Research Fellow Hospital for Special Surgery Hospital for Special Surgery
Introduction: Literature suggests recovery after lumbar laminectomy occurs mostly within 3-6 months; however, some patients improve more rapidly than others. We compared early-improvers with non-early improvers after 1- and 2-level lumbar laminectomy using a novel definition of improvement.
Methods: Patients > 18 years undergoing primary 1- and 2-level lumbar laminectomy were included. Early-improvers (EI) achieved significant Oswestry Disability Index (ODI) improvement between consecutive postoperative timepoints at short-term (2 or 6 weeks), while non-early improvers did not. Significant ODI improvement was defined by optimal cutoff point of a receiver operating characteristic (ROC) curve using change in ODI to predict improvement on Global Rating of Change (GRC) between consecutive timepoints. Variables assessed included patient-reported outcomes (PROMs) (ODI, visual analog scale [VAS] for back and leg pain, and Patient-Reported Outcomes Measurement Information System for Physical Function [PROMIS-PF]), sagittal alignment, psoas and paralumbar muscle health, and Goutallier. Poor muscle health was defined by lowest gender-specific quartile of L3-L4 cross-sectional area (CSA)/height-squared (psoas) and CSA/body mass index (paralumbars). Logistic regression covariates were determined using p < 0.20 on univariate analyses and clinical relevance.
Results: 234 patients (EI = 206, non-EI = 28) were included. AUC was 0.76. Optimal cutoff for ODI improvement was 4.1. There were no differences in demographics. The EI cohort had significantly greater preoperative ODI, VAS leg, and lower PROMIS-PF. The EI cohort had lower VAS leg at 6-months (1.85 ± 2.58 versus 2.82 ± 2.72, p = 0.040). There were no significant differences in sagittal alignment, muscle health, or Goutallier. Logistic regression including preoperative symptom duration, arthritis, preoperative PROMs, and muscle health showed that preoperative VAS leg was a positive predictor for early improvement (OR: 1.29 [1.00 - 1.66], p = 0.048) while VAS back was a negative predictor (OR 0.69 [0.50 - 0.96], p = 0.026).
Conclusion : VAS leg is a positive predictor while VAS back is a negative predictor for early improvement following 1- and 2-level lumbar laminectomy. This information may help spine surgeons during perioperative counseling and may help predict patient recovery based on preoperative symptom status.