Ulf S Nerland1, Asgeir S Jakola2, Charalampis Giannadakis3, Ole Solheim4, Clemens Weber5, Øystein P Nygaard6, Tore K Solberg7, Sasha Gulati8. 1. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Electronic address: ulfskule@gmail.com. 2. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; National Centre for Ultrasound and Image-Guided Therapy, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 3. Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 4. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Centre for Ultrasound and Image-Guided Therapy, Trondheim, Norway. 5. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olav's University Hospital, Trondheim, Norway. 6. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Advisory Unit on Spinal Surgery Center for Spinal Disorders, St. Olav's University Hospital, Trondheim, Norway. 7. Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway; The Norwegian National Registry for Spine Surgery, Center for Clinical Documentation and Evaluation (SKDE), North Norway Regional Health Authority, Tromsø, Norway. 8. Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norwegian Centre of Competence in Deep Brain Stimulation for Movement Disorders, St. Olav's University Hospital, Trondheim, Norway.
Abstract
OBJECTIVE: To investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis. METHODS: Prospectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up. RESULTS: There were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00-1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42-3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07-2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02-1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18-3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19-3.53, P = 0.009). CONCLUSIONS: Overall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery.
OBJECTIVE: To investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis. METHODS: Prospectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up. RESULTS: There were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00-1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42-3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07-2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02-1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18-3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19-3.53, P = 0.009). CONCLUSIONS: Overall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery.
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