title: Short- and Long-Term Outcome of Microscopic Lumbar Spine Surgery in Patients with Predominant Back or Predominant Leg Pain.
abstract: OBJECTIVE
  This study assessed whether predominant back pain (pBP) represents a negative outcome predictor in patients undergoing microscopic spine surgery without fusion for a lumbar disc herniation (LDH) or spinal stenosis (LSS).
  
  
  METHODS
  Retrospective analysis of prospectively collected data on consecutive patients with LDH or LSS at 2 centers. Patients with visual analog scale (VAS) back pain ≥VAS leg pain were assigned to the pBP group, and compared with patients with predominant VAS leg pain (pLP). Outcome measures included the Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), health-related quality of life measures, Short-Form (SF)-12 Physical Component Summary (PCS), and EuroQol (EQ-5D) index at 3 days, 6 weeks (W6), 6 months, and 1 year postoperatively.
  
  
  RESULTS
  A total of 325 patients (154 [47.4%] with pBP and 171 [52.6%] with pLP) were included. Patients with pBP were about 6 years older and more often had LSS. There was no significant difference between the group means of the RMDI, ODI, SF-12 PCS, or EQ-5D at any postoperative time point. The most improvement was observed until the W6 follow-up with little or no improvement thereafter up to 1 year postoperatively. Patients with pBP were as likely as patients with pLP to be W6 responders on the RMDI (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.38-2.16; P = 0.831), ODI (OR, 1.00; 95% CI 0.52-1.92; P = 0.996), SF-12 PCS (OR, 1.09; 95% CI 0.58-2.04; P = 0.791), and EQ-5D (OR, 0.62; 95% CI 0.32-1.21; P = 0.164). Disease-specific subgroup analyses confirmed the results.
  
  
  CONCLUSIONS
  The present data suggest that patients with pBP have comparable functional and health-related quality of life outcomes after surgery for LDH or LSS with those of patients with pLP.
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Marco V
authors.initials: MV
authors.lastname: Corniola
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
mesh_terms: D019299:Decompression, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology* / Q000601:surgery*; D007866:Leg; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013130:Spinal Stenosis / Q000453:epidemiology* / Q000601:surgery*; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Back pain; Degenerative disc disease; Dominant symptom; Health-related quality of life; Leg pain; Low back pain; Lumbar spine surgery