Koenders N1, Rushton A2, Verra ML3, Willems PC4, Hoogeboom TJ5, Staal JB5,6
1Radboud University Medical Center, Orthopaedics Department - Physical Therapy, Nijmegen, Netherlands, 2University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain, Birmingham, United Kingdom, 3Bern University Hospital, Department of Physiotherapy, Bern, Switzerland, 4Maastricht University, Orthopaedics Department, Maastricht, Netherlands, 5Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands, 6HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands
Background: Lumbar spinal fusion (LSF) is frequently and increasingly used in lumbar degenerative disorders despite conflicting results and recommendations. A thorough understanding of patient outcomes after LSF is required to inform decisions regarding surgery and to improve post-surgery management.
Purpose: The current study aims to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine after first-time LSF.
Methods: A systematic review and meta-analysis of pain and disability outcomes in prospective cohort studies up to 31 March 2017 is identified in four electronic databases. Two independent researchers determined study eligibility, extracted data, and assessed risk of bias (modified Quality in Prognostics tool). A random effects model (maximum likelihood) was used to calculate means and 95% confidence intervals. The primary analysis was performed on complete data, and a sensitivity analysis was performed on all data.
Results: Twenty-five studies (n = 1777 participants) were included. The mean (95% confidence interval) Visual Analogue Scale (VAS) back pain (n = 9 studies) decreased from 64 (57-71) pre-surgery to 20 (16-24) at 24-month follow-up. Leg pain (n = 9 studies) improved from VAS 70 (65-74) pre-surgery to 17 (12-23) at 24-month interval. Disability (n = 12 studies), measured with the Oswestry Disability Index, decreased from 44.8 (40.1-49.4) pre-surgery to 17.3 (11.9-22.8) at 24-month follow-up. The sensitivity analysis yielded similar results.
Conclusion(s): There is a substantial improvement in pain and disability after first-time LSF for degenerative disorders. However, long-term outcomes indicate that leg pain might be more reduced and for a longer period of time than axial back pain and disability.
Implications: A clinically meaningful result might be expected after first-time LSF in patients with degenerative lumbar disorders and predominant leg pain. In patients with predominant back pain, more caution seems needed.
Keywords: Spinal fusion, Pain, Disability
Funding acknowledgements: No sources of support or funding were provided for this study.
Purpose: The current study aims to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine after first-time LSF.
Methods: A systematic review and meta-analysis of pain and disability outcomes in prospective cohort studies up to 31 March 2017 is identified in four electronic databases. Two independent researchers determined study eligibility, extracted data, and assessed risk of bias (modified Quality in Prognostics tool). A random effects model (maximum likelihood) was used to calculate means and 95% confidence intervals. The primary analysis was performed on complete data, and a sensitivity analysis was performed on all data.
Results: Twenty-five studies (n = 1777 participants) were included. The mean (95% confidence interval) Visual Analogue Scale (VAS) back pain (n = 9 studies) decreased from 64 (57-71) pre-surgery to 20 (16-24) at 24-month follow-up. Leg pain (n = 9 studies) improved from VAS 70 (65-74) pre-surgery to 17 (12-23) at 24-month interval. Disability (n = 12 studies), measured with the Oswestry Disability Index, decreased from 44.8 (40.1-49.4) pre-surgery to 17.3 (11.9-22.8) at 24-month follow-up. The sensitivity analysis yielded similar results.
Conclusion(s): There is a substantial improvement in pain and disability after first-time LSF for degenerative disorders. However, long-term outcomes indicate that leg pain might be more reduced and for a longer period of time than axial back pain and disability.
Implications: A clinically meaningful result might be expected after first-time LSF in patients with degenerative lumbar disorders and predominant leg pain. In patients with predominant back pain, more caution seems needed.
Keywords: Spinal fusion, Pain, Disability
Funding acknowledgements: No sources of support or funding were provided for this study.
Topic: Musculoskeletal: spine; Disability & rehabilitation; Research methodology & knowledge translation
Ethics approval required: No
Institution: Radboud university medical center
Ethics committee: Commissie Mensgebonden Onderzoek Radboudumc
Reason not required: Literature search, no inclusion of humans.
All authors, affiliations and abstracts have been published as submitted.
