目的:评估年龄≥75岁患者腰椎融合术后下肢持续麻木的术前和围手术期预测因素。
方法:这项单中心回顾性研究检查了304名年龄≥75岁的腰椎退行性疾病患者(102名男性,202名妇女;平均年龄,79.2[75-90]年)。术前和术后2年检查腿部麻木的视觉模拟评分(VAS)评分。持续性腿部麻木组包括术后2年腿部麻木VAS评分≥5分的患者。还审查了人口统计数据。对单变量分析值p<0.2的变量进行多变量逐步逻辑回归分析。
结果:总计,71例患者(23.4%)经历了持续的术后腿部麻木。多因素logistic回归分析显示有腰椎减压史,症状持续时间较长,术前腿部麻木的VAS评分≥5分与腰椎融合术后更大的术后持续腿部麻木相关。相比之下,其他因素,比如性,身体质量指数,椎骨骨折,糖尿病,抑郁症,症状持续时间,硬脑膜损伤,手术时间,估计失血,不是。
结论:术前腰椎减压的病史,症状持续时间较长,术前较高的腿部麻木VAS评分是老年患者腰椎融合术后持续腿部麻木的术前预测因素。虽然腰椎融合有望改善腿部麻木,外科医生应该考虑手术史,持续时间,术前麻木强度和解释术后潜在的持续性腿麻木。
OBJECTIVE: To evaluate the preoperative and perioperative predictors of persistent leg numbness following lumbar fusion in patients aged ≥ 75 years.
METHODS: This single-center retrospective study examined 304 patients aged ≥ 75 years who underwent lumbar fusion for lumbar degenerative disease (102 men, 202 women; mean age, 79.2 [75-90] years). The visual analogue scale (VAS) score for leg numbness was examined preoperatively and at 2 years postoperatively. The persistent leg numbness group included patients with a 2-year postoperative VAS score for leg numbness ≥ 5 points. The demographic data were also reviewed. A multivariate stepwise logistic regression analysis was performed for variables with univariate analysis values of p < 0.2 on univariate analysis.
RESULTS: In total, 71 patients (23.4%) experienced persistent postoperative leg numbness. Multivariate logistic regression analysis revealed that a history of lumbar decompression, longer symptom duration, and a preoperative VAS score for leg numbness ≥ 5 points were associated with greater postoperative persistent leg numbness following lumbar fusion. In contrast, other factors, such as sex, body mass index, vertebral fracture, diabetes mellitus, depression, symptom duration, dural injury, operative time, and estimated blood loss, were not.
CONCLUSIONS: A history of preoperative lumbar decompression, longer symptom duration, and greater preoperative VAS scores for leg numbness were preoperative predictors of persistent postoperative leg numbness following lumbar fusion in older patients. Although lumbar fusion is expected to improve leg numbness, surgeons should consider the surgical history, duration, and preoperative numbness intensity and explain the potential postoperative persistent leg numbness in advance.