Abstract：
OBJECTIVE: Surgical treatment of degenerative lumbar spondylolisthesis (DLS) reliably improves patient-reported quality of life; however, patient population heterogeneity, in addition to other factors, ensures ongoing equipoise in choosing the ideal surgical treatment. Surgeon preference for fusion or decompression alone influences surgical treatment decision-making. Meanwhile, at presentation, patient-reported outcome measures (PROMs) differ considerably between females and males. The aims of this study were to determine whether there exists a difference in the rates of decompression and fusion versus decompression alone based on patient-reported sex, and to determine if widely accepted indications for fusion justify any observed differences or if surgeon preference plays a role.
METHODS: This study is a retrospective cohort analysis of patients enrolled in the Canadian Spine Outcomes Research Network (CSORN) DLS study, a multicentered Canadian prospective study, investigating the surgical management and outcome of DLS. Decompression and fusion rates, patient characteristics, preoperative PROMs, and radiographic measures were compared between males and females before and after propensity score matching.
RESULTS: In the unmatched cohort, female patients were more likely to undergo decompression and fusion than male patients. Females were more likely to have the recognized indications for fusion, including kyphotic disc angle, higher spondylolisthesis grade and slip percentage, and patient-reported back pain. Other radiographic findings associated with the decision to fuse, including facet effusion, facet distraction, or facet angle, were not more prevalent in females. After propensity score matching for demographic and radiographic characteristics, similar proportions of male and female patients underwent decompression and fusion and decompression alone.
CONCLUSIONS: Although it remains unclear who should or should not undergo fusion, in addition to surgical decompression of DLS, female patients undergo fusion at a higher rate than their male counterparts. After matching baseline radiographic factors indicating fusion, this analysis showed that the decision to fuse was not biased by sex differences. Rather, the higher proportion of females undergoing fusion is largely explained by the radiographic and clinical indications for fusion, suggesting that specific clinical and anatomical features of this condition are indeed different between sexes.
METHODS: This study is a retrospective cohort analysis of patients enrolled in the Canadian Spine Outcomes Research Network (CSORN) DLS study, a multicentered Canadian prospective study, investigating the surgical management and outcome of DLS. Decompression and fusion rates, patient characteristics, preoperative PROMs, and radiographic measures were compared between males and females before and after propensity score matching.
RESULTS: In the unmatched cohort, female patients were more likely to undergo decompression and fusion than male patients. Females were more likely to have the recognized indications for fusion, including kyphotic disc angle, higher spondylolisthesis grade and slip percentage, and patient-reported back pain. Other radiographic findings associated with the decision to fuse, including facet effusion, facet distraction, or facet angle, were not more prevalent in females. After propensity score matching for demographic and radiographic characteristics, similar proportions of male and female patients underwent decompression and fusion and decompression alone.
CONCLUSIONS: Although it remains unclear who should or should not undergo fusion, in addition to surgical decompression of DLS, female patients undergo fusion at a higher rate than their male counterparts. After matching baseline radiographic factors indicating fusion, this analysis showed that the decision to fuse was not biased by sex differences. Rather, the higher proportion of females undergoing fusion is largely explained by the radiographic and clinical indications for fusion, suggesting that specific clinical and anatomical features of this condition are indeed different between sexes.
摘要：
目的：退行性腰椎滑脱症(DLS)的手术治疗可靠地改善了患者报告的生活质量；然而，患者群体异质性，除了其他因素,确保在选择理想的手术治疗持续平衡。外科医生对融合或减压的偏好会影响手术治疗决策。同时,在介绍时，患者报告的结局指标（PROM）在女性和男性之间存在很大差异。这项研究的目的是根据患者报告的性别，确定减压和融合率与单纯减压率是否存在差异。并确定是否广泛接受的融合适应症证明任何观察到的差异是合理的，或者外科医生的偏好是否起作用。
方法：本研究是对加拿大脊柱预后研究网络（CSORN）DLS研究的患者进行的回顾性队列分析，一项多中心的加拿大前瞻性研究，研究DLS的手术管理和结果。减压和融合率，患者特征,术前PROM，在倾向评分匹配之前和之后，比较了男性和女性之间的放射学指标。
结果：在不匹配的队列中，女性患者比男性患者更有可能接受减压和融合治疗.女性更有可能有公认的融合适应症，包括后凸盘角度，较高的脊椎滑脱等级和滑脱百分比，和患者报告的背痛。与融合决定相关的其他影像学发现，包括小平面积液,多方面的分心，或刻面角度，在女性中并不普遍。在人口统计和影像学特征的倾向得分匹配后，男性和女性患者的比例相似，接受减压，融合和单纯减压。
结论：尽管尚不清楚谁应该或不应该进行融合，除了DLS的手术减压，女性患者的融合率高于男性患者。在匹配表明融合的基线射线照相因素后，这项分析表明，融合的决定没有性别差异的偏见。相反，接受融合的女性比例较高主要是由融合的影像学和临床适应症解释的，表明这种情况的具体临床和解剖学特征确实在性别之间有所不同。
方法：本研究是对加拿大脊柱预后研究网络（CSORN）DLS研究的患者进行的回顾性队列分析，一项多中心的加拿大前瞻性研究，研究DLS的手术管理和结果。减压和融合率，患者特征,术前PROM，在倾向评分匹配之前和之后，比较了男性和女性之间的放射学指标。
结果：在不匹配的队列中，女性患者比男性患者更有可能接受减压和融合治疗.女性更有可能有公认的融合适应症，包括后凸盘角度，较高的脊椎滑脱等级和滑脱百分比，和患者报告的背痛。与融合决定相关的其他影像学发现，包括小平面积液,多方面的分心，或刻面角度，在女性中并不普遍。在人口统计和影像学特征的倾向得分匹配后，男性和女性患者的比例相似，接受减压，融合和单纯减压。
结论：尽管尚不清楚谁应该或不应该进行融合，除了DLS的手术减压，女性患者的融合率高于男性患者。在匹配表明融合的基线射线照相因素后，这项分析表明，融合的决定没有性别差异的偏见。相反，接受融合的女性比例较高主要是由融合的影像学和临床适应症解释的，表明这种情况的具体临床和解剖学特征确实在性别之间有所不同。
