Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby
{"title":"腰椎管狭窄症患者减压手术后腰椎前凸的变化及与术后两年患者相关结果的关系。NORDSTEN椎管狭窄症试验的放射学和临床结果。","authors":"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby","doi":"10.1097/BRS.0000000000005037","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Objective: </strong>The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient-reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).</p><p><strong>Summary of background: </strong>Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.</p><p><strong>Materials and methods: </strong>Preoperative and postoperative data from 310 patients having standing x-ray both before and two years after surgery were included. The patients were grouped based on the change in LL preoperatively to two years after surgery; group 1: <5° (n=196), group 2: ≥5 <10° (n=55), or group 3: ≥10° (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry disability index (ODI), numeric rating scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the χ 2 test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs two years after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas, and Pfirrmann scores.</p><p><strong>Results: </strong>LL was significantly changed at group level two years after surgery with a mean difference of 2.2° (SD: 9.4°) ( P =0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5° in LL two years after surgery (group 2 and 3) had significantly greater improvements in ODI ( P =0.022) and ZCQ function ( P =0.016) in the adjusted analyses, but was not significant for back and leg pain.</p><p><strong>Conclusion: </strong>Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.</p><p><p>Level of Evidence. Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"40-45"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627310/pdf/","citationCount":"0","resultStr":"{\"title\":\"Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery: Radiologic and Clinical Results From the NORDSTEN Spinal Stenosis Trial.\",\"authors\":\"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby\",\"doi\":\"10.1097/BRS.0000000000005037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>A prospective cohort study.</p><p><strong>Objective: </strong>The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient-reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).</p><p><strong>Summary of background: </strong>Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.</p><p><strong>Materials and methods: </strong>Preoperative and postoperative data from 310 patients having standing x-ray both before and two years after surgery were included. The patients were grouped based on the change in LL preoperatively to two years after surgery; group 1: <5° (n=196), group 2: ≥5 <10° (n=55), or group 3: ≥10° (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry disability index (ODI), numeric rating scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the χ 2 test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs two years after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas, and Pfirrmann scores.</p><p><strong>Results: </strong>LL was significantly changed at group level two years after surgery with a mean difference of 2.2° (SD: 9.4°) ( P =0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5° in LL two years after surgery (group 2 and 3) had significantly greater improvements in ODI ( P =0.022) and ZCQ function ( P =0.016) in the adjusted analyses, but was not significant for back and leg pain.</p><p><strong>Conclusion: </strong>Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.</p><p><p>Level of Evidence. Level III.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"40-45\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627310/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005037\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005037","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/13 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery: Radiologic and Clinical Results From the NORDSTEN Spinal Stenosis Trial.
Study design: A prospective cohort study.
Objective: The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient-reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).
Summary of background: Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.
Materials and methods: Preoperative and postoperative data from 310 patients having standing x-ray both before and two years after surgery were included. The patients were grouped based on the change in LL preoperatively to two years after surgery; group 1: <5° (n=196), group 2: ≥5 <10° (n=55), or group 3: ≥10° (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry disability index (ODI), numeric rating scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the χ 2 test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs two years after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas, and Pfirrmann scores.
Results: LL was significantly changed at group level two years after surgery with a mean difference of 2.2° (SD: 9.4°) ( P =0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5° in LL two years after surgery (group 2 and 3) had significantly greater improvements in ODI ( P =0.022) and ZCQ function ( P =0.016) in the adjusted analyses, but was not significant for back and leg pain.
Conclusion: Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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