Is spinal surgery more risky and less successful than common knee and hip replacement surgeries?

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A new study refutes the commonly-held belief that routine spine surgery is more prone to “fail” or be more dangerous than popular knee and hip replacement surgeries. The study was presented at the 28th annual meeting of the North American Spine Society (NASS) in New Orleans, USA (9–12 October).    

“Thanks to misplaced fear and a mistaken belief, millions of patients are living with daily pain from spinal stenosis, a very treatable condition,” said Eeric Truumees, an Austin-based orthopaedic surgeon and NASS annual meeting programme co-chair. “This study demonstrates that properly indicated and performed spine surgery has a high long-term success rate, similar to that of popular knee and hip replacement surgeries.”

The study, “Comparative outcomes and cost utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 1; Long-term change in health-related quality of life and part 2; Estimated lifetime incremental cost-utility ratios,” was awarded a 2013 “Outstanding Paper Award” from The Spine Journal.

The researchers assessed whether the early improvements in health-related quality of life (HRQoL) following surgical management of focal symptomatic spinal stenosis (FLSS) with or without spondylolisthesis is sustainable over the long term compared to total hip arthroplasty/total knee arthroplasty (THA/TKA) for osteoarthritis.

A prospective, observational cohort study (with a minimum five-year follow-up) of patients who had a primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary osteoarthritis was performed. To measure postoperative change from baseline to last follow-up in SF-36 physical component summary (PCS) scores and mental component summary (MCS) scores between groups were used as the primary outcome measures. An age, sex-matched inception cohort of primary 1–2 level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared to a cohort of primary THA (n=99) and TKA (n=99) for osteoarthritis and followed for a minimum of five years.

Spine surgery vs. common knee and hip replacement surgery

Mean follow-up was 80.5+16.04 (79%), 94.6+16.62 (92%) and 80.6+16.84 (85%) for the FLSS, THA and TKA cohorts respectively, with a range of five to 10 years for all three cohorts. Postoperative PCS (p<0.0001) and MCS (p<0.02) improved significantly for all groups at median five years and at the last follow-up. The proportion of patients reaching MCID for PCS was not significantly different between cohorts (p=0.30: FLSS-61%, H-OA-68%, K-OA-57%) at the last follow-up.

Similar unadjusted MCID proportions were noted at the median five-year period (p=0.11: FLSS-62%, H-osteoarthritis-75%, K-osteoarthritis-65%). Adjusting for baseline age, sex, BMI, PCS and MCS, there was no statistically significant difference in the change from baseline PCS or MCS to last follow-up between groups. The change from baseline was significantly greater in the H-osteoarthritis cohort for both PCS (p=0.003) and MCS (p=0.007) for the H-osteoarthritis vs. FLSS at a median at five years. The proportion of patients reaching PCS-MCID or greater was not significantly different between groups at the last follow-up or at the five-year median follow-up.

The researchers conclude that significant improvement in HRQoL following surgical treatment of FLSS with or without spondylolisthesis, hip and knee osteoarthritis is sustained to a mean of seven to eight years with a minimum of five-year follow-up. The long-term change in HRQoL from baseline and the proportion of patients reaching MCID for PCS was comparable across all three cohorts at a mean of seven to eight years.