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 suffering from neurogenic claudication due to 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 symptomatic spinal stenosis patients regardless of low-grade degenerative spondylolisthesis.</p><p><strong>Methods: </strong>In this retrospective cohort study, lumbar spinal stenosis patients with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 spondylolisthesis and 200 randomly selected stenosis patients. 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 nine years of follow-up, comparable satisfaction rates are reported (69% of spondylolisthesis patients and 68% of stenosis patients (p=0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7 versus 6%).</p><p><strong>Conclusion: </strong>This cohort study demonstrated 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":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Decompression without fusion in low-grade degenerative spondylolisthesis and stenosis patients: 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 suffering from neurogenic claudication due to 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 symptomatic spinal stenosis patients regardless of low-grade degenerative spondylolisthesis.</p><p><strong>Methods: </strong>In this retrospective cohort study, lumbar spinal stenosis patients with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 spondylolisthesis and 200 randomly selected stenosis patients. 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 nine years of follow-up, comparable satisfaction rates are reported (69% of spondylolisthesis patients and 68% of stenosis patients (p=0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7 versus 6%).</p><p><strong>Conclusion: </strong>This cohort study demonstrated 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\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2024-11-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.wneu.2024.10.123\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.10.123","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
Decompression without fusion in low-grade degenerative spondylolisthesis and stenosis patients: long-term patient-reported outcome.
Background: One-third of patients suffering from neurogenic claudication due to 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 symptomatic spinal stenosis patients regardless of low-grade degenerative spondylolisthesis.
Methods: In this retrospective cohort study, lumbar spinal stenosis patients with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 spondylolisthesis and 200 randomly selected stenosis patients. 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 nine years of follow-up, comparable satisfaction rates are reported (69% of spondylolisthesis patients and 68% of stenosis patients (p=0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7 versus 6%).
Conclusion: This cohort study demonstrated 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.
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Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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