Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results

Khan, Jannat M.; Harada, Garrett K.; Basques, Bryce A.; Nolte, Michael T.; Louie, Philip K.; Iloanya, Michael; Tchalukov, Konstantin; Berkowitz, Mark; Derman, Peter B.; Colman, Matthew W.

doi:10.1016/j.spinee.2019.09.021

Cited by 11 publications

(22 citation statements)

References 25 publications

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“…Previous studies have suggested that predominant LP was associated with better outcomes after surgery for spinal stenosis and degenerative spondylolisthesis, 4,6,7,[13][14][15] while others did not find an association. 5,17 Carreon et al 17 reported that PCS and ODI improvement were not associated with BPP, age, BMI and smoking. In contrast, Kleinstuck et al 4 analyzed the Spine Tango registry and reported that BPP patients had lower likelihood of a "good" outcome, and the magnitude of difference between LP and BP was the strongest predictor of 12-month outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Although past studies have shown that patients presenting with predominant BP had inferior results after surgery for lumbar disk herniation 3 and other degenerative disorders, 4 recent ones have questioned this belief. 5 Existing studies have also been conducted in the context of varying diagnoses 4 and treatment options, such as nonsurgical versus surgical treatment 6 or decompression-only versus fusion surgery, 7 thus introducing a degree of diagnostic and surgical heterogeneity that may account for the variability in results. As such, the isolated impact of a patient's preoperative pain pattern on the outcomes of surgery remains unclear.…”

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confidence: 99%

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Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis?

Goh

Yue

Guo

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Retrospective review of prospectively collected data.Objective: The objective of this study was to determine how different combinations of preoperative back pain (BP) and leg pain (LP) may influence functional outcomes, patient satisfaction and return to work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative spondylolisthesis.Summary of Background Data: Surgical decision-making is often based on the traditional assumption that the predominance of lower extremity symptoms is a stronger indication for lumbar spine surgery. Surprisingly, there is a paucity of literature supporting this notion and the isolated impact of the preoperative pattern of pain on outcome remains unclear.Methods: Prospectively collected data for patients who underwent primary MIS-TLIF for degenerative spondylolisthesis were reviewed. Patients were categorized into 3 groups depending on predominant pain location: LP predominant (LP > BP), back pain predominant [(BPP); BP > LP] and equal pain predominance (BP = LP). Patients were prospectively followed for at least 2 years.Results: In total, 781 patients were included: 33.4% LP predominant, 28.7% BPP and 37.9% equal pain predominance cases. The BPP group was significantly younger (P = 0.005) and showed a trend towards poorer baseline Short-Form-36 Mental Component Summary (P = 0.069). After adjusting for baseline differences, there was no significant difference in BP, LP, Oswestry Disability Index (ODI), SF-36 Physical Component Summary, and SF-36 Mental Component Summary between the 3 groups at all time points (P > 0.05) except for poorer 1-month ODI in the BPP group (P = 0.010). The rate of minimal clinically important difference attainment for ODI and SF-36 Physical Component Summary, satisfaction, expectation fulfilment and RTW were also similar (P > 0.05). Conclusions:The functional outcomes, quality of life and satisfaction after MIS-TLIF were similar, regardless of the predominant pain location. Equal proportions of patients achieved the minimal clinically important difference and RTW. In the context of proper indications, these results suggest that MIS-TLIF can be equally effective for patients with varying combinations of BP or LP.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis?

Goh

Yue

Guo

et al. 2021

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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“…In addition, the satisfaction rates with the surgical outcome is low in this group of patients. Using a somewhat different criteria for MICD, Khan et al 11 reported 50% of the patients achieving MICD for ODI, 57% for back pain and 49% for leg pain. In that study, 57% of the patients with prominent leg pain achieved MICD, which stands in contrast to our study of patients with mild leg pain where 43% reach MICD in terms of ODI.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Although the main indication for surgery in LSS is well established, studies have shown patients scheduled for LSS surgery to have heterogenous pain profiles with significant burden of back pain that may influence the outcome of surgery. 5 , 7 , 9 - 12 Previous outcome studies have mainly focused on the burden of back pain in surgery for spinal stenosis and have not explored the outcome in patients without significant leg pain. 5 , 7 , 9 - 14 Understandably, patients with leg pain below the minimally important clinical difference (MICD) lack the potential to reach significant clinical improvements in terms of leg pain.…”

Section: Introductionmentioning

confidence: 99%

“… 5 , 7 , 9 - 12 Previous outcome studies have mainly focused on the burden of back pain in surgery for spinal stenosis and have not explored the outcome in patients without significant leg pain. 5 , 7 , 9 - 14 Understandably, patients with leg pain below the minimally important clinical difference (MICD) lack the potential to reach significant clinical improvements in terms of leg pain. 15 The main objective of this study, from the Swedish Spine Register (SweSpine) was to analyze the outcome of surgery in patients with mild leg pain levels.…”

Section: Introductionmentioning

confidence: 99%

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Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

Sigmundsson

Møller

Strömqvist

2020

Global Spine Journal

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Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

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Axial Neck and Back Pain

Zampini

2021

Principles of Orthopedic Practice for Primary Care Providers

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Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results

Cited by 11 publications

References 25 publications

Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis?

Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis?

Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

Axial Neck and Back Pain

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