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}
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.
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