Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age &gt; 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis, using validated patient-reported outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ± standard deviation 9 ± 2 vs 4.01 ± 2.56, p = 0.001), pseudarthrosis (7.41 ± 1 vs 5.52 ± 3.08, p = 0.02), and same-level recurrent stenosis (7 ± 2.00 vs 5.00 ± 2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ± 9 vs 23.10 ± 10.18, p = 0.001), pseudarthrosis (28.47 ± 5.85 vs 24.41 ± 7.75, p = 0.001), and same-level recurrent stenosis (30.83 ± 5.28 vs 26.29 ± 4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ± 5.32 (p = 0.46) and 2.02 ± 9.25 (p = 0.22), respectively.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.</jats:p></jats:sec>

Clinical Experiences of Non-fusion Dynamic Stabilization Surgery for Adjacent Segmental Pathology after Lumbar Fusion

“…[18][19][20] In a recent study about revision lumbar surgery in elderly patients (age >65 years) with symptomatic pseudarthrosis, ASP, or same-level recurrent stenosis, VAS values for back pain and two-year ODI showed significant improvements two years after surgery. 21 However, informal outcome measures taking into account pain, medication use, and return to work showed a good outcome in 35.7% of cases. 20 Two years postoperatively, only 38% and 40% of patients reached the minimum clini-cally important difference (MCID) threshold for the ODI and the 36-item short-form health survey (SF-36) physical component scale, respectively.…”

Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Octogenarian Population

“…Although not directly relevant to the present study because they address revision surgery, Adogwa et al 17,18 reported the results of revision decompression and arthrodesis surgery in patients with lumbar pseudarthrosis (n = 17), adjacent-level disease (n = 28), and same-level recurrent stenosis (n = 24) who were at least sixty-five years of age. The authors found that patients who underwent such surgery for those disorders had significant improvement from baseline in the ODI score and the VAS (visual analog scale) score for back pain at two years of follow-up.…”

Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion

“…Rare studies report good results regarding back pain, leg pain, and disability for decompression and fusion for same-level recurrent stenosis. 22,23 However, to our knowledge there are no data on re-decompression for recurrent stenosis.…”