Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis

Athiviraham, Aravind; Wali, Zubair; Yen, David

doi:10.1016/j.spinee.2011.03.008

Cited by 57 publications

(55 citation statements)

References 16 publications

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“…Similarly, as demonstrated by other studies, patients with comorbidities present higher levels of complications as a result of surgical treatment for degenerative lumbar stenosis. 17,18 Although Athiviraham et al 19 , in a population study, concluded that comorbidities, sex and age were not associated with a poor prognosis or increased level of complications, our evaluation corroborates the literature that supports higher levels of surgical complications with associated clinical diseases, 14,[16][17][18] and like Kurd et al, 20 do not demonstrate an association of complications with any particular comorbidity, but with the simultaneous presence of two or more comorbidities. Thus, factors like age, lifestyle, expectation, and general state of health of the patients can contribute to the decision on surgical conduct.…”

Section: Resultssupporting

confidence: 87%

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

2014

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Objectives: To study the characteristics of patients who underwent surgical treatment of degenerative spinal stenosis in the last 10 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) RESUMOObjetivos: Estudar as características dos pacientes que foram submetidos ao tratamento cirúrgico da estenose lombar degenerativa nos últimos 10 anos (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMR-USP), e correlacionar as complicações pós-operatórias e as comorbidades pré-operatórias encontradas na população estudada. Métodos: Avaliação retrospectiva dos prontuários e exames radiográficos dos pacientes portadores de estenose lombar degenerativa submetidos a tratamento cirúrgico. Análise dos dados descritivos com o programa SAS 9.0. Resultados: Foram incluídos 92 pacientes, sendo 47 (51,08%) do sexo masculino e 45 (48,91%) do sexo feminino, com idade que variou de 32 a 86 anos (média de 64,27). As comorbidades mais prevalentes foram a hipertensão arterial sistêmica (47,82%) e o diabetes mellitus (25%). Vinte e três pacientes (25%) apresentaram duas ou mais comorbidades associadas. A infecção pós-operatória foi a complicação mais comum, encontrada em 12 casos (13%). Os pacientes que tinham apenas uma comorbidade pré-operatória apresentaram iguais índices de complicação frente à população sem comorbidades. No entanto, pacientes com duas ou mais comorbidades apresentaram maior incidência de complicações pós-operatórias (p < 0,001). Conclusão: A presença de comorbidades influenciou negativamente o resultado do tratamento cirúrgico da estenose lombar degenerativa, com maiores índices de complicações pós-operatórias.Descritores: Estenose espinhal/cirurgia; Claudicação intermitente; Hipertensão; Diabetes mellitus. RESUMEN Objetivos: Estudiar las características de pacientes que se sometieron a tratamiento quirúrgico de la estenosis lumbar degenerativa en los últimos 10 años (2000-2010) en el Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMR-USP) y correlacionar las complicaciones postoperatorias y las comorbilidades preoperatorias encontradas

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Section: Resultssupporting

confidence: 87%

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

2014

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“…7 The expectations of patients, their characteristics, and assessments of psychosocial factors should be integrated into any treatment plan for lumbar canal stenosis, as these can determine which patients will benefit from the proposed surgical treatment. 24,25 In our study, like that of Mannion et al, 20 after being questioned about expectations, 40% of patients were overly optimistic, considering the improvement of the following items: leg pain, walking ability, independence in daily activities, and mental well-being. This percentage increased to 50% when evaluating the results related to sports activities, back pain, social contacts, and physical ability.…”

Section: Discussionsupporting

confidence: 61%

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

et al. 2014

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Objective: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL) with symptoms of anxiety and depression. Methods: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI) and 36-item Medical Outcomes Survey Short Form (SF-36) and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. Results: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. Conclusion: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery.

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“…23 The preoperative duration of spinal stenosis symptoms as a predictor of postoperative outcome is controversial. 24 Some investigators have found that symptom duration greater than 1 year is associated with a poorer surgical outcome, 19,25,26 whereas others have refuted this association. 27,28 However, several of these studies were retrospective, subgroup post-hoc analyses that relied on patient recall to define the preoperative symptom duration.…”

Section: Discussionmentioning

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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Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis

Cited by 57 publications

References 16 publications

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

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

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