Sigita Burneikiene, MD; Alan T. Villavicencio, MD; Alexander Mason, MD; Sharad Rajpal, MD

Transcription

1 The Timing of Surgery and Symptom Resolu6on in Pa6ents Undergoing Transforaminal Lumbar Interbody Fusion for Lumbar Degenera6ve Disc Disease and Radiculopathy Sigita Burneikiene, MD; Alan T. Villavicencio, MD; Alexander Mason, MD; Sharad Rajpal, MD

2 Background Success rates of surgical interventions for lumbar disorders vary significantly depending on multiple factors Duration of symptoms (DOS)? Is there a cutoff time when decompression and fusion surgery becomes less effective in the conditions with chronic nerve compression symptomatology Objective: Analyze if the DOS has any effect on clinical outcomes and primarily resolution of radicular pain in patients undergoing TLIF for painful degenerative disc disease and stenosis with spondylolisthesis

3 Methods Prospective observational study was performed A total of 84 patients were enrolled No previous fusion surgeries One- to three-level TLIF surgery 15 patients (18%) lost to FU Clinical outcome measures Numeric pain scale (back and leg), SF-36 PCS, ODI, satisfaction survey FU: pre- and postoperatively at 3, 6, 12 and 24 months

4 Methods Statistical analysis To emphasize the change in clinical outcome scores, the relevant scores were calculated as the ratio of MCID values and change scores The change scores = baseline scores postoperative scores Multiple regression analyses were conducted to examine relationship of the DOS and MCID ratio values while controlling for independent variables A comparison between groups: Surgery within < 24 months Surgery > 24 months

5 Results < 24 months > 24 months P value N Age 58.4 (37 77) 60.8 (38 77) 0.98 F/M 14/14 25/16 0.5* DOS (mos.) 7.8 (1.5 18) (24 480) - Previous surgeries 5 (18%) 9 (22%) 0.8* Surgical Parameters TLIF levels 1.3 (1 3) 1.4 (1 3) One-level fusions 20 (71%) 26 (63%) Two-level fusions 7 (25%) 13 (32%) 0.5 Three-level fusions 1 (4%) 2 (5%) EBL (ml) 167 (30 500) 180 (25 750) 0.7 OR time (min) 168 ( ) 168 (81 319) 0.9 LOS (days) 2.6 (0 10) 1.7 (0 8) Table 1. Selected demographic and Surgical Parameters

6 Results < 24 months > 24 months P value N Reoperations 3 (11%) 3 (7%) 0.7* Complications Wound infections 3 (10.7%) 1 (2.4%) Adj. level degeneration 3 (10.7%) 5 (12.2%) Durotomy 1 (3.6%) 2 (4.9%) Cage migration 1 (3.6%) - Pedicle fracture - 1 (2.4%) 0.6* Fusion 26 (92.9%) 37 (90.2%) 1.0* Table 2. Reoperations, Complications and Fusion Status

7 Results MCID < 24 months > 24 months P value Back pain 2.8 ( ) 3.4 ( ) 0.34 Reached MCID (%) 19 (68%) 36 (88%) - Leg pain 3.3 ( ) 2.2 ( ) Reached MCID (%) 25 (89%) 29 (71%) - ODI 1.4 ( ) 1.5 ( ) 0.6 Reached MCID (%) 19 (68%) 22 (54%) - SF-36 PCS 2.3 ( ) 2.4 ( ) 0.8 Reached MCID (%) 20 (71%) 32 (78%) - Satisfaction 79% (25 100) 86% (25 100) 0.14 Table 3. Clinical outcome MCID ratio scores

8 Results Multiple regression analyses Controlling for age, sex, previous surgeries, TLIF levels, complications, reoperations, fusion status DOS was significant predictor for: Better radiculopathy symptom resolution (p = 0.018) But not for: Back pain resolution (p = 0.27) Improvement in ODI scores(p = 0.10) SF-36 PCS scores (p = 0.19)

9 Discussion The optimal timing for MCD < 2 mos. (Hurme et al, 1987; Rothoerl et al, 2002) < 12 mos. (Ng et al, 2004; Nygaard et al, 2000; Silverplats et al, 2010; Woertgen et al, 1997) Spondylolisthesis and stenosis (SPORT study as- treated analysis, Radcliff et al, Spine 2011) Improvement in patients treated conservatively or surgically for spinal stenosis (< 12 mos. vs. > 12 mos.) No difference for patients with spondylolisthesis

10 Discussion Lumbar fusion outcomes in 388 injured Washington state workers compensation patients (Franklin et al, 1994) Shorter time from injury predicted better functional outcomes No correlations with duration of symptoms Decompression surgeries for spinal stenosis (Athiviraham et al, 2011; Yasar et al, 2009)

11 Conclusion A shorter duration of symptoms was found to be a statistically significant predictor for better resolution of radicular symptoms in patients undergoing TLIF for radiculopathy due to degenerative disc disease and stenosis with spondylolisthesis

12 Disclosures None of the authors have any potential conflict of interest