title: Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis.
abstract: BACKGROUND
  The results of single-center studies have shown that surgical intervention for lumbar spinal stenosis yielded comparable health-related quality of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these results are generalizable to routine clinical practice in Canada is unknown.
  
  
  OBJECTIVE
  The primary purpose of this equivalence study was to compare the relative improvement in physical HRQoL after surgery for focal lumbar spinal stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six Canadian centers.
  
  
  METHODS
  A Canadian multicenter ambispective cohort study.
  
  
  METHODS
  A cohort of 371 primary one- to two-level spinal decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip (n=156) and knee (n=208) arthroplasty for OA.
  
  
  METHODS
  The primary outcome was the change in preoperative to 2-year postoperative 36-Item Short Form Health Survey Physical Component Summary (PCS) score as reflected by the number of patients reaching minimal clinically important difference (MCID) and substantial clinical benefit (SCB).
  
  
  METHODS
  Univariate analyses were conducted to identify baseline differences and factors that were significantly related to outcomes at 2 years. Multivariable regression modeling was used as our primary analysis to compare outcomes between groups.
  
  
  RESULTS
  The mean age (years) and percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, and 65.8/64.3, respectively. All three groups experienced significant improvement of baseline PCS (p<.001). Multivariate analyses, adjusting for baseline differences (age, gender, baseline Mental Component Summary score, baseline PCS), demonstrated no significant differences in PCS outcome between spinal surgery and arthroplasty (combined hip and knee cohorts) patients with an odds ratio of 0.80 (95% confidence interval [CI], 0.57-1.11; p=.17) and 0.79 (95% CI, 0.58-1.09; p=.15) for achieving MCID or SCB, respectively. In subgroup analysis, spine and knee outcomes were not significantly different, with hip arthroplasty superior to both (p<.0001).
  
  
  CONCLUSIONS
  Significant improvement in physical HRQoL after surgical treatment of FLSS (including DLS) is consistently achieved nationally. Our overall results demonstrate that a comparable number of patients can expect to achieve MCID and SCB 2 years after surgical intervention for FLSS and total knee arthroplasty.
authors: Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. raja.rampersaud@uhn.on.ca
authors: Y Raja
authors: YR
authors: Rampersaud
authors: Eugene K
authors: EK
authors: Wai
authors: Charles G
authors: CG
authors: Fisher
authors: Albert J M
authors: AJ
authors: Yee
authors: Marcel F S
authors: MF
authors: Dvorak
authors: Joel A
authors: JA
authors: Finkelstein
authors: Rajiv
authors: R
authors: Gandhi
authors: Edward P
authors: EP
authors: Abraham
authors: Stephen J
authors: SJ
authors: Lewis
authors: David I
authors: DI
authors: Alexander
authors: William M
authors: WM
authors: Oxner
authors: J R
authors: JR
authors: Davey
authors: Nizar
authors: N
authors: Mahomed
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome