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. We compared rapid-improvers with non-rapid improvers after lumbar laminectomy using a novel definition of improvement.
Methods: Patients > 18 years undergoing primary 1- and 2-level lumbar laminectomy were included. Rapid improvers (RI) achieved significant Oswestry Disability Index (ODI) improvement between consecutive postoperative timepoints in the short-term (2 or 6 weeks), but not mid-term (3 or 6 months) or late-term (1 or 2 years). ODI improvement was defined by optimal cutoff of receiver operating characteristic (ROC) curve using change in ODI to predict Global Rating of Change (GRC) improvement between consecutive timepoints. Variables assessed included ODI, visual analog scale (VAS) for back and leg pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), sagittal alignment, 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 (RI = 38, non-RI = 196) were included. AUC was 0.76. Optimal cutoff for ODI improvement was 4.1. There were no demographic differences. RI cohort had significantly lower preoperative ODI, VAS back and leg. At 12 weeks and 6 months, the RI cohort had significantly lower ODI and VAS leg. There were no differences in muscle health or Goutallier. Logistic regression including age, sex, preoperative ODI, VAS back, VAS leg, and paralumbar muscle health showed that preoperative VAS back was a negative predictor for rapid improvement (OR 0.78 [0.64 - 0.95], p = 0.012).
Conclusion : Increased preoperative back pain in patients undergoing 1- or 2- level lumbar decompression may be a negative predictor for rapid postoperative improvement. This information may aid spine surgeons with perioperative patient counseling.