PMID- 22122836
OWN - NLM
STAT- MEDLINE
DCOM- 20120326
LR  - 20220321
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 11
IP  - 11
DP  - 2011 Nov
TI  - Postoperative improvement in health-related quality of life: a national 
      comparison of surgical treatment for focal (one- to two-level) lumbar spinal 
      stenosis compared with total joint arthroplasty for osteoarthritis.
PG  - 1033-41
LID - 10.1016/j.spinee.2011.10.011 [doi]
AB  - BACKGROUND CONTEXT: The results of single-center studies have shown that surgical 
      intervention for lumbar spinal stenosis yielded comparable health-related quality 
      of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these 
      results are generalizable to routine clinical practice in Canada is unknown. 
      PURPOSE: The primary purpose of this equivalence study was to compare the 
      relative improvement in physical HRQoL after surgery for focal lumbar spinal 
      stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six 
      Canadian centers. STUDY DESIGN/SETTING: A Canadian multicenter ambispective 
      cohort study. PATIENT SAMPLE: A cohort of 371 primary one- to two-level spinal 
      decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative 
      lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip 
      (n=156) and knee (n=208) arthroplasty for OA. OUTCOME MEASURES: The primary 
      outcome was the change in preoperative to 2-year postoperative 36-Item Short Form 
      Health Survey Physical Component Summary (PCS) score as reflected by the number 
      of patients reaching minimal clinically important difference (MCID) and 
      substantial clinical benefit (SCB). METHODS: Univariate analyses were conducted 
      to identify baseline differences and factors that were significantly related to 
      outcomes at 2 years. Multivariable regression modeling was used as our primary 
      analysis to compare outcomes between groups. RESULTS: The mean age (years) and 
      percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, 
      and 65.8/64.3, respectively. All three groups experienced significant improvement 
      of baseline PCS (p<.001). Multivariate analyses, adjusting for baseline 
      differences (age, gender, baseline Mental Component Summary score, baseline PCS), 
      demonstrated no significant differences in PCS outcome between spinal surgery and 
      arthroplasty (combined hip and knee cohorts) patients with an odds ratio of 0.80 
      (95% confidence interval [CI], 0.57-1.11; p=.17) and 0.79 (95% CI, 0.58-1.09; 
      p=.15) for achieving MCID or SCB, respectively. In subgroup analysis, spine and 
      knee outcomes were not significantly different, with hip arthroplasty superior to 
      both (p<.0001). CONCLUSIONS: Significant improvement in physical HRQoL after 
      surgical treatment of FLSS (including DLS) is consistently achieved nationally. 
      Our overall results demonstrate that a comparable number of patients can expect 
      to achieve MCID and SCB 2 years after surgical intervention for FLSS and total 
      knee arthroplasty.
CI  - Copyright (c) 2011 Elsevier Inc. All rights reserved.
FAU - Rampersaud, Y Raja
AU  - Rampersaud YR
AD  - Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, 
      University of Toronto, Toronto Western Hospital, University Health Network, 
      Toronto, Ontario, Canada. raja.rampersaud@uhn.on.ca
FAU - Wai, Eugene K
AU  - Wai EK
FAU - Fisher, Charles G
AU  - Fisher CG
FAU - Yee, Albert J M
AU  - Yee AJ
FAU - Dvorak, Marcel F S
AU  - Dvorak MF
FAU - Finkelstein, Joel A
AU  - Finkelstein JA
FAU - Gandhi, Rajiv
AU  - Gandhi R
FAU - Abraham, Edward P
AU  - Abraham EP
FAU - Lewis, Stephen J
AU  - Lewis SJ
FAU - Alexander, David I
AU  - Alexander DI
FAU - Oxner, William M
AU  - Oxner WM
FAU - Davey, J R
AU  - Davey JR
FAU - Mahomed, Nizar
AU  - Mahomed N
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Aged
MH  - Arthroplasty, Replacement, Hip/*statistics & numerical data
MH  - Arthroplasty, Replacement, Knee/*statistics & numerical data
MH  - Canada
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Osteoarthritis/*surgery
MH  - Outcome Assessment, Health Care
MH  - *Quality of Life
MH  - Spinal Fusion/*statistics & numerical data
MH  - Spinal Stenosis/*surgery
MH  - Treatment Outcome
EDAT- 2011/11/30 06:00
MHDA- 2012/03/27 06:00
CRDT- 2011/11/30 06:00
PHST- 2011/02/10 00:00 [received]
PHST- 2011/07/20 00:00 [revised]
PHST- 2011/10/22 00:00 [accepted]
PHST- 2011/11/30 06:00 [entrez]
PHST- 2011/11/30 06:00 [pubmed]
PHST- 2012/03/27 06:00 [medline]
AID - S1529-9430(11)01329-5 [pii]
AID - 10.1016/j.spinee.2011.10.011 [doi]
PST - ppublish
SO  - Spine J. 2011 Nov;11(11):1033-41. doi: 10.1016/j.spinee.2011.10.011.