Publication year: 2011
Source: World Neurosurgery, Available online 24 December 2011
Owoicho Adogwa, Scott L. Parker, Stephen K. Mendenhall, David N. Shau, Oran Aaronson, ...
ObjectiveAdjacent Segment Disease (ASD) may occur as a long-term consequence of spinal fusion and is associated with significant back and leg pain. Surgical management of symptomatic ASD consists of neural decompression and extension of fusion. However, conflicting results have been reported with respect to the long-term clinical effectiveness of revision surgery in this setting. We set out to comprehensively assess the long-term clinical outcome after revision surgery and determine its effectiveness in the treatment of adjacent segment disease.MethodsFifty patients undergoing revision surgery for ASD-associated back and leg pain were included in this study. Baseline and two-year VAS-BP, VAS-LP, Oswestry Disability Index (ODI), physical and mental quality of life (SF-12 PCS & MCS) and health-state utility [EuroQol (EQ-5D)] were assessed.ResultsA sustained improvement in VAS-BP(8.72 ± 1.85 vs. 3.92 ± 2.84, p=0.001), VAS-LP(6.30 ± 3.90 vs. 3.02 ± 3.03, p=0.001), ODI(28.72 ± 9.64 vs. 18.48 ± 11.31, p=0.001), SF-12 PCS (26.89 ± 8.85 vs. 35.58 ± 11.97, p=0.001) and SF-12 MCS(44.66 ± 12.85 vs. 53.16 ± 9.46, p=0.001) was observed two years after revision surgery, with a cumulative mean two-year gain of 0.76 QALYs(EQ-5D). Median [IQR] time to narcotic independence and return to work was 1.7 [1.0-8.0] months and 2.0 [1.0-4.75] months, respectively.ConclusionsPatients undergoing decompression and extension of fusion for adjacent segment disease-associated back and leg pain reported long-term improvement in pain, disability and both physical and mental quality of life, suggesting that revision surgery is a highly effective treatment strategy in this patient population.
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