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Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery.
J Spinal Disord Tech. 2014 Oct; 27(7):353-7.JS

Abstract

STUDY DESIGN

Single-cohort study of patients undergoing revision neural decompression and fusion for same-level recurrent lumbar stenosis.

OBJECTIVE

To assess the long-term outcomes of revision surgery using validated patient-reported outcomes measures.

SUMMARY OF BACKGROUND DATA

Recurrent lumbar stenosis may occur after lumbar spine surgery, leading to significant discomfort and radicular pain. Although numerous studies have reported clinical outcomes after primary lumbar surgery, there remains a paucity of data on the outcomes after revision surgery for recurrent same-level stenosis.

METHODS

Fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Baseline and 2-year visual analog scale for leg pain (LP-VAS), visual analog scale for low back pain (BP-VAS), Oswestry Disability Index (ODI), Zung self-reported depression score (ZDS), time to narcotic independence, time to return to work, health-state utility [EuroQol (EQ-5D)], and physical and mental quality of life [SF-12 physical and mental component scores (PCS and MCS)] were assessed.

RESULTS

Mean±SD duration of time between index surgery and revision surgery was 4.00±4.19 years. A significant improvement from baseline was observed in BP-VAS (9.28±1.01 vs. 5.00±2.94, P=0.001), LP-VAS (9.55±0.93 vs. 3.45±2.95, P=0.001), and ODI (36.02±6.01 vs. 21.75±12.08, P=0.001). Mean±SD SF-12 PCS (7.17±11.22, P=0.001), SF-12 MCS (12.57±13.03, P=0.001), ZDS (12.37±16.80, P=0.001), and EQ-5D (0.42±0.34, P=0.001) were also significantly improved. The mean cumulative 2-year gain in health-utility state was 0.84 QALY. Median (interquartile range) duration of postoperative narcotic use was 6 (1.4-12.2) months and time of missed work was 6 (4.0-10.0) months.

CONCLUSIONS

Our study suggests that revision neural decompression and instrumented fusion for recurrent same-level stenosis provides significant improvement in all patient-assessed outcome metrics and should be offered as a viable treatment option.

Authors+Show Affiliations

Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25247253

Citation

Mendenhall, Stephen K., et al. "Long-term Outcomes After Revision Neural Decompression and Fusion for Same-level Recurrent Lumbar Stenosis: Defining the Effectiveness of Surgery." Journal of Spinal Disorders & Techniques, vol. 27, no. 7, 2014, pp. 353-7.
Mendenhall SK, Parker SL, Adogwa O, et al. Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery. J Spinal Disord Tech. 2014;27(7):353-7.
Mendenhall, S. K., Parker, S. L., Adogwa, O., Shau, D. N., Cheng, J., Aaronson, O., Devin, C. J., & McGirt, M. J. (2014). Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery. Journal of Spinal Disorders & Techniques, 27(7), 353-7. https://doi.org/10.1097/BSD.0b013e31826105a5
Mendenhall SK, et al. Long-term Outcomes After Revision Neural Decompression and Fusion for Same-level Recurrent Lumbar Stenosis: Defining the Effectiveness of Surgery. J Spinal Disord Tech. 2014;27(7):353-7. PubMed PMID: 25247253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes after revision neural decompression and fusion for same-level recurrent lumbar stenosis: defining the effectiveness of surgery. AU - Mendenhall,Stephen K, AU - Parker,Scott L, AU - Adogwa,Owoicho, AU - Shau,David N, AU - Cheng,Joseph, AU - Aaronson,Oran, AU - Devin,Clinton J, AU - McGirt,Matthew J, PY - 2014/9/24/entrez PY - 2014/9/24/pubmed PY - 2014/12/17/medline SP - 353 EP - 7 JF - Journal of spinal disorders & techniques JO - J Spinal Disord Tech VL - 27 IS - 7 N2 - STUDY DESIGN: Single-cohort study of patients undergoing revision neural decompression and fusion for same-level recurrent lumbar stenosis. OBJECTIVE: To assess the long-term outcomes of revision surgery using validated patient-reported outcomes measures. SUMMARY OF BACKGROUND DATA: Recurrent lumbar stenosis may occur after lumbar spine surgery, leading to significant discomfort and radicular pain. Although numerous studies have reported clinical outcomes after primary lumbar surgery, there remains a paucity of data on the outcomes after revision surgery for recurrent same-level stenosis. METHODS: Fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Baseline and 2-year visual analog scale for leg pain (LP-VAS), visual analog scale for low back pain (BP-VAS), Oswestry Disability Index (ODI), Zung self-reported depression score (ZDS), time to narcotic independence, time to return to work, health-state utility [EuroQol (EQ-5D)], and physical and mental quality of life [SF-12 physical and mental component scores (PCS and MCS)] were assessed. RESULTS: Mean±SD duration of time between index surgery and revision surgery was 4.00±4.19 years. A significant improvement from baseline was observed in BP-VAS (9.28±1.01 vs. 5.00±2.94, P=0.001), LP-VAS (9.55±0.93 vs. 3.45±2.95, P=0.001), and ODI (36.02±6.01 vs. 21.75±12.08, P=0.001). Mean±SD SF-12 PCS (7.17±11.22, P=0.001), SF-12 MCS (12.57±13.03, P=0.001), ZDS (12.37±16.80, P=0.001), and EQ-5D (0.42±0.34, P=0.001) were also significantly improved. The mean cumulative 2-year gain in health-utility state was 0.84 QALY. Median (interquartile range) duration of postoperative narcotic use was 6 (1.4-12.2) months and time of missed work was 6 (4.0-10.0) months. CONCLUSIONS: Our study suggests that revision neural decompression and instrumented fusion for recurrent same-level stenosis provides significant improvement in all patient-assessed outcome metrics and should be offered as a viable treatment option. SN - 1539-2465 UR - https://www.unboundmedicine.com/medline/citation/25247253/Long_term_outcomes_after_revision_neural_decompression_and_fusion_for_same_level_recurrent_lumbar_stenosis:_defining_the_effectiveness_of_surgery_ L2 - https://doi.org/10.1097/BSD.0b013e31826105a5 DB - PRIME DP - Unbound Medicine ER -