Dataset Information

Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study.

ABSTRACT:

Background

Waits for elective spine surgery are common in Canada. We examined whether a prolonged wait for surgery for lumbar degenerative spinal stenosis was detrimental to outcome.

Methods

In this prospective observational study, we enrolled 166 consecutive patients referred to our centre for treatment of lumbar degenerative spinal stenosis between 2006 and 2010. Outcome measures were assessed at referral, preoperatively and until 24 months postoperatively. Primary outcome measures were the physical and mental component summary scores of the 36-Item Short-Form Health Survey and the Oswestry Disability Index. Secondary outcome measures included the symptom severity scale of the Zurich Claudication Questionnaire, a numeric rating scale for back and leg pain, and patient satisfaction with treatment. Wait time was defined as the time from referral to surgery.

Results

The follow-up rate at 2 years was 85%. The median wait time was 349 days. All health-related quality of life measures deteriorated during the waiting period, but there was no significant correlation between wait time and magnitude of the change in outcome measure. At 6 months postoperatively, the Pearson correlation was significantly positive between wait time and change in disability (r = 0.223), Zurich Claudication Questionnaire score (r = 0.2) and leg pain score (r = 0.221). At 12 months, the correlation remained significant for change in disability (r = 0.205) and was significant for change in mental well-being (r = -0.224). At 12 months, patients with a shorter wait (? 12 months) showed greater improvement in mental well-being (mean difference in change [and 95% confidence interval (CI)] 5.7 [1.4-9.9]) and decrease in disability (-9.3 [95% CI -15.1 to -3.6]) and leg pain (-1.6 [95% CI -3.0 to -0.3]). There were no statistically significant differences in outcome or patient satisfaction with treatment between those with shorter and longer waits at 24 months.

Interpretation

Patients awaiting spinal surgery experienced deterioration in health-related quality of life irrespective of the length of wait time. However, longer waits were associated with a delay in recovery during the first year after surgery.

SUBMITTER: Bailey CS

PROVIDER: S-EPMC4933598 | biostudies-literature | 2016 Apr-Jun

REPOSITORIES: biostudies-literature

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Publications

Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study.

Bailey Christopher S CS Gurr Kevin R KR Bailey Stewart I SI Taylor David D Rosas-Arellano M Patricia MP Tallon Corinne C Bureau Yves Y Urquhart Jennifer C JC

CMAJ open 20160428 2

<h4>Background</h4>Waits for elective spine surgery are common in Canada. We examined whether a prolonged wait for surgery for lumbar degenerative spinal stenosis was detrimental to outcome.<h4>Methods</h4>In this prospective observational study, we enrolled 166 consecutive patients referred to our centre for treatment of lumbar degenerative spinal stenosis between 2006 and 2010. Outcome measures were assessed at referral, preoperatively and until 24 months postoperatively. Primary outcome measu ...[more]

PMID: 27398362

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Project description:BackgroundDegenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability.MethodsSixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC).ResultsThe participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P?=?.001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001???P???.01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P?=?.042).ConclusionsThe dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants' self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.

Project description:Retrospective review of a prospectively collected database.To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers.Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated.Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed.A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (Short Form-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with Short Form-36 scores trending toward significance.There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures, although further studies are required to investigate which center characteristics are most important.

Dataset Information

Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study.

Background

Methods

Results

Interpretation

Publications

Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study.

Similar Datasets

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