| Risk for Adjacent Segment and Same Segment Reoperation After Surgery for Lumbar Stenosis: A subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). | |
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MedLine Citation:
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PMID: 23154835 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT: Study Design. Subgroup analysis of prospective, randomized database.Objective. The purpose of this study was to compare surgical or patient characteristics, such as fusion, instrumentation, or obesity, to identify whether these factors were associated with increased risk of reoperation for spinal stenosis. This prognostic information would be valuable to patients, healthcare professionals, and society as strategies to reduce reoperation, such as motion preservation, are developed.Summary of Background Data. Reoperation due to recurrence of index level pathology or adjacent segment disease is a common clinical problem. Despite multiple studies on the incidence of reoperation, there have been few comparative studies establishing risk factors of reoperation after spinal stenosis surgery. The hypothesis of this subgroup analysis was that lumbar fusion or particular patient characteristics, such as obesity, would render patients with lumbar stenosis more susceptible to reoperation at the index or adjacent levels.Methods. The study population combined the randomized and observational cohorts enrolled in SPORT for treatment of spinal stenosis. The surgically treated patients were stratified according to those who had reoperation (n = 54) or no-reoperation (n = 359). Outcome measures were assessed at baseline, 1 year, 2 years, 3 years, and 4 years. The difference in improvement between those who had reoperation and those who did not was determined at each follow-period.Results. Of the 413 patients who underwent surgical treatment for spinal stenosis, 54 patients had a reoperation within four years. At baseline, there were no significant differences in demographic characteristics or clinical outcome scores between reoperation and non-reoperation groups. Furthermore, between groups there were no differences in the severity of symptoms, obesity, physical examination signs, levels of stenosis, location of stenosis, stenosis severity, levels of fusion, levels of laminectomy, levels decompressed, operation time, intraoperative or postoperative complications. There was an increased percentage of patients with duration of symptoms greater than 12 months in the reoperation group (56% reoperation vs 36% no-reoperation, p<0.008).At final follow-up, there was significantly less improvement in the outcome of the reoperation group in SF36 PF (14.4 vs 22.6, p < 0.05), ODI (-12.4 vs. -21.1, p < 0.01), and Sciatica Bothersomeness Index (-5 vs -8.1, p < 0.006).Conclusion. Lumbar fusion and instrumentation were not associated with increased rate of reoperation at index or adjacent levels compared to nonfusion techniques. The only specific risk factor for reoperation after treatment of spinal stenosis was duration of pretreatment symptoms > 12 months. The overall incidence of reoperations for spinal stenosis surgery was 13% and reoperations were equally distributed between index and adjacent lumbar levels. Reoperation may be related to the natural history of spinal degenerative disease. |
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Authors:
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K Radcliff; P Curry; A Hilibrand; C Kepler; W Zhao; J Lurie; T Albert; Jn Weinstein |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-11-14 |
Journal Detail:
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Title: Spine Volume: - ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Kris Radcliff, MD, Assistant Professor, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107 Patrick Curry, MD, Orthopedic Resident, Thomas Jefferson University, Philadelphia, PA Alan Hilibrand, MD, Professor, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107 Chris Kepler, MD, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107 Jon Lurie, MD, Dartmouth Medical Center, Dartmouth, NH, Wenyan Zhao, PhD, Dartmouth Medical Center, Dartmouth, NH Todd Albert, MD, Richard H. Rothman Professor and Chairman, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107 James Weinstein, MD, Dartmouth Medical Center, Dartmouth, NH. |
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