term Patient-Reported Outcome.\",\"authors\":\"Judith M P van Grafhorst, Wilco C Peul, Carmen L A Vleggeert-Lankamp\",\"doi\":\"10.1016/j.wneu.2024.10.123\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>One-third of patients with neurogenic claudication caused by lumbar spinal stenosis have low-grade degenerative spondylolisthesis. Decompression in these patients is considered a risk factor for instability, and it remains unclear whether instrumented fusion should be added. This study aims to assess the long-term clinical outcomes of decompressive surgery without instrumented fusion in patients with symptomatic spinal stenosis regardless of low-grade degenerative spondylolisthesis.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients with lumbar spinal stenosis with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 patients with spondylolisthesis and 200 randomly selected patients with stenosis. Demographic characteristics, surgical technique, reoperation indication and incidence, and patient-reported outcome measures were assessed.</p><p><strong>Results: </strong>At long-term follow-up, the mean Oswestry Disability Index was 23.6 ± 20.15 in the spondylolisthesis group and 23.4 ± 20.9 (P = 0.957) in the stenosis group. The EuroQol-5D was 0.74 ± 0.28 and 0.75 ± 0.24 (P = 0.793), respectively. The Zurich Claudication Questionnaire score was 48.2% ± 18.8 and 49.6% ± 18.5 (P = 0.646), respectively. After 9 years of follow-up, comparable satisfaction rates were reported (69% of patients with spondylolisthesis and 68% of patients with stenosis; P = 0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7% vs. 6%).</p><p><strong>Conclusions: </strong>This cohort study showed comparable satisfaction and clinical outcomes after decompressive surgery for symptomatic spinal stenosis in patients with and without grade 1 degenerative spondylolisthesis. Decompressive surgery can, therefore, be considered an effective treatment for symptomatic lumbar spinal stenosis, even if it is accompanied by degenerative spondylolisthesis. Therefore, routinely adding instrumented spondylodesis is not deemed necessary.</p>\",\"PeriodicalId\":23906,\"journal\":{\"name\":\"World neurosurgery\",\"volume\":\" \",\"pages\":\"893-902\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.10.123\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.10.123","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:三分之一因腰椎管狭窄而出现神经源性跛行的患者患有低度退行性脊椎滑脱症。对这些患者进行减压手术被认为是导致不稳定的危险因素,目前仍不清楚是否应增加器械融合术。本研究旨在评估无症状椎管狭窄症患者(无论是否存在低度退行性椎体滑脱)在不进行器械融合的情况下进行减压手术的长期临床疗效:在这项回顾性队列研究中,研究对象是接受减压手术的腰椎管狭窄症患者,无论是否患有脊柱滑脱症。对 250 名椎体滑脱症患者和随机抽取的 200 名椎管狭窄症患者进行了疼痛、功能和满意度问卷调查。对人口统计学特征、手术技术、再手术指征和发生率以及患者报告的结果进行了评估:在长期随访中,椎体滑脱症组的平均 Oswestry 失能指数为 23.6 ± 20.15,椎管狭窄组为 23.4 ± 20.9(P=0.957)。EuroQol-5D分别为0.74±0.28和0.75±0.24(P=0.793)。苏黎世跛行问卷得分分别为(48.2%±18.8)和(49.6%±18.5)(P=0.646)。经过九年的随访,满意率相当(69%的脊柱滑脱症患者和68%的狭窄症患者(P=0.855)。椎体滑脱症组和椎管狭窄症组的再手术率相当(7% 对 6%):这项队列研究表明,对患有和未患有1级退行性脊椎滑脱症的症状性椎管狭窄患者进行减压手术后,其满意度和临床疗效相当。因此,即使伴有退行性椎体骨质疏松,减压手术也可被视为治疗症状性腰椎管狭窄症的有效方法。因此,常规添加器械性脊椎矫正术被认为是不必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Decompression without Fusion in Patients with Low-Grade Degenerative Spondylolisthesis and Stenosis: Long-Term Patient-Reported Outcome.

Background: One-third of patients with neurogenic claudication caused by lumbar spinal stenosis have low-grade degenerative spondylolisthesis. Decompression in these patients is considered a risk factor for instability, and it remains unclear whether instrumented fusion should be added. This study aims to assess the long-term clinical outcomes of decompressive surgery without instrumented fusion in patients with symptomatic spinal stenosis regardless of low-grade degenerative spondylolisthesis.

Methods: In this retrospective cohort study, patients with lumbar spinal stenosis with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 patients with spondylolisthesis and 200 randomly selected patients with stenosis. Demographic characteristics, surgical technique, reoperation indication and incidence, and patient-reported outcome measures were assessed.

Results: At long-term follow-up, the mean Oswestry Disability Index was 23.6 ± 20.15 in the spondylolisthesis group and 23.4 ± 20.9 (P = 0.957) in the stenosis group. The EuroQol-5D was 0.74 ± 0.28 and 0.75 ± 0.24 (P = 0.793), respectively. The Zurich Claudication Questionnaire score was 48.2% ± 18.8 and 49.6% ± 18.5 (P = 0.646), respectively. After 9 years of follow-up, comparable satisfaction rates were reported (69% of patients with spondylolisthesis and 68% of patients with stenosis; P = 0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7% vs. 6%).

Conclusions: This cohort study showed comparable satisfaction and clinical outcomes after decompressive surgery for symptomatic spinal stenosis in patients with and without grade 1 degenerative spondylolisthesis. Decompressive surgery can, therefore, be considered an effective treatment for symptomatic lumbar spinal stenosis, even if it is accompanied by degenerative spondylolisthesis. Therefore, routinely adding instrumented spondylodesis is not deemed necessary.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信