Patients undergoing surgery for lumbar spinal stenosis experience unique courses of pain and disability: A group-based trajectory analysis

Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes. We recruited patients with degenerative lumbar s...

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Bibliographic Details
Published in:PloS one 2019-11, Vol.14 (11), p.e0224200-e0224200
Main Authors: Hebert, Jeffrey J, Abraham, Edward, Wedderkopp, Niels, Bigney, Erin, Richardson, Eden, Darling, Mariah, Hall, Hamilton, Fisher, Charles G, Rampersaud, Y Raja, Thomas, Kenneth C, Jacobs, Bradley, Johnson, Michael, Paquet, Jerome, Attabib, Najmedden, Jarzem, Peter, Wai, Eugene K, Rasoulinejad, Parham, Ahn, Henry, Nataraj, Andrew, Stratton, Alexandra, Manson, Neil
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Back pain
Biology and Life Sciences
Bone surgery
Disabilities
Disability Evaluation
Disabled Persons
Female
Health care networks
Hospitals
Humans
Leg
Lumbar Vertebrae - physiopathology
Lumbar Vertebrae - surgery
Male
Medicine
Medicine and Health Sciences
Middle Aged
Neurosurgery
Pain
Pain - etiology
Pain - physiopathology
Pain management
Pain Measurement - methods
Patients
People and Places
Research and Analysis Methods
Social Sciences
Spinal stenosis
Spinal Stenosis - complications
Spinal Stenosis - physiopathology
Spinal Stenosis - surgery
Spine
Spine (lumbar)
Spondylolisthesis - complications
Spondylolisthesis - physiopathology
Spondylolisthesis - surgery
Stenosis
Studies
Subgroups
Surgery
Systematic review
Trajectory analysis
Treatment Outcome
University faculty
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Description
Summary:Identify patient subgroups defined by trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis, and investigate the construct validity of the subgroups by evaluating for meaningful differences in clinical outcomes. We recruited patients with degenerative lumbar spinal stenosis from 13 surgical spine centers who were deemed to be surgical candidates. Study outcomes (leg and back pain numeric rating scales, modified Oswestry disability index) were measured before surgery, and after 3, 12, and 24 months. Group-based trajectory models were developed to identify trajectory subgroups for leg pain, back pain, and pain-related disability. We examined for differences in the proportion of patients achieving minimum clinically important change in pain and disability (30%) and clinical success (50% reduction in disability or Oswestry score ≤22) 12 months from surgery. Data from 548 patients (mean[SD] age = 66.7[9.1] years; 46% female) were included. The models estimated 3 unique trajectories for leg pain (excellent outcome = 14.4%, good outcome = 49.5%, poor outcome = 36.1%), back pain (excellent outcome = 13.1%, good outcome = 45.0%, poor outcome = 41.9%), and disability (excellent outcome = 30.8%, fair outcome = 40.1%, poor outcome = 29.1%). The construct validity of the trajectory subgroups was confirmed by between-trajectory group differences in the proportion of patients meeting thresholds for minimum clinically important change and clinical success after 12 postoperative months (p < .001). Subgroups of patients with degenerative lumbar spinal stenosis can be identified by their trajectories of pain and disability following surgery. Although most patients experienced important reductions in pain and disability, 29% to 42% of patients were classified as members of an outcome trajectory subgroup that experienced little to no benefit from surgery. These findings may inform appropriate expectation setting for patients and clinicians and highlight the need for better methods of treatment selection for patients with degenerative lumbar spinal stenosis.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0224200