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Comparative Outcomes and Cost-Utility following Surgical Treatment of Focal Lumbar Spinal Stenosis Compared with Osteoarthritis of the Hip or Knee: Part 1. Long-Term Change in Health-Related Quality of Life.
MedLine Citation:
PMID:  24325880     Owner:  NLM     Status:  Publisher    
BACKGROUND: It is well accepted that hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes to THA/TKA following surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome following LSS surgery compared to THA/TKA remains uncertain.
OBJECTIVE: The primary purpose of this study is to assess whether improvements in HRQoL following surgical management of focal LSS (FLSS) with or without spondylolisthesis is sustainable over the long-term compared to that of THA/TKA for OA.
STUDY DESIGN: Single-center, retrospective longitudinal matched cohort study of prospectively collected outcomes, with minimum 5-year follow-up.
PATIENT SAMPLE: Patients who had primary 1-2 level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary osteoarthritis.
OUTCOME MEASURES: Postoperative change from baseline to last follow-up in SF-36 physical component summary (PCS) scores and mental component summary (MCS) scores between groups was used as the primary outcome measure.
METHODS: An age, sex matched inception cohort of primary 1-2 level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared to a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was utilized for the primary analysis.
RESULTS: Mean follow-up in months and (percent follow-up) was 80.5 + 16.04 (79%), 94.6 + 16.62 (92%), and 80.6 + 16.84 (85%) for the FLSS, THA and TKA cohorts respectively with a range of 5 to 10 years for all three cohorts. The number of patients that have undergone revision including those lost to follow-up, for the FLSS, THA and TKA cohorts was n=20 (20.2% - same site (n=7) and adjacent segment(n=13)) requiring 27 operations, n=3 (3% -same site) requiring 5 operations and n=8 (8.1% -same site) requiring 12 operations, respectively (p<0.01). The average time to first revision was 56/65/43 months, respectively. Mean postoperative PCS (p<0.0001) and MCS (p<0.02) improved significantly and was durable for all groups at the last follow-up. The mean change from baseline PCS / MCS to last follow-up, was 8.5 / 6.4, 12.3 /7.0 and 8.3 /4.9 for FLSS, THA and TKA respectively. Adjusting for baseline age, sex, BMI, PCS and MCS, there was a strong trend in favour of greater sustained change in the PCS of THA over FLSS (p=0.07) and TKA (p=0.08). No difference was noted between change in PCS between FLSS and TKA (p=0.95). No differences were noted for change in MCS between all three cohorts (p>0.1).
CONCLUSION: Significant improvements in HRQoL following surgical treatment of FLSS with or without spondylolisthesis, and hip and knee osteoarthritis are sustained for a mean of 7-8 years, with a minimum of 5 years, follow-up. Despite a higher revision rate, patients undergoing surgery for FLSS can expect a comparable long-term average improvement in HRQoL from baseline compared to their peers undergoing TKA and to a lesser extent THA.
Y R Rampersaud; S J Lewis; J R Davey; R Gandhi; N Mahomed
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-7
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  -     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address:
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