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Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results From the Spine Patient Outcomes Research Trial (SPORT)

Pearson, Adam, MD, MS*; Blood, Emily, PhD; Lurie, Jon, MD, MS†,‡; Abdu, William, MD, MS*,†; Sengupta, Dilip, MBBS*,†; Frymoyer, John Frymoyer, MD*; Weinstein, James, DO, MS*,†,‡

doi: 10.1097/BRS.0b013e3181d77c21
Clinical Case Series
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Study Design. As-treated analysis of the Spine Patient Outcomes Research Trial.

Objective. To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e., leg vs. back).

Summary of Background Data. Evidence suggests that DS and SpS patients with predominant leg pain may have better surgical outcomes than patients with predominant low back pain (LBP).

Methods. The DS cohort included 591 patients (62% underwent surgery), and the SpS cohort included 615 patients (62% underwent surgery). Patients were classified as leg pain predominant, LBP predominant, or having equal pain according to baseline pain scores. Baseline characteristics were compared between the 3 predominant pain location groups within each diagnostic category, and changes in surgical and nonoperative outcome scores were compared for 2 years. Longitudinal regression models including baseline covariates were used to control for confounders.

Results. Among DS patients at baseline, 34% had predominant leg pain, 26% had predominant LBP, and 40% had equal pain. Similarly, 32% of SpS patients had predominant leg pain, 26% had predominant LBP, and 42% had equal pain. DS and SpS patients with predominant leg pain had baseline scores indicative of less severe symptoms. Leg pain predominant DS and SpS patients treated surgically improved significantly more than LBP predominant patients on all primary outcome measures at 1 and 2 years. Surgical outcomes for the equal pain groups were intermediate to those of the predominant leg pain and LBP groups. The differences in nonoperative outcomes were less consistent.

Conclusion. Predominant leg pain patients improved significantly more with surgery than predominant LBP patients. However, predominant LBP patients still improved significantly more with surgery than with nonoperative treatment.

This Spine Patient Outcomes Research Trial subgroup analysis demonstrated that degenerative spondylolisthesis and spinal stenosis patients with predominant leg pain improved significantly more with surgery than patients with predominant back pain. However, predominant back pain patients still improved significantly more with surgery than with nonoperative treatment.

*Departments of Medicine and of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Departments of Medicine and of Orthopaedics, Dartmouth Medical School, Lebanon, NH

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH

Address correspondence and reprint requests to Adam Pearson, MD, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756; E-mail: adam.m.pearson@hitchcock.org or tamara.s.morgan@dartmouth.edu

Acknowledgment date: August 10, 2009. Revision date: October 19, 2009. Acceptance date: November 20, 2009.

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

Federal funds were received in support or 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.

Supported by The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444) and the Office of Research on Women's Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention.

© 2011 Lippincott Williams & Wilkins, Inc.