Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

Javid, Manucher J.; Hadar, Eldad

doi:10.3171/jns.1998.89.1.0001

Cited by 128 publications

(40 citation statements)

References 32 publications

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“…The cumulative change in ODI during 4 years (area under the curve) also showed a significant difference between centers, with the other 2 functional outcome indices (SF-36 scores) trending toward significance. These results are in accordance with this literature, which has suggested that there is considerable variation in the proportion of individuals reporting long-term benefit from surgical treatment of SPS and DS 11,17,19,34–36. Of note, a meta-analysis demonstrated considerable variation in reported success rates among several single-institution studies 37…”

Section: Discussionsupporting

confidence: 90%

“…Several studies have investigated the outcomes after surgery for SPS and DS, and they have attributed its variable success to multiple factors 10,11,15,16,35. Factors such as age, sex, smoking, low socioeconomic status, working or disability status, regular exercise, and disease level and type have been investigated 10,11,15,35.…”

Section: Discussionmentioning

confidence: 99%

“…A certain proportion of these patients will, however, remain symptomatic and then may require further operative management. Poor outcomes after surgery have been attributed to several factors, including misdiagnosis, surgical technique failure, new pathology, untreated instability, facet syndrome, and adjacent level disease 10,11. The literature examining these factors is largely based on single-institution studies, therefore, the effect on outcomes of different centers has not been studied.…”

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confidence: 99%

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Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial

Desai¹,

Bekelis²,

Ball³

et al. 2013

Spine

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Study Design Retrospective review of a prospectively collected database. Objective To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers. Summary of Background Data Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated. Methods Spine patient outcomes research trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed. Results A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (SF-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with SF-36 scores trending toward significance. Conclusion There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures, although further studies are required to investigate which center characteristics are most important. In this retrospective study, outcome variation after surgery for spinal stenosis and degenerative spondylolisthesis among centers participating in the spine patient outcomes research trial (SPORT) were analyzed. Significant variation, including the presence of outlier centers, was found. This suggests that the choice of center influences the outcome after these procedures, although further studies are required to ascertain which center characteristics may be most important.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial

Desai¹,

Bekelis²,

Ball³

et al. 2013

Spine

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“…Other studies on the results of back surgery reported that adequate pain relief was not achieved in up to 30% of patients receiving a single lumbar segment operation [6] and that only 34% of reoperation patients had successful outcomes (at least 50% sustained relief of pain and satisfaction with the results), showing high postsurgery pain occurrence rates [7]. There are also studies reporting the difficulties of reoperation with success rates falling to 15% following a third back operation and around 5% after the fourth [8].…”

Section: Introductionmentioning

confidence: 99%

Demographic Characteristics and Medical Service Use of Failed Back Surgery Syndrome Patients at an Integrated Treatment Hospital Focusing on Complementary and Alternative Medicine: A Retrospective Review of Electronic Medical Records

Choi

Hya

Kim

et al. 2014

Evidence-Based Complementary and Alternative Medicine

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Objective. To report the patient demographics and nonsurgical complementary and alternative medicine treatment used at a Korean medicine hospital for low back pain (LBP) and/or sciatica after surgery. Methods. Medical records of patients who visited a spine-specialized Korean medicine hospital at 2 separate sites for continuous or recurrent LBP or sciatica following back surgery were reviewed. The demographics, MRI and/or CT scans, and treatments were assessed. Results. Of the total 707 patients, 62% were male and the average age was 50.20 years. Ninety percent of patients presented with LBP and 67% with sciatica. Eighty-four percent were diagnosed with herniated nucleus pulposus at time of surgery. Of these patients, 70% had pain recurrence 6 months or later, but 19% experienced no relief or immediate aggravation of pain after surgery. Many patients selected traditional Korean medicine treatment as primary means of postsurgery care (47%). When time to pain recurrence was short or pain persisted after surgery, return of symptoms at the same disc level and side was frequent. Conclusion. An integrative treatment model focusing on Korean medicine and used in conjunction with radiological diagnostics and conventional medicine is currently used as a treatment option for patients with pain after lumbar spine surgery.

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“…6 7 Authoritative publications, mainly large case series and clinical trials, report that 10%-40% of all patients who undergo lumbar surgery develop some form of chronic PPP. [8][9][10][11][12][13][14][15][16] The wide range of estimates reported reflect varying clinical experiences of different institutions and the small samples of patients on which these estimates are based. In 2013, Thompson took a mid-range estimate of 20% failure applied to a rate of lumbar surgery in the UK population of 5 per 10 000 people and concluded that there are approximately 6000 new cases of PPP following spine surgery in the UK every year.…”

Section: Introductionmentioning

confidence: 99%

The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

Weir¹,

Samnaliev

Kuo³

et al. 2017

BMJ Open

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ObjectiveTo characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.DesignRetrospective, population-based cohort study.SettingClinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.ParticipantsPopulation-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD–HES.Primary and secondary outcomes measuresIncidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.ResultsThe rate of individuals undergoing lumbar surgery in the CPRD–HES linked data doubled over the 15-year study period, fiscal years 1997/1998 to 2011/2012, from 2.5 to 4.9 per 10 000 adults. Over the most recent 5-year period (2007/2008 to 2011/2012), on average 20.8% (95% CI 19.7% to 21.9%) of lumbar surgery patients met criteria for PPP. Rates of healthcare usage were significantly higher for patients with PPP across all types of care. Over 2 years following initial spine surgery, the mean cost difference between patients with and without PPP was £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), respectively. Extrapolated to the UK population, we estimate that nearly 5000 adults experience PPP after spine surgery annually, with each new cohort costing the UK National Health Service in excess of £70 million over the first 10 years alone.ConclusionsPersistent pain affects more than one-in-five lumbar surgery patients and accounts for substantial long-term healthcare costs. There is a need for formal, evidence-based guidelines for a coherent, coordinated management strategy for patients with continuing pain after lumbar surgery.

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Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

Abstract: In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

Cited by 128 publications

References 32 publications

Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial

Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial

Demographic Characteristics and Medical Service Use of Failed Back Surgery Syndrome Patients at an Integrated Treatment Hospital Focusing on Complementary and Alternative Medicine: A Retrospective Review of Electronic Medical Records

The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

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