The spine journal : official journal of the North American Spine Society · 2026
The association of operative versus nonoperative treatment for lumbar spondylolisthesis and stenosis with future metabolic conditions and allostatic burden: an emulated target trial.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ibrahim Muhammad Talal, Kuttner Nicolas, Schoenfeld Roman J, Alvarez Paul, Kavuri Venkat, Singh Varun Kumar, Schoenfeld Andrew J, Yu Elizabeth
Аннотация
BACKGROUND CONTEXT: Lumbar spinal stenosis adversely impacts mobility and function. Persistent lack of exercise and ambulatory capacity may contribute to the development of metabolic conditions.
PURPOSE: To determine the effect of surgical intervention, as compared to nonoperative treatment, on the development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).
STUDY DESIGN: Retrospective emulation target trial.
PATIENT SAMPLE: A total of 2,521,827 patients were included, of which 329,314 (13.1%) underwent surgery.
OUTCOME MEASURES: Development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).
METHODS: Data was sourced from EPIC COSMOS. We conducted a clone analysis using inverse probability censoring weights and inverse probability of treatment weights that accounted for confounders. Risk ratios (RR) were calculated at 1- and 3-years postindex diagnosis for post-operative metabolic burden and frailty, and at 1 and 2 years for active opioid prescription, using weighted pooled logistic regression. Generalized Estimating Equation was used to determine the mean difference in AL at 1 and 3 years.
RESULTS: Surgery within 12 months of index diagnosis demonstrated a significantly lower risk of metabolic burden (1-year RR [95% confidence interval (CI)]: 0.98 [0.98 to 0.98]; 3-year: 0.98 [0.98 to 0.98]) and frailty (1-year: 0.98 [0.98 to 0.99]; 3-year: 0.99 [0.98 to 0.99]). The risk of metabolic burden was lowest if surgery occurred within 6 months (1-year RR [95% CI]: 0.93 [0.93 to 0.94]; 3-year RR [95% CI]: 0.94 [0.94 to 0.95]). No significant difference in AL was noted at 1-year, and the difference was negligible at 3-years. The surgery cohort had a higher risk of active opioid prescription at 1-year (RR [95% CI]: 1.04 [1.04 to 1.04]) and 3-year (RR [95% CI]: 1.19 [1.17 to 1.20]) follow-up.
CONCLUSIONS: We found that surgical intervention was associated with greater reductions in metabolic burden and frailty up to 3 years following the procedure. We also found evidence of a time-dependent effect such that maximal benefit was appreciated when surgery was performed within 6-months of presentation.
PURPOSE: To determine the effect of surgical intervention, as compared to nonoperative treatment, on the development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).
STUDY DESIGN: Retrospective emulation target trial.
PATIENT SAMPLE: A total of 2,521,827 patients were included, of which 329,314 (13.1%) underwent surgery.
OUTCOME MEASURES: Development of metabolic conditions, chronic pain, frailty, and allostatic load (AL).
METHODS: Data was sourced from EPIC COSMOS. We conducted a clone analysis using inverse probability censoring weights and inverse probability of treatment weights that accounted for confounders. Risk ratios (RR) were calculated at 1- and 3-years postindex diagnosis for post-operative metabolic burden and frailty, and at 1 and 2 years for active opioid prescription, using weighted pooled logistic regression. Generalized Estimating Equation was used to determine the mean difference in AL at 1 and 3 years.
RESULTS: Surgery within 12 months of index diagnosis demonstrated a significantly lower risk of metabolic burden (1-year RR [95% confidence interval (CI)]: 0.98 [0.98 to 0.98]; 3-year: 0.98 [0.98 to 0.98]) and frailty (1-year: 0.98 [0.98 to 0.99]; 3-year: 0.99 [0.98 to 0.99]). The risk of metabolic burden was lowest if surgery occurred within 6 months (1-year RR [95% CI]: 0.93 [0.93 to 0.94]; 3-year RR [95% CI]: 0.94 [0.94 to 0.95]). No significant difference in AL was noted at 1-year, and the difference was negligible at 3-years. The surgery cohort had a higher risk of active opioid prescription at 1-year (RR [95% CI]: 1.04 [1.04 to 1.04]) and 3-year (RR [95% CI]: 1.19 [1.17 to 1.20]) follow-up.
CONCLUSIONS: We found that surgical intervention was associated with greater reductions in metabolic burden and frailty up to 3 years following the procedure. We also found evidence of a time-dependent effect such that maximal benefit was appreciated when surgery was performed within 6-months of presentation.