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The Duration of Symptoms Does Not Impact Clinical Outcomes Following Lumbar Decompression Surgery

Movassaghi, Kamran, MD; Basques, Bryce A., MD; Louie, Philip K., MD; Khan, Jannat M., BS; Derman, Peter B., MD; Nolte, Michael T., MD; Paul, Justin C., MD; Goldberg, Edward J., MD; An, Howard S., MD

doi: 10.1097/BRS.0000000000002818
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Study Design. A retrospective cohort analysis.

Objective. The aim of this study was to assess whether duration of symptoms (DOS) has an effect on clinical outcomes in patients undergoing lumbar decompression.

Summary of Background Data. The success of surgical interventions for lumbar spinal stenosis varies depending on numerous factors, including DOS. However, existing literature does not provide a clear indication of the outcome of lumbar decompression surgery in regard to DOS secondary to nerve root compression.

Methods. Analysis of patients who underwent primary lumbar laminectomy from 2008 through 2015 by one of two senior orthopedic spine surgeons was conducted. Exclusion criteria were as follows: previous lumbar surgery, patient under 18 years of age at time of surgery, or postoperative follow-up less than 3 months. Patients were divided into groups on the basis of preoperative DOS: less than 1 year and 1 year or greater. Patient-reported outcomes were obtained using Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. Patients were surveyed about expectations and postoperative satisfaction.

Results. Two hundred ten patients were assessed; 108 with DOS of less than 1 year and 102 with DOS of 1 year or more. On multivariate analysis, patients with DOS of 1 year or greater presented with significantly lower SF-12 scores (P = 0.043). No significant differences existed in other outcome survey scores. Reoperation rates were not significantly different (P = 0.904). Both groups reported high levels of satisfaction (odds ratio 0.42, P = 0.483) and that surgery met or exceeded their expectations (odds ratio 1.00, P = 0.308).

Conclusion. Symptom chronicity did not significantly affect postoperative clinical outcomes, reoperation rates, or patient satisfaction. Nonoperative treatment of lumbar spinal stenosis is often successful but may delay operative intervention. However, results of this study suggest that the delay does not negatively impact surgical outcomes.

Level of Evidence: 3

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL

OrthoConnecticut, Danbury, CT.

Address correspondence and reprint requests to Philip K. Louie, MD, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612; E-mail: louie.philip@gmail.com

Received 21 June, 2018

Revised 2 July, 2018

Accepted 13 July, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.