The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery

Braybrooke, Jason; Ahn, Henry; Gallant, Aimee; Ford, Michael; Bronstein, Yigel; Finkelstein, Joel; Yee, Albert

doi:10.1007/s00586-007-0452-5

Cited by 71 publications

(64 citation statements)

References 19 publications

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“…This indicates that the main therapeutic effect, clinically and with regard to the level of activity, appears to be achieved by decompressive surgery and occurs shortly after surgery. The present clinical results are similar to those of other studies investigating comparable patients [8,15,34,39].…”

Section: Discussionsupporting

confidence: 92%

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

et al. 2010

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Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and RolandMorris score were used to assess the patients' clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm 2 . The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.

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Section: Discussionsupporting

confidence: 92%

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

et al. 2010

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“…Despite poorer preoperative scores (which were controlled for in the postoperative analysis), patients with a shorter wait experienced greater improvements during the first year after surgery. Similarly, in 53 patients undergoing elective posterior lumbar surgery, Braybrooke and colleagues 11 reported that a longer wait was associated with less improvement in outcome following surgery. In a retrospective study of prospectively followed patients with spinal stenosis treated with both surgery and nonoperative care, Radcliff and colleagues 19 compared outcome between a patient cohort with symptom duration of 1 year or less versus a cohort with symptom duration greater than 1 year.…”

Section: Discussionmentioning

confidence: 94%

“…3,9,10 In Canada, the wait time for spinal procedures is long, with a perceived detrimental effect on outcome and satisfaction. 11 Furthermore, with the aging of the population in industrialized countries, wait times may become longer over time. The effect of these prolonged wait times on HRQoL and postoperative outcome for patients awaiting spinal stenosis is unknown.…”

mentioning

confidence: 99%

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

Cs¹,

Kr²,

Si³

et al. 2016

CMAJ Open

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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)

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“…The paper by Braybrooke et al [5] and the comments on the paper by Freeman [18] should both be carefully studied by the excessively cautious surgeon, or the therapist who persists in conservative treatment for overlong, for a disorder that has a surgical solution. The recommendation in the European Guidelines is that one should delay some 2 years before doing a fusion for back pain, is challenged by Cost [10].…”

Section: Back Painmentioning

confidence: 99%

A survey of the “surgical and research” articles in the European Spine Journal, 2007

Mulholland

2008

Eur Spine J

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Over the last couple of years the European Spine Journal has become truly international with papers from all over the world, and at the same time it has increased its size. Professor Mulholland has selected and reviewed some 40 papers from over 200 published in 2007 and that he felt were of particular interest to practicing surgeons and would influence their management of patients, or papers that challenged established beliefs. Papers dealing with back pain, spondylolyses, tumors, spinal stenosis, spinal infection, clinical examination, lumbar disc herniation, spinal fractures, etc. are reviewed and their significance assessed. The aim of the review is to encourage readers to read the papers themselves, hopefully stimulated by the trenchant comments of the reviewer, both critical and laudatory.

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The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery

Cited by 71 publications

References 19 publications

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

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

A survey of the “surgical and research” articles in the European Spine Journal, 2007

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