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

Author:

Bech-Azeddine Rachid12,Fruensgaard Søren3,Andersen Mikkel45,Carreon Leah Y.45

Affiliation:

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

Abstract

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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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