Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis

English version

Autoři: Jeffrey J. Hebert ^aff001; Edward Abraham ^aff003; Niels Wedderkopp ^aff006; Erin Bigney ^aff003; Eden Richardson ^aff003; Mariah Darling ^aff003; Hamilton Hall ^aff008; Charles G. Fisher ^aff009; Y. Raja Rampersaud ^aff010; Kenneth C. Thomas ^aff011; Bradley Jacobs ^aff011; Michael Johnson ^aff013; Jerome Paquet ^aff014; Najmedden Attabib ^aff003; Peter Jarzem ^aff016; Eugene K. Wai ^aff018; Parham Rasoulinejad ^aff019; Henry Ahn ^aff021; Andrew Nataraj ^aff022; Alexandra Stratton ^aff018; Neil Manson ^aff003
Působiště autorů: Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada ^aff001; School of Psychology and Exercise Science, Murdoch University, Perth, Australia ^aff002; Canada East Spine Centre, Saint John, New Brunswick, Canada ^aff003; Division of Orthopaedic Surgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada ^aff004; Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada ^aff005; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark ^aff006; The Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark ^aff007; University of Toronto, Department of Surgery, Toronto, Canada ^aff008; Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada ^aff009; University of Toronto, University Health Network, Arthritis Program, Krembil Research Institute, Toronto, Ontario, Canada ^aff010; University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada ^aff011; Department of Clinical Neurosciences, Division of Neurosurgery-Spine Program, University of Calgary, Calgary, Alberta, Canada ^aff012; Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada ^aff013; Division of Neurosurgery, Department of Surgery, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada ^aff014; Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick, Canada ^aff015; McGill Scoliosis and Spine Research Group, Montreal, Quebec, Canada ^aff016; Division of Orthopaedics, McGill University Health Centre, Montreal, Quebec, Canada ^aff017; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada ^aff018; London Health Sciences Center, Victoria Hospital, London, Ontario, Canada ^aff019; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada ^aff020; University of Toronto Spine Program, Toronto, Ontario, Canada ^aff021; Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada ^aff022
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224200

Souhrn

Objective

Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes.

Methods

We recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery.

Results

Data from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001).

Conclusion

Subgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.

Klíčová slova:

Lower back pain – Systematic reviews – Surgical and invasive medical procedures – Spine – Stenosis – Decision making – Minimally invasive surgery – Surgeons

Zdroje

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