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


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
doi: 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:

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


Zdroje

1. Otani K, Kikuchi S, Yabuki S, Igarashi T, Nikaido T, Watanabe K, et al. Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. ScientificWorldJournal. 2013;2013:590652. doi: 10.1155/2013/590652 24453878; PubMed Central PMCID: PMC3885225.

2. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage. 2013;21(6):783–8. doi: 10.1016/j.joca.2013.02.656 23473979.

3. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;(1):CD010264. doi: 10.1002/14651858.CD010264.pub2 26824399.

4. Comer CM, Redmond AC, Bird HA, Conaghan PG. Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC musculoskeletal disorders. 2009;10:121. doi: 10.1186/1471-2474-10-121 19796387; PubMed Central PMCID: PMC2762954.

5. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259–65. doi: 10.1001/jama.2010.338 20371784; PubMed Central PMCID: PMC2885954.

6. Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine. 2007;32(1):1–8. Epub 2007/01/05. doi: 10.1097/01.brs.0000251014.81875.6d 17202885.

7. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358(8):794–810. Epub 2008/02/22. doi: 10.1056/NEJMoa0707136 18287602; PubMed Central PMCID: PMC2576513.

8. Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, et al. Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med. 2008;149(12):845–53. Epub 2008/12/17. doi: 10.7326/0003-4819-149-12-200812160-00003 19075203; PubMed Central PMCID: PMC2658642.

9. Machado GC, Ferreira PH, Yoo RI, Harris IA, Pinheiro MB, Koes BW, et al. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;11:CD012421. doi: 10.1002/14651858.CD012421 27801521.

10. Fritsch CG, Ferreira ML, Maher CG, Herbert RD, Pinto RZ, Koes B, et al. The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies. Eur Spine J. 2017;26(2):324–35. doi: 10.1007/s00586-016-4668-0 27443531.

11. McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice: Mosby; 1989.

12. Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med. 2007;22(10):1453–8. Epub 2007/08/02. doi: 10.1007/s11606-007-0321-2 17668269; PubMed Central PMCID: PMC2305860.

13. Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain. 2005;115(1–2):29–36. Epub 2005/04/20. doi: 10.1016/j.pain.2005.01.028 15836967.

14. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine. 2005;30:1331–5. doi: 10.1097/01.brs.0000164099.92112.29 15928561

15. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain. 1994;58:387–92. doi: 10.1016/0304-3959(94)90133-3 7838588

16. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4. Epub 2008/01/01. doi: 10.1097/BRS.0b013e31815e3a10 18165753.

17. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry disability questionnaire and the Quebec back pain disability scale. Phys Ther. 2001;81:776–88. doi: 10.1093/ptj/81.2.776 11175676

18. Fritz JM, Hebert J, Koppenhaver S, Parent E. Beyond minimally important change: defining a successful outcome of physical therapy for patients with low back pain. Spine. 2009;34(25):2803–9. Epub 2009/11/17. doi: 10.1097/BRS.0b013e3181ae2bd4 19910868.

19. van Hooff ML, Mannion AF, Staub LP, Ostelo RW, Fairbank JC. Determination of the Oswestry Disability Index score equivalent to a "satisfactory symptom state" in patients undergoing surgery for degenerative disorders of the lumbar spine-a Spine Tango registry-based study. Spine J. 2016;16(10):1221–30. Epub 2016/06/28. doi: 10.1016/j.spinee.2016.06.010 27343730.

20. Laursen B, Hoff E. Person-centered and variable-centered approaches to longitudinal data. Merrill-Palmer Quarterly. 2006;52(3):377–89.

21. Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109–38. Epub 2010/03/03. doi: 10.1146/annurev.clinpsy.121208.131413 20192788.

22. Nagin D. Group-based modeling of development. Cambridge, Mass.: Harvard University Press,; 2005.

23. Frankfurt S, Frazier P, Syed M, Jung KR. Using Group-Based Trajectory and Growth Mixture Modeling to Identify Classes of Change Trajectories. The Counseling Psychologist. 2016;44(5):622–60. doi: 10.1177/0011000016658097 1011066311.

24. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1. Epub 2012/03/02. doi: 10.1056/NEJMp1109283 22375967.

25. Hebert JJ, Fritz JM, Thackeray A, Koppenhaver SL, Teyhen D. Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function. Br J Sports Med. 2015;49(2):100–6. Epub 2013/09/14. doi: 10.1136/bjsports-2013-092402 24029724.

26. McGregor AH, Probyn K, Cro S, Dore CJ, Burton AK, Balague F, et al. Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database Syst Rev. 2013;(12):CD009644. Epub 2013/12/11. doi: 10.1002/14651858.CD009644.pub2 24323844.


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