Short- and Long-Term Outcome of Microscopic Lumbar Spine Surgery in Patients with Predominant Back or Predominant Leg Pain

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• 作者：Martin N. Stienen¹ ; ^{mnstienen@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Holger Joswig² ; Nicolas R. Smoll³ ; Marco V. Corniola¹ ; Karl Schaller¹ ; Gerhard Hildebrandt² ; Oliver P. Gautschi¹
• 关键词：Back pain ; Degenerative disc disease ; Dominant symptom ; Health-related quality of life ; Leg pain ; Low back pain ; Lumbar spine surgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：458-465.e1
• 全文大小：3654 K

文摘

This study assessed whether predominant back pain (pBP) represents a negative outcome predictor in patients undergoing microscopic spine surgery without fusion for a lumbar disc herniation (LDH) or spinal stenosis (LSS).

Methods

Retrospective analysis of prospectively collected data on consecutive patients with LDH or LSS at 2 centers. Patients with visual analog scale (VAS) back pain ≥VAS leg pain were assigned to the pBP group, and compared with patients with predominant VAS leg pain (pLP). Outcome measures included the Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), health-related quality of life measures, Short-Form (SF)-12 Physical Component Summary (PCS), and EuroQol (EQ-5D) index at 3 days, 6 weeks (W6), 6 months, and 1 year postoperatively.

Results

A total of 325 patients (154 [47.4%] with pBP and 171 [52.6%] with pLP) were included. Patients with pBP were about 6 years older and more often had LSS. There was no significant difference between the group means of the RMDI, ODI, SF-12 PCS, or EQ-5D at any postoperative time point. The most improvement was observed until the W6 follow-up with little or no improvement thereafter up to 1 year postoperatively. Patients with pBP were as likely as patients with pLP to be W6 responders on the RMDI (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.38–2.16; P = 0.831), ODI (OR, 1.00; 95% CI 0.52–1.92; P = 0.996), SF-12 PCS (OR, 1.09; 95% CI 0.58–2.04; P = 0.791), and EQ-5D (OR, 0.62; 95% CI 0.32–1.21; P = 0.164). Disease-specific subgroup analyses confirmed the results.

Conclusions

The present data suggest that patients with pBP have comparable functional and health-related quality of life outcomes after surgery for LDH or LSS with those of patients with pLP.