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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(06): 766-771
DOI: 10.1055/s-0041-1724083
Artigo Original
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Lumbar Decompression Versus Spinal Fusion in a Private Outpatient Setting: A Retrospective Study with Three Years of Follow-up[*]

Article in several languages: português | English
Isadora Orlando de Oliveira 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
2   Instituto Wilson Mello, Campinas, SP, Brasil
,
Mario Lenza 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Eliane Antonioli 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Mario Ferretti 
1   Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Abstract

Objective To compare pain, function, quality of life and adverse events of lumbar decompression and spinal fusion in patients with degenerative spinal pathologies who participated in a second opinion program for spinal surgeries with a 36-month follow-up.

Methods The data for this retrospective cohort were withdrawn from a private healthcare system between June 2011 and January 2014. The study sample consisted of 71 patients with a lumbar spine surgical referral. The outcomes for the comparisons between lumbar decompression and spinal fusion were quality of life (evaluated through the EuroQoL 5D), pain (measured by the Numerical Rating Scale) and function (assessed through the Roland Morris Disability Questionnaire) measured at baseline, and at 12 and 36 months after the surgical procedures. The definitions of recovery were established by the minimal clinically important difference (MCID). The baseline differences between the groups were analyzed by non-paired t-test, and the differences in instrument scores between time points, by generalized mixed models. The results were presented as mean values adjusted by the models and 95% confidence intervals.

Results Concerning the surgical techniques, 22 patients were submitted to spinal fusion and 49 patients, to lumbar decompression. As for the comparisons of the findings before and after the surgical interventions, the MCID was achieved in all outcomes regarding quality of life, pain and function at both time points when compared to baseline scores Moreover, concerning the complication rates, only lumbar decompression presented a surgical rate of 4% (n = 3) for recurrence of lumbar disc hernia.

Conclusion Patients with degenerative spinal pathologies present improvements in long-term outcomes of pain, function and quality of life which are clinically significant, no matter the surgical intervention.

Keywords

outcome assessment, health care - musculoskeletal diseases - back pain - spine - surgical interventions

Authors' Contributions

All authors conceived the study. IOO chose the study design, and ML, EA and MF helped with the final version of the manuscript. IOO and EA were involved in the statistical analysis. All authors contributed to the refinement of the study and approved the final manuscript.


Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Work developed at the Department of Orthopedics and Traumatology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.




Publication History

Received: 24 July 2020

Accepted: 17 September 2020

Article published online:
11 September 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Gakidou E, Afshin A, Abajobir AA. et al. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390 (10100): 1345-1422
    CrossrefPubMedGoogle Scholar
  • 2 Kaiser MG, Eck JC, Groff MW. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: introduction and methodology. J Neurosurg Spine 2014; 21 (01) 2-6
    CrossrefPubMedGoogle Scholar
  • 3 Jain N, Acharya S, Adsul NM. et al. Lumbar Canal Stenosis: A Prospective Clinicoradiologic Analysis. J Neurol Surg A Cent Eur Neurosurg 2020; 81 (05) 387-391
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Verbiest H. A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 1954; 36 (02) 230-237
    CrossrefPubMedGoogle Scholar
  • 5 Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; 2016 (01) CD010264
    PubMedGoogle Scholar
  • 6 Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM. Lumbar spinal stenosis: syndrome, diagnostics and treatment. Nat Rev Neurol 2009; 5 (07) 392-403
    CrossrefPubMedGoogle Scholar
  • 7 Barrick WT, Schofferman JA, Reynolds JB. et al. Anterior lumbar fusion improves discogenic pain at levels of prior posterolateral fusion. Spine (Phila Pa 1976) 2000; 25 (07) 853-857
    CrossrefPubMedGoogle Scholar
  • 8 Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis F. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976) 2013; 38 (07) E409-E422
    CrossrefPubMedGoogle Scholar
  • 9 Fritzell P, Hägg O, Wessberg P, Nordwall A. Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 2002; 27 (11) 1131-1141
    CrossrefPubMedGoogle Scholar
  • 10 Arai Y, Takahashi M, Kurosawa H, Shitoto K. Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion. J Orthop Surg (Hong Kong) 2002; 10 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 11 Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine 2005; 30 (20) 2312-2320
    CrossrefPubMedGoogle Scholar
  • 12 Kim KT, Lee SH, Lee YH, Bae SC, Suk KS. Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine (Phila Pa 1976) 2006; 31 (12) 1351-1357
    CrossrefPubMedGoogle Scholar
  • 13 Miyauchi A. Decompression Alone is Effective in Lumbar Spinal Stenosis with Degenerative Spondylolisthesis. Spine J 2012; 12 (09) S92-S93
    CrossrefGoogle Scholar
  • 14 Miller JW, Sasso RC. Lumbar extraforaminal decompression: A technical note and retrospective study looking at potential complications as an outpatient procedure. SAS J 2011; 5 (01) 4-8
    CrossrefPubMedGoogle Scholar
  • 15 Deyo RA, Mirza SK, Martin BI. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2011; 306 (10) 1088
    CrossrefPubMedGoogle Scholar
  • 16 Costa LO, Maher CG, Latimer J. et al. Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best?. Spine (Phila Pa 1976) 2008; 33 (22) 2459-2463
    CrossrefPubMedGoogle Scholar
  • 17 EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (03) 199-208
    CrossrefPubMedGoogle Scholar
  • 18 Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris. Braz J Med Biol Res 2001; 34 (02) 203-210
    CrossrefPubMedGoogle Scholar
  • 19 Grotle M, Brox JI, Vøllestad NK. Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain. Spine (Phila Pa 1976) 2004; 29 (21) E492-E501
    CrossrefPubMedGoogle Scholar
  • 20 Soer R, Reneman MF, Speijer BL, Coppes MH, Vroomen PC. Clinimetric properties of the EuroQol-5D in patients with chronic low back pain. Spine J 2012; 12 (11) 1035-1039
    CrossrefPubMedGoogle Scholar
  • 21 Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 2005; 30 (11) 1331-1334
    CrossrefPubMedGoogle Scholar
  • 22 Stratford PW, Binkley J, Solomon P, Finch E, Gill C, Moreland J. Defining the minimum level of detectable change for the Roland-Morris questionnaire. Phys Ther 1996; 76 (04) 359-365
    CrossrefPubMedGoogle Scholar
  • 23 Alentado VJ, Caldwell S, Gould HP, Steinmetz MP, Benzel EC, Mroz TE. Independent predictors of a clinically significant improvement after lumbar fusion surgery. Spine J 2017; 17 (02) 236-243
    CrossrefPubMedGoogle Scholar
  • 24 Soegaard R, Christensen FB, Christiansen T, Bünger C. Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J 2007; 16 (05) 657-668
    CrossrefPubMedGoogle Scholar
  • 25 Machado GC, Maher CG, Ferreira PH. et al. Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2017; 42 (22) 1737-1743
    CrossrefPubMedGoogle Scholar
  • 26 Camino Willhuber G, Kido G, Mereles M. et al. Factors associated with lumbar disc hernia recurrence after microdiscectomy. Rev Esp Cir Ortop Traumatol 2017; 61 (06) 397-403
    PubMedGoogle Scholar
  • 27 Piper K, DeAndrea-Lazarus I, Algattas H. et al. Risk Factors Associated with Readmission and Reoperation in Patients Undergoing Spine Surgery. World Neurosurg 2018; 110: e627-e635
    CrossrefPubMedGoogle Scholar
  • 28 Oliveira IO, Lenza M, Vasconcelos RA, Antonioli E, Cendoroglo Neto M, Ferretti M. Second opinion programs in spine surgeries: an attempt to reduce unnecessary care for low back pain patients. Braz J Phys Ther 2019; 23 (01) 1-2
    CrossrefPubMedGoogle Scholar
  • 29 Gaudin D, Krafcik BM, Mansour TR, Alnemari A. Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain: Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A Review of the Literature. World Neurosurg 2017; 98: 21-27
    CrossrefPubMedGoogle Scholar
  • 30 Martin BI, Deyo RA, Mirza SK. et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299 (06) 656-664
    CrossrefPubMedGoogle Scholar
  • 31 Martin BI, Mirza SK, Franklin GM, Lurie JD, MacKenzie TA, Deyo RA. Hospital and surgeon variation in complications and repeat surgery following incident lumbar fusion for common degenerative diagnoses. Health Serv Res 2013; 48 (01) 1-25
    CrossrefPubMedGoogle Scholar