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Short- and long-term outcome of microscopic lumbar spine surgery in patients with predominant back or predominant leg pain


Stienen, Martin N; Joswig, Holger; Smoll, Nicolas R; Corniola, Marco V; Schaller, Karl; Hildebrandt, Gerhard; Gautschi, Oliver P (2016). Short- and long-term outcome of microscopic lumbar spine surgery in patients with predominant back or predominant leg pain. World Neurosurgery, 93:458-465.

Abstract

OBJECTIVE This study assessed whether predominant back pain (pBP) represents a negative outcome predictor in patients undergoing microscopic spine surgery without fusion for a lumbar disc herniation (LDH) or spinal stenosis (LSS).
METHODS Retrospective analysis of prospectively collected data on consecutive patients with LDH or LSS at 2 centers. Patients with visual analog scale (VAS) back pain ≥VAS leg pain were assigned to the pBP group, and compared with patients with predominant VAS leg pain (pLP). Outcome measures included the Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), health-related quality of life measures, Short-Form (SF)-12 Physical Component Summary (PCS), and EuroQol (EQ-5D) index at 3 days, 6 weeks (W6), 6 months, and 1 year postoperatively.
RESULTS A total of 325 patients (154 [47.4%] with pBP and 171 [52.6%] with pLP) were included. Patients with pBP were about 6 years older and more often had LSS. There was no significant difference between the group means of the RMDI, ODI, SF-12 PCS, or EQ-5D at any postoperative time point. The most improvement was observed until the W6 follow-up with little or no improvement thereafter up to 1 year postoperatively. Patients with pBP were as likely as patients with pLP to be W6 responders on the RMDI (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.38-2.16; P = 0.831), ODI (OR, 1.00; 95% CI 0.52-1.92; P = 0.996), SF-12 PCS (OR, 1.09; 95% CI 0.58-2.04; P = 0.791), and EQ-5D (OR, 0.62; 95% CI 0.32-1.21; P = 0.164). Disease-specific subgroup analyses confirmed the results.
CONCLUSIONS The present data suggest that patients with pBP have comparable functional and health-related quality of life outcomes after surgery for LDH or LSS with those of patients with pLP.

Abstract

OBJECTIVE This study assessed whether predominant back pain (pBP) represents a negative outcome predictor in patients undergoing microscopic spine surgery without fusion for a lumbar disc herniation (LDH) or spinal stenosis (LSS).
METHODS Retrospective analysis of prospectively collected data on consecutive patients with LDH or LSS at 2 centers. Patients with visual analog scale (VAS) back pain ≥VAS leg pain were assigned to the pBP group, and compared with patients with predominant VAS leg pain (pLP). Outcome measures included the Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), health-related quality of life measures, Short-Form (SF)-12 Physical Component Summary (PCS), and EuroQol (EQ-5D) index at 3 days, 6 weeks (W6), 6 months, and 1 year postoperatively.
RESULTS A total of 325 patients (154 [47.4%] with pBP and 171 [52.6%] with pLP) were included. Patients with pBP were about 6 years older and more often had LSS. There was no significant difference between the group means of the RMDI, ODI, SF-12 PCS, or EQ-5D at any postoperative time point. The most improvement was observed until the W6 follow-up with little or no improvement thereafter up to 1 year postoperatively. Patients with pBP were as likely as patients with pLP to be W6 responders on the RMDI (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.38-2.16; P = 0.831), ODI (OR, 1.00; 95% CI 0.52-1.92; P = 0.996), SF-12 PCS (OR, 1.09; 95% CI 0.58-2.04; P = 0.791), and EQ-5D (OR, 0.62; 95% CI 0.32-1.21; P = 0.164). Disease-specific subgroup analyses confirmed the results.
CONCLUSIONS The present data suggest that patients with pBP have comparable functional and health-related quality of life outcomes after surgery for LDH or LSS with those of patients with pLP.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:September 2016
Deposited On:31 Jan 2017 14:28
Last Modified:28 Mar 2017 10:27
Publisher:Elsevier
ISSN:1878-8750
Publisher DOI:https://doi.org/10.1016/j.wneu.2016.06.120
PubMed ID:27389938

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