Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis
| Autor: | Niels Wedderkopp, Neil Manson, Michael Johnson, Hamilton Hall, Charles G. Fisher, Najmedden Attabib, W Bradley Jacobs, Kenneth Thomas, Andrew Nataraj, Mariah A. Darling, Peter Jarzem, Y. Raja Rampersaud, Jeffrey J. Hebert, Jerome Paquet, Eden Richardson, Eugene K. Wai, Alexandra Stratton, Parham Rasoulinejad, Edward Abraham, Erin Bigney, Henry Ahn |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
spinal surgery Epidemiology Neurosurgical Procedures Postoperative Complications Spinal Stenosis 0302 clinical medicine Quality of life Back pain pain Orthopedics and Sports Medicine Longitudinal Studies Prospective Studies Prospective cohort study Depression (differential diagnoses) Pain Measurement Aged 80 and over 030222 orthopedics Lumbar Vertebrae disease course Middle Aged Prognosis Chiropractic Oswestry Disability Index Treatment Outcome Female Neurosurgery medicine.symptom Adult medicine.medical_specialty 03 medical and health sciences Preoperative Care medicine trajectories Humans Disabled Persons Aged business.industry prognostic factors prediction Surgery disability Back Pain Orthopedic surgery Quality of Life Neurology (clinical) business 030217 neurology & neurosurgery patient selection Follow-Up Studies |
| Zdroj: | Hebert, J J, Abraham, E, Wedderkopp, N, Bigney, E, Richardson, E, Darling, M, Hall, H, Fisher, C G, Rampersaud, Y R, Thomas, K C, Jacobs, W B, Johnson, M, Paquet, J, Attabib, N, Jarzem, P, Wai, E K, Rasoulinejad, P, Ahn, H, Nataraj, A, Stratton, A & Manson, N 2020, ' Preoperative Factors Predict Postoperative Trajectories of Pain and Disability Following Surgery for Degenerative Lumbar Spinal Stenosis ', Spine, vol. 45, no. 21, pp. E1421-E1430 . https://doi.org/10.1097/BRS.0000000000003587 Spine |
| Popis: | We investigated for potential predictors of outcome following degenerative lumbar spinal stenosis surgery. In this longitudinal study of 529 patients, approximately one in three patients experienced a poor clinical outcome. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. Study Design. Longitudinal analysis of prospectively collected data. Objective. Investigate potential predictors of poor outcome following surgery for degenerative lumbar spinal stenosis (LSS). Summary of Background Data. LSS is the most common reason for an older person to undergo spinal surgery, yet little information is available to inform patient selection. Methods. We recruited LSS surgical candidates from 13 orthopedic and neurological surgery centers. Potential outcome predictors included demographic, health, clinical, and surgery-related variables. Outcome measures were leg and back numeric pain rating scales and Oswestry disability index scores obtained before surgery and after 3, 12, and 24 postoperative months. We classified surgical outcomes based on trajectories of leg pain and a composite measure of overall outcome (leg pain, back pain, and disability). Results. Data from 529 patients (mean [SD] age = 66.5 [9.1] yrs; 46% female) were included. In total, 36.1% and 27.6% of patients were classified as experiencing a poor leg pain outcome and overall outcome, respectively. For both outcomes, patients receiving compensation or with depression/depression risk were more likely, and patients participating in regular exercise were less likely to have poor outcomes. Lower health-related quality of life, previous spine surgery, and preoperative anticonvulsant medication use were associated with poor leg pain outcome. Patients with ASA scores more than two, greater preoperative disability, and longer pain duration or surgical waits were more likely to have a poor overall outcome. Patients who received preoperative chiropractic or physiotherapy treatment were less likely to report a poor overall outcome. Multivariable models demonstrated poor-to acceptable (leg pain) and excellent (overall outcome) discrimination. Conclusion. Approximately one in three patients with LSS experience a poor clinical outcome consistent with surgical non-response. Demographic, health, and clinical factors were more predictive of clinical outcome than surgery-related factors. These predictors may assist surgeons with patient selection and inform shared decision-making for patients with symptomatic LSS. Level of Evidence: 2 |
| Databáze: | OpenAIRE |
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