背景:Oswestry残疾指数(ODI),是一种广泛使用的患者报告的结果指标(PROM),用于评估腰椎病理患者的功能状态。外科医生使用ODI来确定初始状态并监测手术后的进展。编译的ODI数据使得能够在不同手术技术之间进行比较。退行性腰椎滑脱(DLS)通常会引起诸如背痛和神经源性跛行等症状,从而影响ODI捕获的生活质量和日常生活活动。尽管对脊柱手术后的ODI变化进行了广泛的研究,对不同ODI小节的特征和变化知之甚少。
目的:分析择期腰椎手术2年后总ODI和ODI分节的基线特征和变化。
方法:回顾性分析2016-2018年前瞻性纳入的退行性腰椎滑脱症脊柱手术患者。术前和术后2年评估ODI。
方法:本研究共纳入265例患者,60%是女性。患者平均年龄为67±8岁,平均BMI为30±6kg/m2。
方法:分析考虑了手术前后ODI评分的差异,以及DLS选择性腰椎手术2年后所有ODI小节的变化。
方法:分析评估了ODI评分的差异和不同小节的差异。在2年时没有ODI随访的患者被排除在研究之外。该研究对所有配对前-后样品使用Wilcoxon签名秩检验。Wilcoxon秩和检验用于总体ODI和ODI分段分析的性别和程序比较。以年龄和BMI为自变量,对总体和小节特定的ODI结果应用单变量线性回归。分别。统计学显著性水平设定为p<0.05。
结果:在242例患者(91%)中观察到ODI的改善。关于疼痛强度的问题发现了最高的基线残疾值(3.4±1.3),提升(3.2±1.9),站立(3.4±1.3)。术前功能限制最低者为睡眠(1.6±1.3),个人护理(1.6±1.4),旅行(1.6±1.2)和坐(1.5±1.4)。在2年的随访中,所有问题和总ODI均有显著改善(均p<0.001).显示出最大绝对改善的ODI小节是疼痛程度的变化(-2.6),89%的患者经历了改善,站立(-2.4),87%的患者经历改善,和疼痛强度(-2.1),81%的患者经历改善。改进最小的小节是个人护理(-0.6),坐(-0.7),和睡眠(-0.9)。研究发现,与男性患者相比,女性患者在各个小节中的术前残疾明显更高,但总ODI改善更大(p=0.001)。此外,坐姿改善(p<0.001),旅行(p<0.001),女性患者的社交生活(p<0.001)和睡眠(p=0.018)明显高于女性患者。老年患者在坐姿(p=0.005)和睡眠(p=0.002)方面的改善明显较少。在各个小节中,较高的BMI与疼痛变化程度的改善(p=0.025)和较高的基线残疾显着相关。与仅接受减压的患者相比,接受减压和融合的患者在几个小节中的基线残疾明显更高。在ODI的总体改善和小节的改善方面,单独减压和融合减压之间没有显着差异。
结论:这些结果为ODI及其在不同小节中的变化提供了更全面的理解。这种洞察力对于改善术前教育和有效管理患者对特定区域潜在术后残疾的期望非常宝贵。
BACKGROUND: The Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections.
OBJECTIVE: To analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery.
METHODS: Retrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively.
METHODS: A total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67 ± 8 years, and the mean BMI was 30 ± 6 kg/m2.
METHODS: The analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS.
METHODS: The analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all pre-post paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p<0.05.
RESULTS: Improvement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4 ± 1.3), lifting (3.2 ± 1.9), and standing (3.4 ± 1.3). The lowest preoperative functional limitations were observed in sleeping (1.6 ± 1.3), personal care (1.6 ± 1.4), traveling (1.6 ± 1.2) and sitting (1.5 ± 1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p<0.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (-2.6), with 89% of patients experiencing improvement, standing (-2.4) with 87% of patients experiencing improvement, and pain intensity (-2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were personal care (-0.6), sitting (-0.7), and sleeping (-0.9). The study found that female patients had a significantly higher preoperative disability in various subsections but showed greater improvement in total ODI compared to male patients (p=0.001). Additionally, improvement in sitting (p<0.001), traveling (p<0.001), social life (p<0.001) and sleeping (p=0.018) were significantly higher in female patients. Older patients showed significantly less improvement in sitting (p=0.005) and sleeping (p=0.002). A higher BMI was significantly associated with less improvement in changing degree of pain (p=0.025) and higher baseline disability in various subsections. Patients who underwent decompression and fusion had significantly higher baseline disability in several subsections compared to those who underwent decompression alone. There was no significant difference between decompression alone and decompression with fusion in terms of overall improvement in the ODI and improvement in the subsections.
CONCLUSIONS: These results offer a more comprehensive understanding of ODI and its changes across different subsections. This insight is invaluable for improving preoperative education and effectively managing patient expectations regarding potential post-surgery disability in specific areas.