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The Influence of Preoperative Back Pain on the Outcome of Lumbar Decompression Surgery

Kleinstück, Frank S. MD; Grob, Dieter MD; Lattig, Friederike MD; Bartanusz, Viktor MD; Porchet, Francois MD; Jeszenszky, Dezsö MD; O’Riordan, David BSc; Mannion, Anne F. PhD

doi: 10.1097/BRS.0b013e31819fcf35
Health Services Research

Study Design. Prospective study with 12-month follow-up.

Objective. To examine how the relative severity of low back pain (LBP) to leg/buttock pain (LP) influences the outcome of decompression surgery for spinal stenosis.

Summary of Background Data. Decompression surgery is a common treatment for lumbar spinal canal stenosis, with generally good outcome. However, concomitant LBP at presentation can make it difficult to decide whether decompression alone will result in a good overall outcome.

Methods. The Spine Society of Europe Spine Tango system was used to acquire the data from 221 patients. Inclusion criteria were lumbar degenerative spinal stenosis, first-time surgery, maximum 3 affected levels, and decompression as the only procedure. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI; includes 0–10 LP and LBP scales); at 12 months, global outcome was rated on a Likert-scale and dichotomized into “good” and “poor” groups.

Results. There was a low but significant positive correlation between baseline LP-minus-LBP scores and both improvement in the multidimensional COMI score after 12 months (r = 0.21, P = 0.003) and the score on the 12-month global outcome scale (r = 0.19, P = 0.007). In the good outcome group, mean baseline LP was 2.3 (±3.7) points higher than LBP; in the poor group, the corresponding value was 0.8 (±3.4) (P = 0.01 between groups). In multivariate regression analyses (controlling for age, gender, comorbidity), baseline LBP intensity was the most significant predictor of the 12-month COMI score, and preoperative LP-minus-LBP score of the global outcome (each P < 0.05).

Conclusion. Overall, greater back pain relative to LP at baseline was associated with a significantly worse outcome after decompression. This finding seems intuitive, but has rarely been quantified in the many predictor studies conducted to date. Consideration of relative LBP and LP scores may assist in clinical decision-making and in establishing realistic patient expectations.

The influence of concomitant low back pain on the outcome of patients undergoing decompression surgery for spinal stenosis was examined. Higher back pain at baseline was associated with a significantly worse outcome after 12 months.

From the Spine Center, Schulthess Klinik, Zürich, Switzerland.

Acknowledgment date: July 25, 2008. Revision date: November 26, 2008. Acceptance date: December 3, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Anne F. Mannion, PhD, Spine Center Division, Department of Research and Development, Schulthess Klinik, Lennghalde 2, 8008 Zürich, Switzerland; E-mail: anne.mannion@kws.ch

© 2009 Lippincott Williams & Wilkins, Inc.