Author(s): Sunderland G.; Foster M.; Pillay R.; Dheerendra S.
Source: Global Spine Journal; May 2018; vol. 8 (no. 1)
Publication Date: May 2018
Publication Type(s): Conference Abstract
Available at Global Spine Journal – from Europe PubMed Central – Open Access
Abstract:Background: Lumbar decompression surgery is a wellestablished surgical strategy with proven efficacy in numerous large-scale systematic reviews and meta-analyses. Patient Reported Outcome Measures (PROMs) based on core outcome sets are increasingly recognised as vital for surgeons and healthcare providers to appreciate effectiveness of interventions from a patient perspective as well as standardising assessment and promoting service improvement. The aim of the study was to assess the efficacy of lumbar decompression surgery based on PROMs. Methods: Between January 2012 and October 2016, Lumbar decompression surgeries were undertaken for degenerative lumbar spine disease on 2838 patients in a single centre. Data was collected routinely from patientcompleted questionnaires at baseline, 3 months, 1 year and 2 years post-operatively on the Spine Tango registry. Median age of patients was 61 years (71-49). All primary (n = 1983) and revision (n = 855) decompression surgeries performed during this time period were included for analysis. Spine Tango international spine registry core outcome measures index (COMI) for low back pain 2011 version, a validated multidimensional questionnaire that investigates five dimensions in low back pain, Scored from 0 (best) to 10 (worst) was used. Patient demographics and surgical details were collected routinely in addition to patient questionnaires. Data was analysed using Microsoft Excel 2010 and GraphPad Prism 7. Results: Completion rate of questionnaires was 83%. The majority of surgeries were performed with peripheral pain relief as the patients’ stated goal (57%) followed by functional improvement (26.4%). The operation was rated as having ‘helped’ or ‘helped a lot’ by 71% of respondents at 3 months and 67% at both 1 year and 2 year follow up. Median COMI score (scored 0 – best to 10 – worst) was 8.3 at baseline, improving to 5.15 at 3 months (p < 0.001), 5.2 at 1 year (p < 0.001) and 4.9 at 2 years (p < 0.001). Mean leg pain/back pain scores (visual analogue score 0-10) improved significantly (p < 0.005) from pre-op to 3 months, 1 year and 2 years follow-up. Interestingly the percentage of patients reporting back pain doubled from pre-operative (20%) to 2-year (40%) follow-up (p < 0.005). Quality of life (QoL) rating improved post-operatively; 29% of patients rated QoL ‘moderate’, ‘good’ or ‘very good’ preoperatively, improving to 74% at 3 months (OR = 0.142, 95%CI 0.125-0.161). This was maintained at 1 year (71%, OR = 0.165, 95%CI 0.15:0.187) and 2 year follow up (73%, OR = 0.153, 95%CI 0.133-0.176). 6.4% of patients had undergone revision surgery at the end of 2 years. All the results were significantly (p < 0.005) inferior in patients undergoing revision surgery compared to primary surgery. Conclusions: Lumbar decompression has impressive efficacy in the improvement of symptoms and QoL for patients with degenerative lumbar stenosis. As expected the outcomes were inferior in revision surgery. Much of the improvement a patient will experience will be present at 3 months and is sustained for at least 2 years. The number of patients reporting back pain as most troubling doubled at 2-year follow-up. PROMs are an extremely useful method for assessing treatment efficacy and demonstrate excellent patient satisfaction from this surgery and can be used as a tool in counselling prospective patients regarding surgery.