Spine：多节段腰椎管狭窄并单节段滑脱之多节段减压单节段融合vs多节段融合

研究设计  亚组分析研究。
研究目的 比较多节段腰椎管狭窄并单节段退变性腰椎滑脱症患者采用多节段减压、多节段融合与多节段减压、单节段融合的手术效果与并发症差异。
背景资料 对于退变性腰椎滑脱症的手术治疗，减压融合手术可实现比单纯减压更佳的临床效果。多节段腰椎管狭窄并退变性腰椎滑脱症的手术治疗中除了对滑脱节段实施减压融合之外，对于存在椎管狭窄的其他节段也要实施减压手术，但对滑脱水平之外其他节段是否要进行融合手术尚存在争议，目前也尚无对照研究比较滑脱水平之外其他狭窄节段融合与非融合的临床效果。
研究方法 该脊柱患者治疗效果研究试验（Spine Patient Outcomes Research Trial）为一项多中心对照观察研究，比较多节段减压、单节段融合与多节段减压、多节段融合治疗腰椎滑脱并多节段椎管狭窄的临床效果。在术后1、2、3、4年时评价手术治疗效果，主要评价指标为躯体疼痛、躯体功能评估量表，简短全身健康状况调查量表(Study 36-item Short-Form General Health Survey, SF-36)，改良Oswestry功能障碍指数；其他评价措施包括椎管狭窄烦扰指数，腰痛烦扰指数，腿痛程度，患者满意度以及动态自我评价等。
结 果 共有207例患者纳入研究，其中130例采用多节段减压、单节段融合，另外77例采用多节段减压、多节段融合。无论主要临床疗效评价指标，还是其他评价指标，两组的数据结果差异均无统计学意义。然而，在手术时间和术中失血量方面，多节段融合组的水平显著更高。
结 论 在多节段腰椎管狭窄并单节段滑脱症的手术治疗中，多节段减压单节段融合与多节段融合可实现相似的临床效果。
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Single- versus multilevel fusion for single-level degenerative spondylolisthesis and multilevel lumbar stenosis: four-year results of the spine patient outcomes research trial.
STUDY DESIGN
A subanalysis study. OBJECTIVE.: To compare surgical outcomes and complications of multilevel decompression and single-level fusion with multilevel decompression and multilevel fusion for patients with multilevel lumbar stenosis and single-level degenerative spondylolisthesis (DS).
SUMMARY OF BACKGROUND DATA
In patients with DS who are treated surgically, decompression and fusion provide a better clinical outcome than decompression alone. Surgical treatment for multilevel lumbar stenosis and DS typically includes decompression and fusion of the spondylolisthesis segment and decompression with or without fusion for the other stenotic segments. To date, no study has compared the results of these 2 surgical options for single-level DS with multilevel stenosis.
METHODS
The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial comparing multilevel decompression and single-level fusion and multilevel decompression and multilevel fusion for spinal stenosis with spondylolisthesis, were analyzed. The primary outcome measures were the bodily pain and physical function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 1, 2, 3, and 4 years postoperatively. Secondary analysis consisted of stenosis bothersomeness index, low back pain bothersomeness, leg pain, patient satisfaction, and self-rated progress.
RESULTS
Overall, 207 patients were enrolled for the study, 130 had multlilevel decompression with 1 level fusion and 77 patients had multilevel decompression and multilevel fusion. For all primary and secondary outcome measures, there were no statistically significant differences in surgical outcomes between the 2 surgical techniques. However, operative time and intraoperative blood loss were significantly higher in the multilevel fusion group.
CONCLUSION
Decompression and single-level fusion and decompression and multilevel fusion provide similar outcomes in patients with multilevel lumbar stenosis and single-level DS.