Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study

Abstract

Background: Waits for elective spine surgery are common in Canada. We examined whether a prolonged wait for surgery for lumbar degenerative spinal stenosis was detrimental to outcome. Methods:In this prospective observational study, we enrolled 166 consecutive patients referred to our centre for treatment of lumbar degenerative spinal stenosis between 2006 and 2010. Outcome measures were assessed at referral, preoperatively and until 24 months postoperatively. Primary outcome measures were the physical and mental component summary scores of the 36-Item ShortForm Health Survey and the Oswestry Disability Index. Secondary outcome measures included the symptom severity scale of the Zurich Claudication Questionnaire, a numeric rating scale for back and leg pain, and patient satisfaction with treatment. Wait time was defined as the time from referral to surgery. Results:The follow-up rate at 2 years was 85%. The median wait time was 349 days. All health-related quality of life measures deteriorated during the waiting period, but there was no significant correlation between wait time and magnitude of the change in outcome measure. At 6 months postoperatively, the Pearson correlation was significantly positive between wait time and change in disability (r = 0.223), Zurich Claudication Questionnaire score (r = 0.2) and leg pain score (r = 0.221). At 12 months, the correlation remained significant for change in disability (r = 0.205) and was significant for change in mental well-being (r = -0.224). At 12 months, patients with a shorter wait (≤ 12 months) showed greater improvement in mental well-being (mean difference in change [and 95% confidence interval (CI)] 5.7 [1.4-9.9]) and decrease in disability ) and leg pain ). There were no statistically significant differences in outcome or patient satisfaction with treatment between those with shorter and longer waits at 24 months.Interpretation: Patients awaiting spinal surgery experienced deterioration in health-related quality of life irrespective of the length of wait time. However, longer waits were associated with a delay in recovery during the first year after surgery. Abstract Research CMAJ OPEN E186CMAJ OPEN, 4(2)

The Effect of Symptom Duration on Outcomes After Fusion for Degenerative Spondylolisthesis

“…More recent research sought to determine if the wait time to surgery for patients with degenerative spine conditions affected short- and medium-term clinical outcomes. 7,8 Braybrooke et al 8 examined if time spent on a Canadian wait list for surgery effected the outcome for lumbar spinal disease. A component of this study was based on the time between symptom onset and surgery.…”

“…These time frames were selected in order for the current study to be comparable to previously published literature. Prior studies used similar time frames, 5-9 with a majority using the cutoffs used in the SPORT trials. 2,3,9 An additional time frame of 1 to 2 years was added to the current study in order to increase the increase the sensitivity.…”

“…However, the effect of symptom duration on surgical outcomes after decompression and fusion for degenerative lumbar spondylolisthesis has been debated, as prior studies have shown conflicting results. 7 -9…”

Response to Surgical Triage in an Evolving Pandemic Based on Disease Classification and Predictive Modeling

“…5 Whereas the decision to proceed with surgical care for those patients with acute neurological injury such as cervical myelopathy or metastatic epidural spinal cord compression may be clear, measuring this impact in other spinal pathologies such as lumbar stenosis is far more difficult to interpret. 19 This presents the spine surgeon with a situation of significant moral hazard as they feel pressure to advocate for their own patients. Formal structured and objective guidelines that are highly responsive are required to resolve these difficult conflicts and ethical dilemmas.…”

Feasibility of conducting an active exercise prehabilitation program in patients awaiting spinal stenosis surgery: a randomized pilot study

“…cataract, hip and knee), which account for less than 50% of performed elective surgeries, the wait for elective surgery is estimated to be longer in Canada than other developed worldwide countries 4 . As such, despite being one of the most frequent degenerative conditions in older-aged patients 5 and the main reason for undergoing surgery in adults aged over 65 6 , waiting time for lumbar spinal stenosis (LSS) surgery reaches a median of 140 days from initial consultation with a spine surgeon up to a median of 349 days from primary care physician referral 7 .…”