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
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Článek vyšel v časopise
PLOS One
2019 Číslo 11
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