Outcomes of decompression without fusion in patients with lumbar spinal stenosis and substantial back pain

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  • 1 Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup;
  • 2 Department of Clinical Medicine, University of Copenhagen;
  • 3 Department of Orthopedic Surgery, Regionshospitalet Silkeborg;
  • 4 Center for Spine Surgery and Research, Middelfart Hospital, Middelfart; and
  • 5 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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OBJECTIVE

The predominant symptom of lumbar spinal stenosis (LSS) is neurogenic claudication or radicular pain. Some surgeons believe that the presence of substantial back pain is an indication for fusion, and that decompression alone may lead to worsening of back pain from destabilization associated with facet resection. The purpose of this study was to determine if patients with LSS and clinically significant back pain could obtain substantial improvements in back pain after a decompression alone without fusion.

METHODS

The DaneSpine database was used to identify 2737 patients with LSS without segmental instability and a baseline back pain visual analog scale (VAS) score ≥ 50 who underwent a decompression procedure alone without fusion. Standard demographic and surgical variables and patient outcomes, including back and leg pain VAS score (0–100), Oswestry Disability Index (ODI), and EQ-5D at baseline and at 12 months postoperatively, were collected.

RESULTS

A total of 1891 patients (69%) had 12-month follow-up data available for analysis; the mean age was 66.4 years, 860 (46%) were male, the mean BMI was 27.8 kg/m2, and 508 (27%) were current smokers. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for back pain (72.1 to 42.1), leg pain (71.2 to 41.3), EQ-5D (0.35 to 0.61), and ODI (44.1 to 27.8).

CONCLUSIONS

Patients with LSS, clinically substantial back pain, and no structural instability obtain improvement in back pain after decompression-only surgery and do not need a concomitant fusion.

ABBREVIATIONS LSS = lumbar spinal stenosis; MCID = minimal clinically important difference; ODI = Oswestry Disability Index; PRO = patient-reported outcome; VAS = visual analog scale.

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Contributor Notes

Correspondence Rachid Bech-Azeddine: Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark. rbechazeddine@dadlnet.dk.

INCLUDE WHEN CITING Published online January 22, 2021; DOI: 10.3171/2020.8.SPINE20684.

Disclosures Dr. Andersen receives consulting fees from Cerapedics, outside the submitted work. Dr. Carreon is a member of the University of Louisville Institutional Review Board; is on the Editorial Advisory Board of Spine, The Spine Journal, and Spine Deformity; receives consulting fees from the National Spine Health Foundation; and receives a salary from Norton Healthcare and the University of Southern Denmark. Researchers and PhD students affiliated with The Center for Spine Surgery and Research received financial support from Lillebælt Hospital Research Council, Lillebælt Hospital Development Council, SDU Faculty Scholarship, The Gangsted Foundation, Danish Rheumatism Association, Region of Southern Denmark’s Ph.D. Pool, Region of Southern Denmark’s Research Fund, Region Zealand and Region of Southern Denmark’s Joint Research Fund, Independent Research Fund Denmark, A.P. Møller Foundation for the Promotion of Medicine, Inger Goldmann’s Fund, IMK General Fund, Aase and Ejnar Danielsen’s Fund, Chief Physician Jørgen Werner Schous and wife, Else-Marie Schou, born Wonge’s Fund, Cerapedics, Foundation for the Promotion of Chiropractic Research and Postgraduate Education, Eli Lilly, Kroghs Scholarship, Ortotech, and the Guildal Foundation.

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