scholarly journals Construct validity and responsiveness of commonly used patient reported outcome instruments in decompression for lumbar spinal stenosis

2021 ◽  
Vol 16 ◽  
pp. 125-131
Author(s):  
Karthik Vishwanathan ◽  
Ian Braithwaite
Keyword(s):  
Construct Validity ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Lumbar Spinal

Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone

1996 ◽  
Vol 85 (5) ◽  
pp. 793-802 ◽  
Author(s):  
Mark W. Fox ◽  
Burton M. Onofrio ◽  
Arlen D. Hanssen
Keyword(s):  
Spinal Stenosis ◽  
Patient Reported Outcome ◽  
Dynamic Imaging ◽  
Content Type ◽  
Degenerative Lumbar Spinal Stenosis ◽  
Poor Outcome ◽  
Patient Reported ◽  
Patients At Risk ◽  
Lumbar Spinal ◽  
Fine Print

✓ One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6–6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2–20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2–13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) postoperative radiological instability is more likely to occur when the following criteria are present: preoperative spondylolisthesis, abnormal motion detected on preoperative dynamic imaging, decompression occuring across a minimally degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery.

scholarly journals Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study

2021 ◽  
Author(s):  
Jørn Aaen ◽  
Ivar Magne Austevoll ◽  
Christian Hellum ◽  
Kjersti Storheim ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Patient Characteristics ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Mri Findings ◽  
Multifidus Muscle ◽  
Cross Sectional ◽  
Patient Reported ◽  
Lumbar Spinal

Abstract Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

scholarly journals P.217 Patient reported outcomes following surgery for lumbar spinal stenosis: Comparison of a universal and multitier health care system

2021 ◽  
Vol 48 (s3) ◽  
pp. S82-S82
Author(s):  
O Ayling ◽  
C FIsher
Keyword(s):  
United States ◽  
Health Care ◽  
Spinal Stenosis ◽  
Health Care System ◽  
Lumbar Spinal Stenosis ◽  
Outcome Research ◽  
Patient Reported Outcomes ◽  
The United States ◽  
Patient Reported ◽  
Lumbar Spinal

Background: Canada has a universal health care system while the United States utilizes a combined public and private payer system. The purpose of this study is to investigate whether there are differences in clinical outcomes between those surgically treated for spinal stenosis in Canada as compared to the United States. Methods: Surgical lumbar spinal stenosis patients treated in Canada that were enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Spine-related patient reported outcomes (PROs) were compared at 3 months and 1 year post-operatively. Results: The CSORN cohort consisted of 432 patients and the SPORT cohort was made up of 278 patients. The CSORN cohort had a higher proportion of patients with a symptom duration greater than 6 months (92.3% vs. 58.3%, p<0.0001). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 months (p=0.003) and 1 year (p<0.001). Conclusions: Patients undergoing surgical treatment for lumbar spinal stenosis in Canada (CSORN cohort) reported higher rates of satisfaction at 3 months and 1 year post-operatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery.

scholarly journals Association between payer status and patient-reported outcomes in adult patients with lumbar spinal stenosis treated with decompression surgery

2019 ◽  
Vol 30 (2) ◽  
pp. 198-210 ◽  
Author(s):  
Galal Elsayed ◽  
Samuel G. McClugage ◽  
Matthew S. Erwood ◽  
Matthew C. Davis ◽  
Esther B. Dupépé ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Private Insurance ◽  
Mean Difference ◽  
Leg Pain ◽  
Decompression Surgery ◽  
Patient Reported ◽  
Lumbar Spinal

OBJECTIVEInsurance disparities can have relevant effects on outcomes after elective lumbar spinal surgery. The aim of this study was to evaluate the association between private/public payer status and patient-reported outcomes in adult patients who underwent decompression surgery for lumbar spinal stenosis.METHODSA sample of 100 patients who underwent surgery for lumbar spinal stenosis from 2012 to 2014 was evaluated as part of the prospectively collected Quality Outcomes Database at a single institution. Outcome measures were evaluated at 3 months and 12 months, analyzed in regard to payer status (private insurance vs Medicare/Veterans Affairs insurance), and adjusted for potential confounders.RESULTSAt baseline, patients had similar visual analog scale back and leg pain, Oswestry Disability Index, and EQ-5D scores. At 3 months postintervention, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.11, p < 0.001) and more leg pain (mean difference 1.26, p = 0.05). At 12 months, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.14, p < 0.001). There were no significant differences at 3 months or 12 months between groups for back pain (p = 0.14 and 0.43) or disability (p = 0.19 and 0.15). Across time points, patients in both groups showed improvement at 3 months and 12 months in all 4 functional outcomes compared with baseline (p < 0.001).CONCLUSIONSBoth private and public insurance patients had significant improvement after elective lumbar spinal surgery. Patients with public insurance had slightly less improvement in quality of life after surgery than those with private insurance but still benefited greatly from surgical intervention, particularly with respect to functional status.

scholarly journals Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review

2019 ◽  
Vol 10 (2) ◽  
pp. 209-215 ◽  
Author(s):  
James P. Winebrake ◽  
Francis Lovecchio ◽  
Michael Steinhaus ◽  
James Farmer ◽  
Andrew Sama
Keyword(s):  
Systematic Review ◽  
Return To Work ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Inclusion Criteria ◽  
Pertinent Data ◽  
Patient Reported ◽  
Lumbar Spinal

Study Design: Systematic review. Objectives: The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis. Methods: A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded. Results: Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used—studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work. Conclusions: The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.

Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study

2022 ◽  
pp. 1-7
Keyword(s):  
Cohort Study ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Sagittal Balance ◽  
Sacral Slope ◽  
Decompression Surgery ◽  
Patient Reported ◽  
Lumbar Spinal ◽  
Prospective Longitudinal ◽  
Over The Top

OBJECTIVE The authors’ objective was to investigate whether sagittal balance improves in patients with spinal stenosis after decompression alone. METHODS This prospective longitudinal cohort study compared preoperative and 6-month postoperative 36-inch full-length radiographs in patients aged older than 60 years. Patients underwent decompression alone for central lumbar spinal stenosis with either a minimally invasive bilateral laminotomy for central decompression, unilateral laminectomy as an over-the-top procedure for bilateral decompression, or traditional wide laminectomy with removal of the spinous processes on both sides. The following radiographic parameters were measured: sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI-LL mismatch, coronal Cobb angle, and sacral slope (SS). Patient-reported outcome measures (PROMs) were collected, including scores on the Oswestry Disability Index (ODI), visual analog scale (VAS) for leg and back pain, and EQ-5D. RESULTS Forty-five patients (24 males) with a mean ± SD age of 71.8 ± 5.6 years were included. Sagittal balance showed statistically significant improvement, with the mean SVA decreasing from 52.3 mm preoperatively to 33.9 mm postoperatively (p = 0.0001). The authors found an increase in LL, from mean −41.5° preoperatively to −43.9° postoperatively, but this was not statistically significant (p = 0.055). A statistically significant decrease in PI-LL mismatch from mean 8.4° preoperatively to 5.8° postoperatively was found (p = 0.002). All PROM scores showed significant improvement after spinal decompression surgery. The correlations between SVA and all PROMs were statistically significant at both preoperative and postoperative time points, although most correlations were weak except for those between preoperative SVA and ODI (r = 0.55) and between SVA and VAS for leg pain (r = 0.58). CONCLUSIONS Sagittal balance and PROMs show improvement at short-term follow-up evaluations in patients who have undergone decompression alone for lumbar spinal stenosis.

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