Health-related quality-of-life improvement with lumbar fusion in patients with lower-extremity arthritis

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  • Norton Leatherman Spine Center, Louisville, Kentucky
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OBJECTIVE

Lumbar fusion can lead to significant improvements in patient-reported outcomes (PROs) in patients with degenerative conditions. It is unknown whether the presence of hip or knee arthritis confounds the responses of patients to low-back–specific PROs. This study examined PROs with lumbar fusion in patients with concomitant lower-extremity arthritis. The purpose of the current study was to examine whether patients with significant lower-extremity arthritis who undergo lumbar fusion achieve similar improvements in low-back–specific PROs compared to patients without lower-extremity arthritis.

METHODS

Patients were identified from a prospectively enrolled multicenter registry of patients undergoing lumbar fusion surgery for degenerative conditions. Two hundred thirty patients identified with lumbar fusion and who also had concomitant lower-extremity arthritis were propensity matched to 233 patients who did not have lower-extremity arthritis based on age, BMI, sex, smoking status, American Society of Anesthesiologists grade, number of levels fused, and surgical approach. One-year improvement in PROs, numeric rating scales (0–10) for back and leg pain, and the Oswestry Disability Index and EuroQol-5D scores were compared for patients with and without lower-extremity arthritis.

RESULTS

Baseline demographics and preoperative outcome measures did not differ between the two propensity-matched groups with 110 cases each. Patients with concomitant lower-extremity arthritis achieved similar improvement in health-related quality-of-life measures to patients without lower-extremity arthritis, with no significant differences between the groups (p > 0.10).

CONCLUSIONS

The presence of lower-extremity arthritis does not adversely affect the results of lumbar fusion in properly selected patients. Patients with lower-extremity arthritis who undergo lumbar fusion can achieve meaningful improvement in PROs similar to patients without arthritis.

ABBREVIATIONS ASA = American Society of Anesthesiologists; EQ-5D = EuroQol-5D; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; SHAR = Swedish Hip Arthroplasty Registry; Swespine = Swedish Spine Registry.

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Contributor Notes

Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. leah.carreon@nortonhealthcare.org.

INCLUDE WHEN CITING Published online September 4, 2020; DOI: 10.3171/2020.6.SPINE20759.

Disclosures Dr. Djurasovic reports receiving royalties from Medtronic and NuVasive. Dr. Glassman reports being an employee of Norton Healthcare; being a consultant to K2M/Stryker and Medtronic; receiving clinical or research support for the study from NuVasive, Integra, Intellirod, and the International Spine Study Group (ISSG); receiving royalties from Medtronic; and being a past president/chair of the SRS and American Spine Registry. Dr. Gum reports being an employee of Norton Healthcare; being a consultant to Medtronic, Acuity, K2M/Stryker, NuVasive, and Mazor; being on the speakers bureau for DePuy; receiving royalties from Acuity and NuVasive; receiving honoraria from Pacira Pharmaceuticals, Baxter, Broadwater, and the NASS; receiving clinical or research support for the study from Integra, Intellirod Spine, Pfizer, ISSG, NuVasive, and Norton Healthcare; having direct stock ownership in Cingulate Therapeutics; being a patent holder for Medtronic; and being on the Advisory/Editorial Board of K2M/Stryker, Medtronic, and the National Spine Health Foundation. Dr. Crawford reports receiving royalties from Alphatec and being a consultant to DePuy-Synthes, Medtronic, and NuVasive. Dr. Owens reports being a consultant to Medtronic and NuVasive, receiving royalties from NuVasive, and receiving support of non–study-related clinical or research from OREF, ISSG, Pfizer, Intellirod, SRS, Cerapedics, Medtronic, and Alan L. & Jacqueline B. Stuart Spine Research. Dr. Carreon reports being an employee of Norton Healthcare and the University of Southern Denmark; being a consultant for the National Spine Health Foundation; receiving support of non–study-related clinical or research effort from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corp., Intellirod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance; being a member of the Editorial Advisory Board for Spine Deformity, The Spine Journal, and Spine; and being a member of the University of Louisville IRB.

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