23. Outcomes of direct vs indirect decompression for lumbar spondylolisthesis: A propensity matched cohort analysis

医学 脊椎滑脱 椎板切除术 倾向得分匹配 外科 腰椎 Oswestry残疾指数 背景(考古学) 脊柱融合术 腰痛 生物 精神科 病理 古生物学 替代医学 脊髓
作者
Lydia McKeithan,Byron F. Stephens,Jacquelyn S. Pennings,Hui Nian,Hunter Waddell,Amir M. Abtahi,Mohamad Bydon,John J. Knightly,Kristin R. Archer,Clinton J. Devin
出处
期刊:The Spine Journal [Elsevier]
卷期号:21 (9): S12-S12
标识
DOI:10.1016/j.spinee.2021.05.048
摘要

BACKGROUND CONTEXT Debate persists regarding the optimal surgical strategy to treat lumbar spondylolisthesis. The recent development of novel anterior approaches (direct lateral and oblique lumbar interbody fusion) has led to a rise in the utilization of anterior lumbar interbody fusion procedural codes. These new techniques rely on indirect decompression to treat the patient's neural compression, which is criticized by proponents of direct decompressive techniques. PURPOSE To compare 3- and 12-month outcomes between patients with lumbar spondylolisthesis treated with direct decompression (DD) vs indirect decompression (ID) and interbody fusion. STUDY DESIGN/SETTING Lumbar module of the Quality Outcomes Database (QOD), a national, multicenter prospective spine registry. PATIENT SAMPLE A total of 4,163 patients underwent DD (posterior lumbar laminectomy with interbody fusion) and 86 patients underwent ID (anterior lumbar interbody fusion and posterior instrumentation/fusion without laminectomy). OUTCOME MEASURES Oswestry Disability Index (ODI), NRS-back pain, NRS-leg pain, EQ5D, satisfaction, major complication, minor complication, readmission, and return to work at 3- and 12-months postsurgery, return to OR within 30 days. METHODS Propensity scores were estimated using logistic regression with surgical procedure as the dependent variable. Independent variables included the baseline covariates that are potentially associated with outcomes. Based on the logit of estimated propensity score, DD patients were one-to-one matched to ID patients using a greedy matching strategy without replacement. Binary outcomes between ID and DD propensity score matched patients were compared using McNemar's test. The estimates of risk difference and relative risk were determined as well as 95% confidence intervals using asymptotic score methods. Continuous outcomes were compared using two sample paired t-test. RESULTS In the propensity-matched analysis, the DD and ID cohorts did not differ with respect to their 12 month postoperative improvement in ODI (p=0.262), back pain (p=0.715), leg pain (p=0.144), EQ5D (0.384), satisfaction (0.423), readmission (p=1.00), return to OR within 30 days (p=0.317), return to work (p=0.366), or minor (p=1.00) / major (p=0.480) complication rates. The ID group did demonstrate a statistically-significant lower level of improvement in achieving a 30-percent reduction in leg pain at 3-months vs the DD cohort (p=0.05, RR 0.85, 95% CI 0.7091-0.9996). CONCLUSIONS DD and ID strategies to treat lumbar spondylolisthesis were similar in terms of 12-month PRO improvement, readmission, complications, return to work and satisfaction. The ID cohort did demonstrate a statistically-significant lower reduction in leg pain at 3 months, which was not maintained at 12 months. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Debate persists regarding the optimal surgical strategy to treat lumbar spondylolisthesis. The recent development of novel anterior approaches (direct lateral and oblique lumbar interbody fusion) has led to a rise in the utilization of anterior lumbar interbody fusion procedural codes. These new techniques rely on indirect decompression to treat the patient's neural compression, which is criticized by proponents of direct decompressive techniques. To compare 3- and 12-month outcomes between patients with lumbar spondylolisthesis treated with direct decompression (DD) vs indirect decompression (ID) and interbody fusion. Lumbar module of the Quality Outcomes Database (QOD), a national, multicenter prospective spine registry. A total of 4,163 patients underwent DD (posterior lumbar laminectomy with interbody fusion) and 86 patients underwent ID (anterior lumbar interbody fusion and posterior instrumentation/fusion without laminectomy). Oswestry Disability Index (ODI), NRS-back pain, NRS-leg pain, EQ5D, satisfaction, major complication, minor complication, readmission, and return to work at 3- and 12-months postsurgery, return to OR within 30 days. Propensity scores were estimated using logistic regression with surgical procedure as the dependent variable. Independent variables included the baseline covariates that are potentially associated with outcomes. Based on the logit of estimated propensity score, DD patients were one-to-one matched to ID patients using a greedy matching strategy without replacement. Binary outcomes between ID and DD propensity score matched patients were compared using McNemar's test. The estimates of risk difference and relative risk were determined as well as 95% confidence intervals using asymptotic score methods. Continuous outcomes were compared using two sample paired t-test. In the propensity-matched analysis, the DD and ID cohorts did not differ with respect to their 12 month postoperative improvement in ODI (p=0.262), back pain (p=0.715), leg pain (p=0.144), EQ5D (0.384), satisfaction (0.423), readmission (p=1.00), return to OR within 30 days (p=0.317), return to work (p=0.366), or minor (p=1.00) / major (p=0.480) complication rates. The ID group did demonstrate a statistically-significant lower level of improvement in achieving a 30-percent reduction in leg pain at 3-months vs the DD cohort (p=0.05, RR 0.85, 95% CI 0.7091-0.9996). DD and ID strategies to treat lumbar spondylolisthesis were similar in terms of 12-month PRO improvement, readmission, complications, return to work and satisfaction. The ID cohort did demonstrate a statistically-significant lower reduction in leg pain at 3 months, which was not maintained at 12 months.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
XJ完成签到,获得积分10
1秒前
2秒前
6秒前
6秒前
眼大肚皮小完成签到,获得积分10
7秒前
8秒前
8秒前
9秒前
万能图书馆应助心杨采纳,获得10
10秒前
太渊发布了新的文献求助10
11秒前
李蕤蕤完成签到,获得积分10
12秒前
淋湿巴黎完成签到,获得积分10
12秒前
13秒前
情怀应助乌鸡鲅鱼采纳,获得10
14秒前
尤萨发布了新的文献求助100
15秒前
ctq完成签到 ,获得积分10
16秒前
16秒前
caohuijun完成签到,获得积分10
16秒前
苗长青完成签到,获得积分20
16秒前
茶包发布了新的文献求助30
17秒前
斐嘿嘿完成签到,获得积分10
17秒前
香蕉觅云应助析界成微采纳,获得10
18秒前
热情的夏完成签到,获得积分10
19秒前
淋湿巴黎发布了新的文献求助10
19秒前
鱼七柒完成签到,获得积分10
21秒前
22秒前
haowu发布了新的文献求助10
23秒前
liuerlong发布了新的文献求助10
24秒前
星辰大海应助重要的水杯采纳,获得10
26秒前
Thanatos关注了科研通微信公众号
26秒前
倩咂完成签到,获得积分10
27秒前
鲤鱼依白发布了新的文献求助10
29秒前
999发布了新的文献求助10
29秒前
29秒前
沉静的迎荷完成签到 ,获得积分10
31秒前
淡淡的若冰应助oky采纳,获得10
32秒前
无敌石墨烯完成签到 ,获得积分10
33秒前
夏虫语冰完成签到,获得积分10
34秒前
太渊发布了新的文献求助10
34秒前
0x1orz发布了新的文献求助10
35秒前
高分求助中
Evolution 10000
юрские динозавры восточного забайкалья 800
English Wealden Fossils 700
Mantiden: Faszinierende Lauerjäger Faszinierende Lauerjäger 600
Distribution Dependent Stochastic Differential Equations 500
A new species of Coccus (Homoptera: Coccoidea) from Malawi 500
A new species of Velataspis (Hemiptera Coccoidea Diaspididae) from tea in Assam 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3157464
求助须知:如何正确求助?哪些是违规求助? 2808880
关于积分的说明 7878772
捐赠科研通 2467260
什么是DOI,文献DOI怎么找? 1313299
科研通“疑难数据库(出版商)”最低求助积分说明 630393
版权声明 601919