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Beitragstitel Factors associated with having an indication for surgery in lumbar spinal stenosis
Beitragscode P025
Autoren
  1. Anne F. Mannion Schulthess Clinic, Zurich, Switzerland Vortragender
  2. Miquel Serra-Burriel
  3. Hans-Jürgen Becker
  4. Selina Nauer Schulthess Clinic Zuerich
  5. Sebastian Winklhofer University Hospital Zurich
  6. Tamas Fekete Schulthess Clinic Zurich
  7. Frank Stefan Kleinstück Schulthess Klinik Zürich
  8. Daniel Haschtmann Schulthess Clinic Zurich
  9. Florian Brunner Department of Rheumatology, Balgrist University Hospital
  10. Jakob M. Burgstaller Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich
  11. Mazda Farshad Balgrist University Hospital
  12. François Porchet Schulthess Clinic, Zurich, Switzerland
Präsentationsform Poster
Themengebiete
  • A03 - Wirbelsäule
Abstract INTRODUCTION
The outcome of surgery for spinal stenosis can be very variable, suggesting patient selection could be improved. The aim of this study was to evaluate, in a comprehensive multivariable model, the baseline characteristics that distinguish patients considered to have an indication for surgery from those with no such indication.
METHODS
Data were extracted from the database of the Lumbar Spinal Stenosis Outcomes Study (LSOS), a multicentre, prospective observational study of patients with spinal stenosis and neurogenic claudication being treated surgically or conservatively. A total of 556 full observations were identified for inclusion; 280 (50.4%) females, mean age 72.8 (8.5) y. A logistic forward stepwise regression model was built with this sample to predict "having an indication of surgery", as documented by the referring clinician, using a range of baseline variables (demographic, clinical history, neurological, radiological, patient self-ratings for pain, disability, HRQL, psychological status) and controlling for study site fixed-effects.
RESULTS
A total of 415 (73%) patients had an indication for surgery and 142 (27%) did not. The predictors of "indication for surgery" with the lowest p values (p< 0.01) in the multivariable model included: worse score on the "back trouble thermometer", lower psychological distress (SCL-K-9), higher Roland Morris score, grade C or D morphological spinal stenosis grade (rootlet to cerebrospinal fluid ratio on axial MRI; Schizas grade), and less disc degeneration (Pfirrmann grade). Other significant predictors (p< 0.05) included non-Swiss nationality, symptoms getting worse in the last 3 months, no PT in the last 3 mo, and numbness of the foot. Model discrimination was good (AUC 87.2%, 95% CI 84.1-90.3%) and the model was well calibrated.
DISCUSSION
The most important variables shown to be associated with having an indication for surgery were a combination of severe/worsening symptoms and disability, less psychological distress, and radiological evidence of severe stenosis without accompanying disc degeneration. We suggest that these should be combined into an algorithm for further investigation as potential "appropriate use criteria" to assist with decision-making in lumbar spinal stenosis. Our ongoing studies will examine whether patients with a higher probability of having a surgical indication based on these criteria actually go on to have a significantly better outcome after surgery.