Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy ; Clinical article

Owoicho Adogwa, Ricardo K. Carr, Katherine Kudyba, Isaac Karikari, Carlos A. Bagley, Ziya L. Gokaslan, Nicholas Theodore, Joseph S. Cheng

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2013

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Pseudarthrosis
Reoperation
Pathologic Constriction
Back Pain
Decompression
Health Surveys
Spine
Depression
Narcotics
Pain Measurement
Low Back Pain
Health Status
Leg
Mental Health
Quality of Life
Databases
Pain
Therapeutics

Keywords

  • Adjacent-segment disease
  • Elderly patient
  • Functional neurosurgery
  • Pseudarthrosis
  • Revision lumbar surgery
  • Same-level recurrent stenosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy ; Clinical article. / Adogwa, Owoicho; Carr, Ricardo K.; Kudyba, Katherine; Karikari, Isaac; Bagley, Carlos A.; Gokaslan, Ziya L.; Theodore, Nicholas; Cheng, Joseph S.

In: Journal of Neurosurgery: Spine, Vol. 18, No. 2, 01.02.2013, p. 139-146.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Carr, Ricardo K. ; Kudyba, Katherine ; Karikari, Isaac ; Bagley, Carlos A. ; Gokaslan, Ziya L. ; Theodore, Nicholas ; Cheng, Joseph S. / Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy ; Clinical article. In: Journal of Neurosurgery: Spine. 2013 ; Vol. 18, No. 2. pp. 139-146.
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abstract = "Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.",
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author = "Owoicho Adogwa and Carr, {Ricardo K.} and Katherine Kudyba and Isaac Karikari and Bagley, {Carlos A.} and Gokaslan, {Ziya L.} and Nicholas Theodore and Cheng, {Joseph S.}",
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T1 - Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy ; Clinical article

AU - Adogwa, Owoicho

AU - Carr, Ricardo K.

AU - Kudyba, Katherine

AU - Karikari, Isaac

AU - Bagley, Carlos A.

AU - Gokaslan, Ziya L.

AU - Theodore, Nicholas

AU - Cheng, Joseph S.

PY - 2013/2/1

Y1 - 2013/2/1

N2 - Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.

AB - Object. Same-level recurrent lumbar stenosis, pseudarthrosis, and adjacent-segment disease (ASD) are potential complications that can occur after index lumbar spine surgery, leading to significant discomfort and radicular pain. While numerous studies have demonstrated excellent results following index lumbar spine surgery in elderly patients (age > 65 years), the effectiveness of revision lumbar surgery in this cohort remains unclear. The aim of this study was to assess the long-term effectiveness of revision lumbar decompression and fusion in the treatment of symptomatic pseudarthrosis, ASD, and samelevel recurrent stenosis, using validated patient-reported outcomes. Methods. After a review of the institutional database, 69 patients who had undergone revision neural decompression and instrumented fusion for ASD (28 patients), pseudarthrosis (17 patients), or same-level recurrent stenosis (24 patients) were included in this study. Baseline and 2-year scores on the visual analog scale for leg pain (VAS-LP), VAS for back pain (VAS-BP), Oswestry Disability Index (ODI), and Zung Self-Rating Depression Scale (SDS) as well as the time to narcotic independence, time to return to baseline activity level, health state utility (EQ-5D, the EuroQol-5D health survey), and physical and mental component summary scores of the 12-Item Short-Form Health Survey (SF-12 PCS and MCS) were assessed. Results. Compared with the preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (mean ±standard deviation±9 ±2 vs 4.01 ±2.56, p = 0.001), pseudarthrosis (7.41 ±1 vs 5.52 ±3.08, p = 0.02), and same-level recurrent stenosis (7 ±2.00 vs 5.00 ±2.34, p = 0.003). The 2-year ODI was also significantly improved after surgery for ASD (29 ±9 vs 23.10 ±10.18, p = 0.001), pseudarthrosis (28.47 ±5.85 vs 24.41 ±7.75, p = 0.001), and same-level recurrent stenosis (30.83 ±5.28 vs 26.29 ±4.10, p = 0.003). The Zung SDS score and SF-12 MCS did not change appreciably after surgery in any of the cohorts, with an overall mean 2-year change of 1.01 ±5.32 (p = 0.46) and 2.02 ±9.25 (p = 0.22), respectively. Conclusions. Data in this study suggest that revision lumbar decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis provides improvement in low-back pain, disability, and quality of life and should be considered a viable treatment option for elderly patients with persistent or recurrent back and radicular pain. Mental health symptoms may be more refractory to revision surgery.

KW - Adjacent-segment disease

KW - Elderly patient

KW - Functional neurosurgery

KW - Pseudarthrosis

KW - Revision lumbar surgery

KW - Same-level recurrent stenosis

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