Kleinstück Mannion
Fakultäten » Medizinische Fakultät » Rheumaklinik und Institut für physikalische Medizin » PD Dr. Anne Mannion » Kleinstück Mannion
Completed research project
| Title / Titel | The influence of preoperative back pain on the outcome of lumbar decompression surgery. A prospective study | ||||
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| Abstract (PDF, 14 KB) | |||||
| Summary / Zusammenfassung | Introduction Decompression surgery is a common treatment for lumbar spinal canal stenosis, with generally good outcome. However, concomitant low back pain (LBP) at presentation can make it difficult to decide whether decompression alone will suffice. This study sought to examine how the relative severity of LBP influences the outcome of decompression surgery Methods The SSE Spine Tango system was used to acquire the data from 155 patients. Inclusion criteria were lumbar degenerative spinal stenosis, first-time surgery, maximum 3 affected levels, and decompression as only procedure. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI; includes 0-10 leg-pain (LP) and LBP scales); at 12 months, global outcome was rated on a Likert-scale and dichotomised into “good” and “poor” groups. Result In the “good” outcome group, mean baseline LP was 2.4 (±3.89) points higher than LBP; in the “poor” group, the corresponding value was 0.8 (±3.1) (p<0.019 between groups). The more that baseline LP predominated at baseline relative to LBP, the greater the improvement in the multidimensional COMI score at 12-months (p=0.005). In patients who declared at baseline that their “main problem” was back pain, 59% had a “good” outcome; leg pain, 77% “good”; sensory disturbances, 74% “good”. In multiple regression analysis (controlling for age, gender, co-morbidity, and baseline COMI-score), baseline LP (p=0.013) and LP-minus-LBP scores (p=0.0001) were significant predictors of the 12-month COMI score, explaining 17% variance in outcome. Discussion Overall, patients in whom leg pain predominated over back pain showed significantly better outcomes after decompression. This finding seems intuitive, but has rarely been quantified in the many predictor studies conducted to date (1). Consideration of relative LBP and LP scores may assist with the clinical decision-making. (1) Aalto TJ et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review.Spine 2006;31:E648-63. | ||||
| Publications / Publikationen | 1) Kleinstück FS, Mannion AF, Lattig F, Bartanusz V, Jeszenszky D, Porchet F, Grob D (2008) The influence of preoperative back pain on the outcome of lumbar decompression surgery. A prospective study. International Society for the Study of the Lumbar Spine (Spine Week), Geneva, Switzerland, 26.5.08-31.5.082) Kleinstück F, Mannion AF, Lattig F, Paus C, Jeszenszky D, Porchet F, Grob D (2008) A prospective study of the influence of preoperative back pain on the outcome of lumbar decompression surgery. Schweizerische Gesellschaft für Orthopädie. Basel, Switzerland, 24-26-9.2008. Swiss Medical Forum 8 (Suppl 44):S24 AWARDED SGO MARATHON PRIZE, 3RD PLACE3) Kleinstueck FS, Grob D, Lattig F, Bartanusz V, Porchet F, Jeszenszky D, O'Riordan D, Mannion AF (2009) The influence of pre-operative back pain on the outcome of lumbar decompression surgery. Spine 34(11): 1198-1203 |
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| Keywords / Suchbegriffe | spinal decompression, spinal stenosis, back pain, leg pain, outcome | ||||
| Project leadership and contacts / Projektleitung und Kontakte |
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| Funding source(s) / Unterstützt durch |
Foundation Stiftung Wilhelm Schulthess Forschungsfonds |
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| Duration of Project / Projektdauer | Feb 2004 to Apr 2008 |