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Previous surgery may negatively affect lumbar stenosis results
An analysis of Spine Tango registry data found the operated level can impact postoperative success.
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Patients undergoing surgery for spinal stenosis can expect better results if their stenosis is at a lower lumbar level or if they had no previous surgery in that area, according to data from a multicenter, prospective, observational study.
Researchers found that the location/height of the affected segment had the greatest impact on surgical outcomes. It was associated with a 2.7 odds ratio for a good outcome for L4-L5 compared to L2-L3, said Thomas H. Zweig, MD, of Bern, Switzerland.
“Furthermore, there was a 1.7 odds ratio for an unsuccessful outcome for patients who had previous surgery on the same level,” he said at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine in Miami. “These findings can help quantify the expected outcome for surgery in patients with lumbar spinal stenosis (LSS).”
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Spine Tango data
Zweig and colleagues used data from the 6-year-old European Spine Tango Registry for spine surgery for their study. It is monitored at the Institute for Evaluative Research at the University of Bern under the auspices of EuroSpine and consists mainly of physician-rated outcomes for more than 20,000 documented surgeries conducted at 29 international centers, he said. Approximately 14,000 surgeries were available when the study was performed. From among 4,500 patients in the registry who received surgery for LSS, 1,775 had valid follow-up information detailed on the physician-based data collection forms.
Researchers included patients treated with decompression alone or with decompression in conjunction with posterior fusion and rigid stabilization. There were 955 women and 820 men, averaging 67 and 68 years old, respectively, “which is typical of this pathology,” Zweig said.
Investigators analyzed the patients’ American Society of Anesthesiologists (ASA) classification. About 50% of the patients were ASA class II (mild systemic disease, but no functional limitations). Interestingly, the type of surgery had no influence, he said.
Factors studied
Zweig and colleagues classified the physicians’ overall outcomes ranked “good” or “excellent” as successful cases (80%) and those that were “fair” or “poor” as unsuccessful cases (20%).
Zweig told Orthopaedics Today Europe that since Spine Tango is a consecutive, prospective and ongoing registry, the data could be re-analyzed at any time to determine longer-term effects these factors might have on surgical outcomes.
For more information:
- Thomas H. Zweig, MD, can be reached at the University of Bern, MEM Research Center, Institute for Evaluative Research in Orthopaedic Surgery, Stauffacherstr. 78, CH-3014 Bern, Switzerland; +41-31-6315941; e-mail: zweig@memcenter.unibe.ch. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- Zweig TH, Aghayev E, Melloh M, et al. An analysis of the surgical treatment of lumbar spinal stenosis (LSS) — Procedures, outcomes, influential factors. A prospective study of 1775 patients in the international “Spine Tango” registry. Paper #51. Presented at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine. May 4-8, 2009. Miami.