TY - JOUR

T1 - Lumbar spinal stenosis

T2 - comparison of surgical practice variation and clinical outcome in three national spine registries

AU - Lønne, Greger

AU - Fritzell, Peter

AU - Hägg, Olle

AU - Nordvall, Dennis

AU - Gerdhem, Paul

AU - Lagerbäck, Tobias

AU - Andersen, Mikkel

AU - Eiskjaer, Søren

AU - Gehrchen, Martin

AU - Jacobs, Wilco

AU - van Hooff, Miranda L.

AU - Solberg, Tore K.

PY - 2019/1

Y1 - 2019/1

N2 - Background Context: Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains controversial, resulting in practice-based variation. Purpose: The present study aimed to evaluate in a pragmatic study if surgical selection criteria and variation in use of arthrodesis in three Scandinavian countries can be linked to variation in treatment effectiveness. Study Design: This is an observational study based on a combined cohort from the national spine registries of Norway, Sweden, and Denmark. Patient Sample: Patients aged 50 and older operated during 2011–2013 for LSS were included. Outcome Measures: Patient-Reported Outcome Measures (PROMs): Oswestry Disability Index (ODI) (primary outcome), Numeric Rating Scale (NRS) for leg pain and back pain, and health-related quality of life (Euro-Qol-5D) were reported. Analysis included case-mix adjustment. In addition, we report differences in hospital stay. Methods: Analyses of baseline data were done by analysis of variance (ANOVA), chi-square, or logistic regression tests. The comparisons of the mean changes of PROMs at 1-year follow-up between the countries were done by ANOVA (crude) and analysis of covariance (case-mix adjustment). Results: Out of 14,223 included patients, 10,890 (77%) responded at 1-year follow-up. Apart from fewer smokers in Sweden and higher comorbidity rate in Norway, baseline characteristics were similar. The rate of additional fusion surgery (patients without or with spondylolisthesis) was 11% (4%, 47%) in Norway, 21% (9%, 56%) in Sweden, and 28% (15%, 88%) in Denmark. At 1-year follow-up, the mean improvement for ODI (95% confidence interval) was 18 (17–18) in Norway, 17 (17–18) in Sweden, and 18 (17–19) in Denmark. Patients operated with arthrodesis had prolonged hospital stay. Conclusions: Real-life data from three national spine registers showed similar indications for decompression surgery but significant differences in the use of concomitant arthrodesis in Scandinavia. Additional arthrodesis was not associated with better treatment effectiveness.

AB - Background Context: Decompression surgery for lumbar spinal stenosis (LSS) is the most common spinal procedure in the elderly. To avoid persisting low back pain, adding arthrodesis has been recommended, especially if there is a coexisting degenerative spondylolisthesis. However, this strategy remains controversial, resulting in practice-based variation. Purpose: The present study aimed to evaluate in a pragmatic study if surgical selection criteria and variation in use of arthrodesis in three Scandinavian countries can be linked to variation in treatment effectiveness. Study Design: This is an observational study based on a combined cohort from the national spine registries of Norway, Sweden, and Denmark. Patient Sample: Patients aged 50 and older operated during 2011–2013 for LSS were included. Outcome Measures: Patient-Reported Outcome Measures (PROMs): Oswestry Disability Index (ODI) (primary outcome), Numeric Rating Scale (NRS) for leg pain and back pain, and health-related quality of life (Euro-Qol-5D) were reported. Analysis included case-mix adjustment. In addition, we report differences in hospital stay. Methods: Analyses of baseline data were done by analysis of variance (ANOVA), chi-square, or logistic regression tests. The comparisons of the mean changes of PROMs at 1-year follow-up between the countries were done by ANOVA (crude) and analysis of covariance (case-mix adjustment). Results: Out of 14,223 included patients, 10,890 (77%) responded at 1-year follow-up. Apart from fewer smokers in Sweden and higher comorbidity rate in Norway, baseline characteristics were similar. The rate of additional fusion surgery (patients without or with spondylolisthesis) was 11% (4%, 47%) in Norway, 21% (9%, 56%) in Sweden, and 28% (15%, 88%) in Denmark. At 1-year follow-up, the mean improvement for ODI (95% confidence interval) was 18 (17–18) in Norway, 17 (17–18) in Sweden, and 18 (17–19) in Denmark. Patients operated with arthrodesis had prolonged hospital stay. Conclusions: Real-life data from three national spine registers showed similar indications for decompression surgery but significant differences in the use of concomitant arthrodesis in Scandinavia. Additional arthrodesis was not associated with better treatment effectiveness.

KW - Case-mix adjustment

KW - Decompressive surgery

KW - Lumbar spinal stenosis

KW - Spine arthrodesis

KW - Spine fusion

KW - Spine registry

U2 - 10.1016/j.spinee.2018.05.028

DO - 10.1016/j.spinee.2018.05.028

M3 - Journal article

C2 - 29792994

AN - SCOPUS:85047966757

VL - 19

SP - 41

EP - 49

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 1

ER -