PMID- 20739917
OWN - NLM
STAT- MEDLINE
DCOM- 20110609
LR  - 20151119
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 36
IP  - 4
DP  - 2011 Feb 15
TI  - Health-related quality of life improvements in patients undergoing lumbar spinal 
      fusion as a revision surgery.
PG  - 269-76
LID - 10.1097/BRS.0b013e3181cf1091 [doi]
AB  - STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To investigate 
      health-related quality of life improvements in patients undergoing lumbar fusion 
      to revise a previous lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Spinal 
      fusion is often used as a surgical intervention in patients who have previously 
      undergone lumbar surgery. Prior studies suggest results that are inferiorto 
      primary fusions. However, most of these studies are based on subjective surgeon 
      evaluations, lack patient-reported outcomes, and include various diagnoses such 
      as prior discectomy, adjacent level degeneration, and nonunion. METHODS: From a 
      single-center database, we identified 171 patients who underwent lumbar fusion to 
      revise a previous lumbar spine surgery. All had prospectively collected outcome 
      measures at a minimum 2-year follow-up. The study group included 91 patients who 
      had previous discectomy or laminectomy, 42 patients undergoing revision for 
      adjacent segment degeneration (ASD) and 38 patients undergoing revision for 
      nonunion. All patients completed the Oswestry Disability Index (ODI), MOS Short 
      Form 36 (SF-36), and back and leg pain numerical rating scores before surgery and 
      at 1 and 2 years after surgery. We compared mean changes in outcome measures and 
      percentage of patients reaching the minimum clinically important difference 
      (MCID) threshold in the 3 groups. Logistic regression analysis was performed to 
      identify preoperative factors which could predict significant improvement. 
      RESULTS: Statistically significant improvements were noted in back pain, leg 
      pain, and ODI in all 3 groups. Postdecompression and ASD patients demonstrated 
      significant improvements in SF-36 PCS at 2 years, while nonunion patients did 
      not. A total of 49% of postdecompression patients, 38% of ASD patients, and 29% 
      of nonunion patients reached the MCID for ODI. About 46% of postdecompression 
      patients, 40% of ASD patients, and 24% of nonunion patients reached the MCID for 
      SF-36 PCS. Significant improvement from index surgery was the only factor which 
      able to predict reaching the MCID for ODI, while worker's compensation and 
      narcotic use predicted failure to reach the MCID for SF-36 PCS. CONCLUSION: The 
      current study demonstrates that patients undergoing lumbar fusion as a revision 
      of a prior lumbar surgery can expect only modest improvements in health-related 
      quality of life. Postdecompression patients achieved moderate improvements in 
      clinical outcome measures, whereas ASD and nonunion patients showed only modest 
      improvements. Further investigation is needed to identify preoperative predictors 
      that will assist the selection of patients who will benefit from revision lumbar 
      fusion.
FAU - Djurasovic, Mladen
AU  - Djurasovic M
AD  - Norton Leatherman Center, Louisville, KY, USA.
FAU - Glassman, Steven D
AU  - Glassman SD
FAU - Howard, Jennifer M
AU  - Howard JM
FAU - Copay, Anne G
AU  - Copay AG
FAU - Carreon, Leah Y
AU  - Carreon LY
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Health Status
MH  - Humans
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Middle Aged
MH  - *Quality of Life
MH  - Reoperation
MH  - Retrospective Studies
MH  - Spinal Fusion/*methods
MH  - *Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2010/08/27 06:00
MHDA- 2011/06/10 06:00
CRDT- 2010/08/27 06:00
PHST- 2010/08/27 06:00 [entrez]
PHST- 2010/08/27 06:00 [pubmed]
PHST- 2011/06/10 06:00 [medline]
AID - 10.1097/BRS.0b013e3181cf1091 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2011 Feb 15;36(4):269-76. doi: 
      10.1097/BRS.0b013e3181cf1091.