A comparison of successful versus failed nonoperative treatment approaches in patients with degenerative conditions of the lumbar spine |
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| Institution: | 1. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States;2. Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States;1. Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain;2. Pathology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain;3. Brain Tumour Laboratory, Fundación Vithas, Grupo Hospitales Vithas, Madrid, Spain;4. Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain;5. Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain;1. Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;2. Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;3. Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;4. Department of General Internal Medicine, JCHO Sendai Hospital, Sendai, Miyagi, Japan;1. Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy;2. Neurology Unit, Careggi University Hospital, Florence, Italy;3. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy;1. Neuromuscular Diseases Clinic, National Institute of Neurology and Neurosurgery, México City, Mexico;2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada |
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| Abstract: | Identifying an optimal composition of nonoperative therapies to trial in patients suffering from degenerative lumbar spine conditions prior to surgical management remains challenging. Contrasting successful versus failed nonoperative treatment approaches may provide clinicians with valuable insight. The purpose of this study was to compare the nonoperative therapy regimens in degenerative lumbar spine disorder patients successfully managed conservatively versus patients who failed primary treatment and opted for lumbar fusion surgery. Clinical records from patients diagnosed with lumbar stenosis or spondylolisthesis from 2007 to 2017 were gathered from a comprehensive insurance database. Patients were separated into two cohorts: patients managed successfully with nonoperative therapies and patients who failed conservative therapy and underwent lumbar fusion surgery. Nonoperative therapy utilization by the two cohorts were collected across a 2-year surveillance window. A total of 531,980 adult patients with lumbar stenosis or spondylolisthesis comprised the base population. There were 523,031 patients (98.3%) successfully treated with conservative management alone, while 8,949 patients (1.7%) ultimately failed nonoperative management and opted for lumbar fusion. Conservative therapy failure rates were especially high in patients with a smoking history (2.1%) and those utilizing lumbar epidural steroid injections (LESIs) (3.7%). A greater percentage of patients who failed conservative management utilized opioid medications (p < 0.0001), muscle relaxants (p < 0.0001), and LESIs (p < 0.0001). Patients who failed nonoperative management spent more than double than the successfully treated cohort (failed cohort: $1806.49 per patient; successful cohort: $768.50 per patient). In a multivariate logistic regression model, smoking, obesity and prolonged opioid use were independently associated with failure of nonoperative treatment. |
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| Keywords: | Lumbar stenosis Lumbar spondylolisthesis Lumbar decompression and fusion Nonoperative therapy Healthcare utilization Costs Chronic lower back pain |
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