P145. Resolution of back pain following minimally invasive laminectomy

• Published in: The spine journal Vol. 23; no. 9; p. S178
• Main Authors: Korsun, Maximilian, Shinn, Daniel, Shahi, Pratyush, Morse, Kyle, Dalal, Sidhant, Subramanian, Tejas, Araghi, Kasra, Asada, Tomoyuki, Tuma, Olivia, Maayan, Omri, Singh, Nishtha, Singh, Sumedha, Qureshi, Sheeraz, Iyer, Sravisht
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2023
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2023.06.370

Evidence has shown that laminectomy can result in improvement of leg pain as the primary symptom, but the resolution of back pain as the predominant presenting symptom has yet to be fully documented. To compare patient reported outcome measures (PROMs) and achievement of minimal clinically important difference (MCID) on the basis of presenting complaint in patients undergoing minimally invasive laminectomy. Retrospective cohort. Consecutive patients who underwent minimally invasive laminectomy for degenerative conditions of the lumbar spine and had a minimum followup of 1-year. 1) PROMs (Oswestry Disability Index;ODI; Visual Analog Scale back and leg, VAS; 12-Item Short Form Survey Physical Component Score, SF-12 PCS; Patient-Reported Outcomes Measurement Information System, PROMIS) and 2) MCID achievement rate and time. For MCID achievement for VAS back and leg, only patients with VAS back >5 and VAS leg >5 were included, respectively. Patients were divided into two groups based on the presenting complaint: predominant back pain (pBP) and predominant leg pain (pLP). The pBP cohort contained all patients with VAS back > VAS leg, and the pLP cohort contained patients with VAS leg <= VAS back. Demographic information such as age, gender, race and body mass index (BMI) were analyzed. Baseline characteristics were summarized using Chi-Squared or two-sample T-test. Changes in PROMs were compared at the early (2 weeks to 6 months) and late (6 months to 2 years) postoperative time points. A total of 390 patients were included (126 pBP and 264 pLP). There were no significant differences in patient demographics and operated levels. There were no significant differences in pre-operative ODI, SF12 PCS, and PROMIS. The pBP cohort had a significantly greater preoperative VAS back than the pLP cohort (pBP: 6.3 vs pLP: 4.5; p<0.001) and the pLP cohort had a significantly greater pre-operative VAS leg than the pBP cohort(pBP: 3.7 vs pLP: 6.9; p<0.001). There was no significant difference in the absolute values or change in ODI, SF12 PCS, and PROMIS at the early and late time points. By the late postoperative timepoint, there was no difference between the groups in VAS back (pBP:3.1 vs pLP: 2.6; p=0.157) and leg (pBP: 2.2 vs pLP: 2.8; p=0.083) scores. There was a significant difference in the early VAS leg absolute scores (pBP: 2.3 vs pLP: 3.1; p=0.029), but no difference in early VAS back scores (pBP: 3.1 vs pLP: 2.7; p=0.215). There was no significant difference in the MCID achievement rate in ODI, SF12 PCS, or PROMIS. By the late postoperative time point, 51.2% and 55.3% achieved MCID in ODI (p=0.528), 58.1% and 62.7% in SF12 PCS (0.501), 60% and 67.6% in PROMIS(p=0.264) 81.1% and 73.2% achieved MCID in VAS back(p=0.3), and 72% and 83.6% in VAS leg(p=0.242) for pBP and pLP respectively. Additionally, there were no significant differences in time to MCID achievement for any PROMs. The pBP and pLP cohorts showed similar improvement in PROMs and MCID achievement rates. This shows that MIS laminectomy is equally effective for patients presenting with pBP or pLP. This abstract does not discuss or include any applicable devices or drugs.