The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study
| Autor: | Clemens Weber, Øystein P. Nygaard, Tore Solberg, Asgeir Store Jakola, Ulf S. Nerland, Ole Solheim, Charalampis Giannadakis, Sasha Gulati |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Quality of life
Male Reoperation medicine.medical_specialty Aging Spinal stenosis Clinical Neurology Risk Assessment Cohort Studies Disability Evaluation Lumbar Spinal Stenosis medicine Humans Prospective Studies Registries Aged Lumbar Vertebrae business.industry Minimal clinically important difference Smoking Lumbar spinal stenosis Odds ratio Middle Aged medicine.disease Decompression Surgical Prognosis Confidence interval Oswestry Disability Index Surgery Spinal Fusion Treatment Outcome Female Spondylosis Neurology (clinical) business Follow-Up Studies |
| Zdroj: | World neurosurgery. 84(4) |
| ISSN: | 1878-8769 |
| Popis: | Objective To investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis. Methods Prospectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up. Results There were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00–1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42–3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07–2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02–1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18–3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19–3.53, P = 0.009). Conclusions Overall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect