TY - JOUR
T1 - Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy ; Clinical article
AU - Adogwa, Owoicho
AU - Carr, Ricardo K.
AU - Kudyba, Katherine
AU - Karikari, Isaac
AU - Bagley, Carlos A.
AU - Gokaslan, Ziya L.
AU - Theodore, Nicholas
AU - Cheng, Joseph S.
PY - 2013/2/1
Y1 - 2013/2/1
N2 - Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.
AB - Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.
KW - Adjacent-segment disease
KW - Elderly patient
KW - Functional neurosurgery
KW - Pseudarthrosis
KW - Revision lumbar surgery
KW - Same-level recurrent stenosis
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U2 - 10.3171/2012.11.SPINE12224
DO - 10.3171/2012.11.SPINE12224
M3 - Article
C2 - 23231354
AN - SCOPUS:84873619398
SN - 1547-5654
VL - 18
SP - 139
EP - 146
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 2
ER -