David J Mazur-Hart, Christian G Lopez Ramos, Joseph G Nugent, Brannan E O'Neill, Barry Cheaney, Hanne A Gehling, Jamila Godil, Brandi W Pang, Arilene Novak, James T Obayashi, Travis C Philipp, Clifford Lin, Jung U Yoo, Christina H Wright, James M Wright, Donald A Ross, Josiah N Orina, Won Hyung A Ryu
{"title":"单纯腰椎减压能改善背痛吗？","authors":"David J Mazur-Hart, Christian G Lopez Ramos, Joseph G Nugent, Brannan E O'Neill, Barry Cheaney, Hanne A Gehling, Jamila Godil, Brandi W Pang, Arilene Novak, James T Obayashi, Travis C Philipp, Clifford Lin, Jung U Yoo, Christina H Wright, James M Wright, Donald A Ross, Josiah N Orina, Won Hyung A Ryu","doi":"10.1097/BSD.0000000000001931","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of a prospectively collected database at an academic institution.</p><p><strong>Objective: </strong>(1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.</p><p><strong>Summary of background data: </strong>LBP is a common complaint for patients with degenerative lumbar spine disease. Often, LBP is considered a contraindication to decompression. Anecdotally, patients with lumbar spinal stenosis (LSS) report improvements in LBP following decompression for neurogenic claudication or radiculopathy.</p><p><strong>Methods: </strong>Patients were analyzed that had decompressive surgery without fusion for LSS from 2017 to 2020. Patients were excluded with a tumor, infection, prior fusion, or incomplete questionnaires. Patient-reported outcome measures (PROMs), clinical variables, and radiographic variables were evaluated. Patients who achieved minimal clinically important difference (MCID) in LBP were compared with those who did not at 12-month follow-up. LASSO methodology was used to identify related predictive variables.</p><p><strong>Results: </strong>One hundred seventy-six patients were analyzed. The majority reached MCID for back pain (n=109, 61.9%). Baseline clinical and radiographic variables were comparable. Patients who achieved MCID in back pain had significantly higher preoperative pain and greater disability on PROMs. ML identified the related variables of age, BMI, VAS-B, ODI total tertile, EQ-5D, PROMIS-P, PROMIS-M, and CCI to accurately predict who will reach meaningful improvement at 12-months postoperatively (AUROC=0.832).</p><p><strong>Conclusions: </strong>The majority experienced significant improvements in LBP following decompression for LSS. Improvers had higher preoperative pain scores and measures of disability. Back pain should not be a contraindication to decompression without fusion. A pilot version of a predictive nomogram was developed to be used in the preoperative clinic visit that can guide clinical management and surgeon/patient expectations.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does Back Pain Improve Following Lumbar Decompression Alone?\",\"authors\":\"David J Mazur-Hart, Christian G Lopez Ramos, Joseph G Nugent, Brannan E O'Neill, Barry Cheaney, Hanne A Gehling, Jamila Godil, Brandi W Pang, Arilene Novak, James T Obayashi, Travis C Philipp, Clifford Lin, Jung U Yoo, Christina H Wright, James M Wright, Donald A Ross, Josiah N Orina, Won Hyung A Ryu\",\"doi\":\"10.1097/BSD.0000000000001931\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study of a prospectively collected database at an academic institution.</p><p><strong>Objective: </strong>(1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.</p><p><strong>Summary of background data: </strong>LBP is a common complaint for patients with degenerative lumbar spine disease. Often, LBP is considered a contraindication to decompression. Anecdotally, patients with lumbar spinal stenosis (LSS) report improvements in LBP following decompression for neurogenic claudication or radiculopathy.</p><p><strong>Methods: </strong>Patients were analyzed that had decompressive surgery without fusion for LSS from 2017 to 2020. Patients were excluded with a tumor, infection, prior fusion, or incomplete questionnaires. Patient-reported outcome measures (PROMs), clinical variables, and radiographic variables were evaluated. Patients who achieved minimal clinically important difference (MCID) in LBP were compared with those who did not at 12-month follow-up. LASSO methodology was used to identify related predictive variables.</p><p><strong>Results: </strong>One hundred seventy-six patients were analyzed. The majority reached MCID for back pain (n=109, 61.9%). Baseline clinical and radiographic variables were comparable. Patients who achieved MCID in back pain had significantly higher preoperative pain and greater disability on PROMs. ML identified the related variables of age, BMI, VAS-B, ODI total tertile, EQ-5D, PROMIS-P, PROMIS-M, and CCI to accurately predict who will reach meaningful improvement at 12-months postoperatively (AUROC=0.832).</p><p><strong>Conclusions: </strong>The majority experienced significant improvements in LBP following decompression for LSS. Improvers had higher preoperative pain scores and measures of disability. Back pain should not be a contraindication to decompression without fusion. A pilot version of a predictive nomogram was developed to be used in the preoperative clinic visit that can guide clinical management and surgeon/patient expectations.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001931\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001931","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Does Back Pain Improve Following Lumbar Decompression Alone?
Study design: Retrospective cohort study of a prospectively collected database at an academic institution.
Objective: (1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.
Summary of background data: LBP is a common complaint for patients with degenerative lumbar spine disease. Often, LBP is considered a contraindication to decompression. Anecdotally, patients with lumbar spinal stenosis (LSS) report improvements in LBP following decompression for neurogenic claudication or radiculopathy.
Methods: Patients were analyzed that had decompressive surgery without fusion for LSS from 2017 to 2020. Patients were excluded with a tumor, infection, prior fusion, or incomplete questionnaires. Patient-reported outcome measures (PROMs), clinical variables, and radiographic variables were evaluated. Patients who achieved minimal clinically important difference (MCID) in LBP were compared with those who did not at 12-month follow-up. LASSO methodology was used to identify related predictive variables.
Results: One hundred seventy-six patients were analyzed. The majority reached MCID for back pain (n=109, 61.9%). Baseline clinical and radiographic variables were comparable. Patients who achieved MCID in back pain had significantly higher preoperative pain and greater disability on PROMs. ML identified the related variables of age, BMI, VAS-B, ODI total tertile, EQ-5D, PROMIS-P, PROMIS-M, and CCI to accurately predict who will reach meaningful improvement at 12-months postoperatively (AUROC=0.832).
Conclusions: The majority experienced significant improvements in LBP following decompression for LSS. Improvers had higher preoperative pain scores and measures of disability. Back pain should not be a contraindication to decompression without fusion. A pilot version of a predictive nomogram was developed to be used in the preoperative clinic visit that can guide clinical management and surgeon/patient expectations.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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