PMID- 35803577
OWN - NLM
STAT- MEDLINE
DCOM- 20221004
LR  - 20221027
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 22
IP  - 10
DP  - 2022 Oct
TI  - Characteristics and outcomes of patients undergoing lumbar spine surgery for 
      axial back pain in the Michigan Spine Surgery Improvement Collaborative.
PG  - 1651-1659
LID - S1529-9430(22)00296-0 [pii]
LID - 10.1016/j.spinee.2022.06.013 [doi]
AB  - BACKGROUND CONTEXT: The indications for surgical intervention of axial back pain 
      without leg pain for degenerative lumbar disorders have been limited in the 
      literature, as most study designs allow some degree of leg symptoms in the 
      inclusion criteria. PURPOSE: To determine the outcome of surgery (decompression 
      only vs. fusion) for pure axial back pain without leg pain. STUDY DESIGN/SETTING: 
      Prospectively collected data in the Michigan Spine Surgery Improvement 
      Collaborative (MSSIC). PATIENT SAMPLE: Patients with pure axial back pain without 
      leg pain underwent lumbar spine surgery for primary diagnoses of lumbar disc 
      herniation, lumbar stenosis, and isthmic or degenerative spondylolisthesis </= 
      grade II. OUTCOME MEASURES: Minimally clinically important difference (MCID) for 
      back pain, Numeric Rating Scale of back pain, Patient-Reported Outcomes 
      Measurement Information System Physical Function (PROMIS-PF), MCID of PROMIS-PF, 
      and patient satisfaction on the North American Spine Surgery Patient Satisfaction 
      Index were collected at 90 days, 1 year, and 2 years after surgery. METHODS: 
      Log-Poisson generalized estimating equation models were constructed with 
      patient-reported outcomes as the independent variable, reporting adjusted risk 
      ratios (RR(adj)). RESULTS: Of the 388 patients at 90 days, multi-level versus 
      single level lumbar surgery decreased the likelihood of obtaining a MCID in back 
      pain by 15% (RR(adj)=0.85, p=.038). For every one-unit increase in preoperative 
      back pain, the likelihood for a favorable outcome increased by 8% (RR(adj)=1.08, 
      p<.001). Of the 326 patients at 1 year, symptom duration > 1 year decreased the 
      likelihood of a MCID in back pain by 16% (RR(adj)=0.84, p=.041). The probability 
      of obtaining a MCID in back pain increased by 9% (RR(adj)=1.09, p<.001) for every 
      1-unit increase in baseline back pain score and by 14% for fusions versus 
      decompression alone (RR(adj)=1.14, p=.0362). Of the 283 patients at 2 years, the 
      likelihood of obtaining MCID in back pain decreased by 30% for patients with 
      depression (RR(adj)=0.70, p<.001) and increased by 8% with every one-unit 
      increase in baseline back pain score (RR(adj)=1.08, p<.001). CONCLUSIONS: Only 
      the severity of preoperative back pain was associated with improvement in MCID in 
      back pain at all time points, suggesting that surgery should be considered for 
      selected patients with severe axial pain without leg pain. Fusion surgery versus 
      decompression alone was associated with improved patient-reported outcomes at 1 
      year only, but not at the other time points.
CI  - Copyright (c) 2022. Published by Elsevier Inc.
FAU - Macki, Mohamed
AU  - Macki M
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Hamilton, Travis
AU  - Hamilton T
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Massie, Lara
AU  - Massie L
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Bazydlo, Michael
AU  - Bazydlo M
AD  - Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand 
      Boulevard, Detroit, MI 48202 USA.
FAU - Schultz, Lonni
AU  - Schultz L
AD  - Department of Public Health Sciences, Henry Ford Hospital, 2799 West Grand 
      Boulevard, Detroit, MI 48202 USA.
FAU - Seyfried, Donald
AU  - Seyfried D
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Park, Paul
AU  - Park P
AD  - Department of Neurosurgery, University of Michigan, 1500 East Medical Center 
      Drive #5201, Ann Arbor, MI 48109 USA.
FAU - Aleem, Ilyas
AU  - Aleem I
AD  - Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical 
      Center Drive, Floor 2 Reception B, Ann Arbor, MI 48109 USA.
FAU - Abdulhak, Muwaffak
AU  - Abdulhak M
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Chang, Victor W
AU  - Chang VW
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA.
FAU - Schwalb, Jason M
AU  - Schwalb JM
AD  - Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 
      Detroit, MI 48202 USA. Electronic address: jschwal1@hfhs.org.
LA  - eng
PT  - Journal Article
DEP - 20220706
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Back Pain/etiology/surgery
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - Michigan
MH  - *Spinal Fusion/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Axial
OT  - Back
OT  - Lumbar
OT  - MCID
OT  - NRS
OT  - PROMIS
OT  - Pain
EDAT- 2022/07/09 06:00
MHDA- 2022/10/05 06:00
CRDT- 2022/07/08 19:28
PHST- 2021/09/28 00:00 [received]
PHST- 2022/06/24 00:00 [revised]
PHST- 2022/06/26 00:00 [accepted]
PHST- 2022/07/09 06:00 [pubmed]
PHST- 2022/10/05 06:00 [medline]
PHST- 2022/07/08 19:28 [entrez]
AID - S1529-9430(22)00296-0 [pii]
AID - 10.1016/j.spinee.2022.06.013 [doi]
PST - ppublish
SO  - Spine J. 2022 Oct;22(10):1651-1659. doi: 10.1016/j.spinee.2022.06.013. Epub 2022 
      Jul 6.