Influence of comorbidities on patients reported outcomes in degenerative lumbar spinal stenosis

Ferrero, Emmanuelle; Lonjon, Guillaume; Bouyer, Benjamin; Sabourin, M.; Ould-Slimane, Mourad; Guigui, P.

doi:10.1016/j.otsr.2018.07.012

Cited by 12 publications

(15 citation statements)

References 29 publications

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“…Questionnaires at baseline/follow-up Age ≥70 years, isolated LSS undergoing conventional decompression laminectomy Radiological signs of instability (spondylolisthesis) considered for fusion procedure Surgery (decompression) 12 101 (50) 75.3 Guigui P et al, 2002, [87] 24 Single center prospective observational study Orthopedic/Surgery Unit, Beaujon Hospital, Clichy, France. Follow-up visits at 3, 6, 12 months Patients undergoing surgery for LSS at hospital of Beaujon from 1998 to 2000 Patients with a deviation of the spine (>20°) in the frontal or sagittal plane Surgery (decompression, and/or fusion) 12 306 (55) 60 (range 22-90) Ferrero E et al, 2018, [88] 25 Single center prospective observational study Department of orthopedic surgery, Hôpital européen Georges-Pompidou, Paris, France. Questionnaires at follow-up LSS diagnosis based on clinical and imaging studies (CT/MRI; ≥1 level(s) narrowing of the central spinal canal (area <100mm2), a foraminal diameter or lateral recess diameter <3mm); neurogenic claudication and/or signs of chronic neurogenic compression Previous spinal surgery; coronal Cobb angle ≥10°; other disease causing polyneuropathy; LSS secondary to tumor or infection; language limitations Unspecified surgery 12 250 (57) 65.6 (12) Papavero L et al, 2009, [89] 26 Single center prospective observational study Spine Surgery Center, Eilbek Medical Center, Hamburg, Germany.…”

Section: Resultsmentioning

confidence: 99%

“…Spearman correlation (r=0.33) with "able to walk 1 mile" 4.1 [27] Univariate: no association between <5 comorbidities and good improvement in disability (>30% ODI improvement) at 2 years 21.1 [40] Higher Cumulative Illness Rating Scale (CIRS, 0-52 or 0-56) associated with poor functional outcome (less Self-administered Beaujon Questionnaire score (SABQ, range 0-100)) at 1 year: adj. beta -0.94 (p=0.001) 25 [88] Univariate, associated diseases: no association with failed clinical improvement (ODI <15% improvement) at a mean of 2.64 years 38 [94] Log. regression, higher American Society of Anesthesiology (ASA, range 1-6) score (dichotomous: ASA 1 and 2 versus (vs.) ASA 3 and 4): no association with less improvement in disability (ODI) at 1 year 23 [24] Univariate, Charlson Comorbidity Index (CCI, 0-3+) >1: no association with less disability (ODI) improvement at mean 5.1 years 37 [45] Age Older age associated with more disability (ODI) at 1 year: adj.…”

Section: Predictors Of Outcomesmentioning

confidence: 99%

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The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

Bays

Stieger

Held

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS. Methods:We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥ 3 studies for the same subgroup and outcome was required for meta-analysis.Results: Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, 2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, 2 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age > 80 years RR 1.22, 95% CI 0.98 to 1.52, 2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, 2 58%). Conclusion:In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction.

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Section: Resultsmentioning

confidence: 99%

Section: Predictors Of Outcomesmentioning

confidence: 99%

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

Bays

Stieger

Held

et al. 2021

North American Spine Society Journal (NASSJ)

View full text Add to dashboard Cite

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“…The sample size (n) was determined using the following formula: n = ([Zα/2+Zβ] 2 *2*σ 2 )/d. 2 Taking critical value Zα/2 as 1.96, and Zβ as 0.84 and to detect hypothesized difference of 1.5 between the two groups (variants = 4.45), significant with 95% confidence interval and power of 80%, the required sample size was 32 patients in each group. 9…”

Section: Sample Sizementioning

confidence: 99%

“…1 However, due to age-related comorbidities, it becomes difficult for elderly patients afflicted with DLSS to immediately go for operative treatment. 2,3 Various conservative treatment modalities are being used to alleviate the symptoms of lumbosacral radiculopathy in patients with DLSS. Many elderly patients find conservative therapy appropriate, as it minimizes invasive intervention and decreases the risks of morbidity.…”

Section: Introductionmentioning

confidence: 99%

Role of Epidural Steroid Injection in Lumbar Spinal Stenosis—A Randomized Controlled Trial

Srivastava

Gupta

Mishra

et al. 2020

Indian Journal of Neurosurgery

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Background Degenerative lumbar spinal stenosis (DLSS) is an important cause of pain and disability among the elderly and common indication for spinal surgery. However, due to age-related comorbidities, it becomes difficult for elderly patients of DLSS to immediately go for operative treatment. Caudal epidural steroid injection (CESI) can be an effective procedure for a selected group of patients who have chronic function-limiting lower back and lower extremity pain secondary to DLSS. The aim of this study was to compare the effects of CESI with physical therapy in patients afflicted with DLSS. Materials and Methods It is a single center, open-label randomized controlled trial conducted in department of Physical Medicine and Rehabilitation at a tertiary care center of northern India from January 2016 to August 2017 among DLSS patients. Trial was registered under the clinical trial registry of India. Patients were randomized in two groups–32 in intervention group A (CESI with local anesthetic and physical therapy) and 32 in control group B (physical therapy alone). Outcome measures were numerical pain rating scale (NPRS), Oswestry disability index (ODI), and mean claudication distance (MCD) at 3, 6, 12, and 24 weeks. Results NPRS and ODI showed significant improvement at 3, 6, 12, and 24 weeks (group A >> group B). Improvement in MCD was seen at each follow-up from baseline (group A >> group B). Conclusion Caudal epidural steroid administration can ameliorate pain, disability and claudication distance in DLSS patients, which provides them a window period for further definitive management.

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“…LSS can also coexist with other musculoskeletal conditions, including OA [ 26 , 27 ]. One study found a mean of two comorbidities (less than 20% reported no comorbidities) in LSS patients, with lower limb arthrosis included among the most common comorbidities [ 28 ]. Hip-spine syndrome has been described in the literature to define coexisting hip and lumbar spine disorders and was originally developed to describe concomitant degenerative spine and hip disease [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of multimorbid degenerative lumbar spinal stenosis with knee and/or hip osteoarthritis: protocol for a systematic review and meta-analysis

et al. 2020

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Background Lumbar spinal stenosis (LSS) and knee and hip osteoarthritis (OA) are prevalent conditions in the aging population and published literature suggests they share many symptoms and often are present at the same time in patients. However, no prevalence estimates of multimorbid LSS and knee and/or hip OA are currently available. The primary objective of this systematic review is therefore to estimate the prevalence of multimorbid LSS with knee and/or hip OA using radiological, clinical, and combined case definitions. Methods This systematic review protocol has been designed according to the guidelines from the Cochrane Collaboration and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A comprehensive search will be performed in the following databases: MEDLINE, EMBASE, CENTRAL, and CINAHL. Forward citation tracking will be performed in Web of Science. No restriction for publication date and language will be applied in the literature search, but only articles in English will be included. The search strategy will include the following domains: LSS, knee OA, and hip OA. Retrieved citations will be screened by two authors independently. Disagreements will be discussed until consensus, and a third reviewer will be consulted if consensus cannot be reached. Data extraction and assessment of risk of bias assessment will be done by two authors independently, using a standardized data extraction form and a modified risk of bias tool for prevalence studies. Meta-analysis estimating prevalence with 95% CI will be performed using a random effects model. Meta-regression analyses will be performed to investigate the impact of the following covariates: LSS clinical presentations, sample population, healthcare setting, risk of bias, and other patient characteristics on prevalence estimates for multimorbid LSS and knee and/or hip OA. Discussion The results of this review will provide the first estimates of the prevalence of multimorbid LSS and hip and knee OA based on various case definitions. The impact of covariates such as LSS clinical presentations, sample population, healthcare setting, risk of bias, and patient characteristics on prevalence estimates will also be presented. Systematic review registration PROSPERO, awaiting registration

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Influence of comorbidities on patients reported outcomes in degenerative lumbar spinal stenosis

Cited by 12 publications

References 29 publications

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

Role of Epidural Steroid Injection in Lumbar Spinal Stenosis—A Randomized Controlled Trial

Prevalence of multimorbid degenerative lumbar spinal stenosis with knee and/or hip osteoarthritis: protocol for a systematic review and meta-analysis

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