Emin Aghayev1, Anne F Mannion2, Tamas F Fekete2, Sven Janssen3, Kelly Goodwin4, Marcel Zwahlen4, Ulrich Berlemann5, Tobias Lorenz3. 1. Spine Centre, Schulthess Clinic, Lengghalde, Zurich, Switzerland. Electronic address: aghayev.emin@yahoo.com. 2. Spine Centre, Schulthess Clinic, Lengghalde, Zurich, Switzerland. 3. Clinic Adelheid, Höhenweg, Unterägeri, Switzerland. 4. Institute for Social and Preventive Medicine, University of Bern, Finkenhubelweg, Bern, Switzerland. 5. The Spine Centre Thun, Bahnhofstrasse, Thun, Switzerland.
Abstract
OBJECTIVE: To determine risk factors for negative global treatment outcomes as self-assessed by patients undergoing surgical treatment for lumbar spinal stenosis (LSS). METHODS: Patients from the Spine Tango registry undergoing first-time surgery for LSS were analyzed. The primary outcome was global treatment outcomes measured at the last available follow-up ≥3 months postoperatively using a single question rating how much the operation had helped the patient's back problem (negative = no change/operation made things worse). A 2-level logistic mixed effects model with the treating department as the random effect was used to assess factors associated with a negative outcome. RESULTS: A total of 4504 patients from 39 departments in 10 countries were included. Overall, 14.4% of patients reported a negative global treatment outcome after an average follow-up of 1.3 years. In patients with dominant leg pain, negative outcome was associated with higher baseline back pain; in those with dominant back pain, it was associated with higher baseline back pain, ASA (American Society of Anesthesiologists) ≥3, lower age, not having rigid stabilization, not having disc herniation, and the vertebral level of the most severely affected segment (L5/S1 vs. L3/4). Four departments had significantly higher odds of a negative outcome, whereas 1 department had significantly lower odds. Three out of the 4 negative effects were related to 2 departments from 1 country. CONCLUSIONS: LSS surgery fails to help at least 1 in 10 patients. High baseline back pain is the most important factor associated with a negative treatment outcome. Department-level and potentially country-level factors of unknown origin explained a nonnegligible variation in the treatment results.
OBJECTIVE: To determine risk factors for negative global treatment outcomes as self-assessed by patients undergoing surgical treatment for lumbar spinal stenosis (LSS). METHODS:Patients from the Spine Tango registry undergoing first-time surgery for LSS were analyzed. The primary outcome was global treatment outcomes measured at the last available follow-up ≥3 months postoperatively using a single question rating how much the operation had helped the patient's back problem (negative = no change/operation made things worse). A 2-level logistic mixed effects model with the treating department as the random effect was used to assess factors associated with a negative outcome. RESULTS: A total of 4504 patients from 39 departments in 10 countries were included. Overall, 14.4% of patients reported a negative global treatment outcome after an average follow-up of 1.3 years. In patients with dominant leg pain, negative outcome was associated with higher baseline back pain; in those with dominant back pain, it was associated with higher baseline back pain, ASA (American Society of Anesthesiologists) ≥3, lower age, not having rigid stabilization, not having disc herniation, and the vertebral level of the most severely affected segment (L5/S1 vs. L3/4). Four departments had significantly higher odds of a negative outcome, whereas 1 department had significantly lower odds. Three out of the 4 negative effects were related to 2 departments from 1 country. CONCLUSIONS:LSS surgery fails to help at least 1 in 10 patients. High baseline back pain is the most important factor associated with a negative treatment outcome. Department-level and potentially country-level factors of unknown origin explained a nonnegligible variation in the treatment results.
Authors: Amandine Bays; Andrea Stieger; Ulrike Held; Lisa J Hofer; Eva Rasmussen-Barr; Florian Brunner; Johann Steurer; Maria M Wertli Journal: N Am Spine Soc J Date: 2021-06-02
Authors: Matteo Briguglio; Paolo Perazzo; Francesco Langella; Tiziano Crespi; Elena De Vecchi; Patrizia Riso; Marisa Porrini; Laura Scaramuzzo; Roberto Bassani; Marco Brayda-Bruno; Giuseppe Banfi; Pedro Berjano Journal: Front Surg Date: 2022-03-16