P47。侧位狭窄作为腰椎手术后MCID成就和慢性疼痛的预测因子：一项回顾性队列研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100671

Dinh Thao Trinh MD , JiannHer Lin MD

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引用次数: 0

摘要

背景：尽管手术技术不断进步，但仍有一部分患者在腰椎手术后不能达到最小临床重要差异（MCID）。确定这背后的因素和原因是改善结果的关键。目的探讨中西医结合治疗失败的临床因素及潜在原因。研究设计/设置回顾性队列研究患者样本：2016年6月至2023年6月在台湾一家医院接受腰椎微创手术的患者。结果测量：Oswestry残疾指数（ODI）、RAND 36项简短健康调查（SF-36）和最小临床重要差异（MCID）方法收集术前和术后一年的临床数据进行分析。MCID是通过计算sf - 36pcs的分数变化（截止值为4.9）或ODI（截止值为12.8）来确定的。两位脊柱外科医生回顾了非mcid成就病例的医疗记录和图像，以确定原因。结果33例（15.3%）患者未达到MCID。在多因素分析中，术前ODI评分较低(OR=1.09, 95%CI 1.04-1.14, p <；0.001)、较高的术后VAS（腿部疼痛或疼痛）（or =0.72, 95%CI 0.57-0.92, p=0.008）、较低的术后心理健康评分（MCS）（or =1.12, 95%CI 1.04-1.21, p=0.003）和3级外侧狭窄（or = 14.84, 95%CI 4.34-50.74）是实现非mcid的危险因素。在非mcid患者中，97%有慢性术后疼痛。非mcid实现的原因包括术前诊断怀疑（21.2%）、复发/并发症（21.2%）、心理障碍（3%）和特发性持续性疼痛（51.6%）。特发性持续性腿痛患者的3级外侧狭窄发生率明显高于特发性持续性腰痛患者。结论本研究强调术前ODI、术后精神状态、腿部疼痛，尤其是侧位狭窄对腰椎术后MCID的实现有显著影响。慢性术后疼痛是患者不满意的主要原因，超过50%的患者经历特发性持续性疼痛，主要是腿部疼痛。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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P47. Lateral stenosis as a predictor of MCID achievement and chronic pain following lumbar spine surgery: a retrospective cohort study

BACKGROUND CONTEXT

Despite advances in surgical techniques, a portion of patients do not achieve the minimal clinically important difference (MCID) after lumbar spine surgery. Identifying factors and causes behind this is key to improving outcomes.

PURPOSE

To investigate clinical factors associated with failure to achieve MCID and potential causes.

STUDY DESIGN/SETTING

A retrospective cohort study

PATIENT SAMPLE

Patients who underwent minimally lumbar spine surgery at one hospital in Taiwan from June 2016 to June 2023.

OUTCOME MEASURES

The Oswestry Disability Index (ODI), RAND 36-item Short Form Health Survey (SF-36), and Minimal Clinically Important Difference (MCID)

METHODS

Pre-operative and post-operative one-year clinical data were collected for analysis. The MCID was determined by calculating the change in score of the SF-36 PCS with a cut-off of 4.9 or ODI with a cut-off of 12.8. Medical records and images of non-MCID achievement cases were reviewed by two spine surgeons to identify the causes.

RESULTS

Thirty-three patients (15.3%) did not reach MCID. In multivariate analysis, lower preoperative ODI scores (OR=1.09, 95%CI 1.04-1.14, p < 0.001), higher postoperative VAS for leg sng or soreness (OR=0.72, 95%CI 0.57-0.92, p=0.008), lower postoperative mental health scores (MCS) (OR=1.12, 95%CI 1.04-1.21, p=0.003) and had grade 3 lateral stenosis (OR= 14.84, 95%CI 4.34-50.74) were risk factors of non-MCID achievement. Among non-MCID achievement patients, 97% had chronic postsurgical pain. Causes of non-MCID achievement included preoperative diagnostic doubts (21.2%), recurrence/complications (21.2%), psychological disorders (3%), and idiopathic persistent pain (51.6%). The prevalence of grade 3 lateral stenosis was significantly higher in patients with idiopathic persistent leg pain than in those with idiopathic persistent back pain.

CONCLUSIONS

This study highlights that preoperative ODI, postoperative mental status, leg Sng (soreness), and especially lateral stenosis significantly impact the achievement of MCID after lumbar spine surgery. Chronic post-surgical pain is the leading cause of patient dissatisfaction, with over fifty percent experiencing idiopathic persistent pain, primarily in leg.