Abstract
As the average life expectancy of the population increases, surgical decompression of the lumbar spine is being performed with increasing frequency. It now constitutes the most common type of lumbar spinal surgery in older patients. The present prospective study examined the 5-year outcome of lumbar decompression surgery without fusion. The group comprised 159 patients undergoing decompression for degenerative spinal disorders who had been participants in a randomised controlled trial of post-operative rehabilitation that had shown no between-group differences at 2 years. Leg pain and back pain intensity (0–10 graphic rating scale), self-rated disability (Roland Morris), global outcome of surgery (5-point Likert scale) and re-operation rates were assessed 5 years post-operatively. Ten patients had died before the 5-year follow-up. Of the remaining 149 patients, 143 returned a 5-year follow-up (FU) questionnaire (effective return rate excluding deaths, 96%). Their mean age was 64 (SD 11) years and 92/143 (64%) were men. In the 5-year follow-up period, 34/143 patients (24%) underwent re-operation (17 further decompressions, 17 fusions and 1 intradural drainage/debridement). In patients who were not re-operated, leg pain decreased significantly (p < 0.05) from before surgery to 2 months FU, after which there was no significant change up to 5 years. Low back pain also decreased significantly by 2 months FU, but then showed a slight, but significant (p < 0.05), gradual increase of <1 point by 5-year FU. Disability decreased significantly from pre-operative to 2 months FU and showed a further significant decrease at 5 months FU. Thereafter, it remained stable up to the 5-year FU. Pain and disability scores recorded after 5 years showed a significant correlation with those at earlier follow-ups (r = 0.53–0.82; p < 0.05). Patients who were re-operated at some stage over the 5-year period showed significantly worse final outcomes for leg pain and disability (p < 0.05). In conclusion, pain and disability showed minimal change in the 5-year period after surgery, but the re-operation rate was relatively high. Re-operation resulted in worse final outcomes in terms of leg pain and disability. At the 5-year follow-up, the “average” patient experienced frequent, but relatively low levels of, pain and moderate disability. This knowledge on the long-term outcome should be incorporated into the pre-operative patient information process.
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Aalto T, Leinonen V, Herno A, Kroger H, Turunen V, Savolainen S, Airaksinen O (2009) Postoperative rehabilitation after spinal stenosis surgery—no effect on outcome in 2-year follow-up. International Society for the Study of the Lumbar Spine, Miami, FL
Adams N, Poole H, Richardson C (2006) Psychological approaches to chronic pain management: part 1. J Clin Nurs 15:290–300
Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F (2000) Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine 25:1424–1435
Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine 30:936–943
Bartlett C, Doyal L, Ebrahim S, Davey P, Bachmann M, Egger M, Dieppe P (2005) The causes and effects of socio-demographic exclusions from clinical trials. Health Technol Assess 9:iii–iv, ix–x, 1–152
Chung SG, Van Rey EM, Bai Z, Rogers MW, Roth EJ, Zhang LQ (2005) Aging-related neuromuscular changes characterized by tendon reflex system properties. Arch Phys Med Rehabil 86:318–327
Ciol MA, Deyo RA, Howell E, Kreif S (1996) An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285–290
Cornefjord M, Byrod G, Brisby H, Rydevik B (2000) A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis. Eur Spine J 9:563–570
Detwiler PW, Spetzler CB, Taylor SB, Crawford NR, Porter RW, Sonntag VK (2003) Biomechanical comparison of facet-sparing laminectomy and Christmas tree laminectomy. J Neurosurg 99:214–220
Dullerud R, Amundsen T, Lie H, Juel NG, Magnaes B (1995) CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy. Acta Radiol 36:613–619
Exner V, Keel P (2000) Erfassung der Behinderung bei Patienten mit chronischen Rückenschmerzen. Schmerz 14:392–400
Fujiwara A, Tamai K, An HS, Kurihashi T, Lim TH, Yoshida H, Saotome K (2000) The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 13:444–450
Goh KJ, Khalifa W, Anslow P, Cadoux-Hudson T, Donaghy M (2004) The clinical syndrome associated with lumbar spinal stenosis. Eur Neurol 52:242–249
Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15(Suppl 1):S17–S24
Hakkinen A, Ylinen J, Kautiainen H, Airaksinen O, Herno A, Kiviranta I (2003) Does the outcome 2 months after lumbar disc surgery predict the outcome 12 months later? Disabil Rehabil 25:968–972
Heiat A, Gross CP, Krumholz HM (2002) Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 162:1682–1688
Hopp JF (1993) Effects of age and resistance training on skeletal muscle: a review. Phys Ther 73:361–373
Jagsi R, Motomura AR, Amarnath S, Jankovic A, Sheets N, Ubel PA (2009) Under-representation of women in high-impact published clinical cancer research. Cancer 115:3293–3301
Javid MJ, Hadar EJ (1998) Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg 89:1–7
Johnsson KE, Redlund-Johnell I, Uden A, Willner S (1989) Preoperative and postoperative instability in lumbar spinal stenosis. Spine 14:591–593
Jonsson B, Annertz M, Sjoberg C, Stromqvist B (1997) A prospective and consecutive study of surgically treated lumbar spinal stenosis Part II: five-year follow-up by an independent observer. Spine 22:2938–2944
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21:92–98
Kleinstuck FS, Grob D, Lattig F, Bartanusz V, Porchet F, Jeszenszky D, O’Riordan D, Mannion AF (2009) The influence of preoperative back pain on the outcome of lumbar decompression surgery. Spine 34:1198–1203
Klosky JL, Tyc VL, Lawford J, Ashford J, Lensing S, Buscemi J (2009) Predictors of non-participation in a randomized intervention trial to reduce environmental tobacco smoke (ETS) exposure in pediatric cancer patients. Pediatr Blood Cancer 52:644–649
Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D (2007) A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J 16:1101–1117
Mannion AF, Elfering A (2006) Predictors of surgical outcome and their assessment. Eur Spine J 15(Suppl 1):S93–S108
Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F, Grob D (2009) Great expectations: really the novel predictor of outcome after spinal surgery? Spine 34:1590–1599
Mannion AF, Müntener M, Taimela S, Dvorak J (1999) A randomised clinical trial of three active therapies for chronic low back pain. Spine 24:2435–2448
Mannion AF, Porchet F, Kleinstück F, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: Part 1. The Core Outcome Measures Index (COMI) in clinical practice. Eur Spine J 18:367–373
Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: Part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18:374–379
McGregor AH, Hughes SPF (2002) The evaluation of the surgical management of nerve root compression in patients with low back pain. Part 1: The assessment of outcome. Spine 27:1465–1470
Postacchini F, Cinotti G (1992) Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 74:862–869
Postacchini F, Cinotti G, Gumina S, Perugia D (1993) Long-term results of surgery in lumbar stenosis. 8-year review of 64 patients. Acta Orthop Scand Suppl 251:78–80
Roder C, Chavanne A, Mannion AF, Grob D, Aebi M, El-Kerdi A (2005) SSE Spine Tango–content, workflow, set-up. Eur Spine J 14:920–924. http://www.eurospine.org, Spine Tango
Roland M, Morris R (1983) A study of the natural history of back pain. Part 1:development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144
Scholz M, Firsching R, Lanksch WR (1998) Long-term follow up in lumbar spinal stenosis. Spinal Cord 36:200–204
Spengler DM (1987) Degenerative stenosis of the lumbar spine (current concepts review). J Bone Joint Surg 69A:305–308
Szpalski M, Gunzburg R, Melot C, Aebi M (2003) The aging of the population: a growing concern for spine care in the twenty-first century. Eur Spine J 12(Suppl 2):S81–S83
Truumees E (2005) Spinal stenosis: pathophysiology, clinical and radiologic classification. Instr Course Lect 54:287–302
Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCulloch JA (1979) Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg Am 61:201–207
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810
Zhao F, Pollintine P, Hole BD, Dolan P, Adams MA (2005) Discogenic origins of spinal instability. Spine 30:2621–2630
Acknowledgements
This study was supported by the Swiss National Science Foundation (Grant no. 32-57123.99) and the Schulthess Klinik Research Fund. We are especially grateful to Renata Heusser, Gordana Balaban and Katrin Knecht for their valuable assistance in managing the study and collecting the data. We also thank Astrid Junge for her help in planning the questionnaire battery.
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Mannion, A.F., Denzler, R., Dvorak, J. et al. Five-year outcome of surgical decompression of the lumbar spine without fusion. Eur Spine J 19, 1883–1891 (2010). https://doi.org/10.1007/s00586-010-1535-2
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DOI: https://doi.org/10.1007/s00586-010-1535-2