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: 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

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Článek vyšel v časopise

PLOS One


2019 Číslo 11