A pilot study to propose a treatment-based classification for subgrouping patients with surgically treated degenerative lumbar spine with focus on comparing decompression versus decompression with fusion

Abstract

Objective and background: Degenerative lumbar spine and chronic back pain is a heterogeneous disorder with controversies over the correlation of degenerative image findings to pain generation. This resulted in variable treatment response and the risk of overdoing unnecessary surgery and instrumentation. The current pilot study is an initial work suggesting a new sub-classification for a heterogeneous disorder of degenerative spine diseases and chronic back pain into 6 homogeneous sub-classes. Addressing all subclasses need at least 3 articles so we presented a pilot data for two of these six subclasses and presented the comparison just as a method for future comparison once we have data for all 6 subclasses from our or other centers research. Methods: A retrospective cohort study reporting health related quality of life outcome (HRQoL), demographics, surgery indications, surgical type, procedural data. The rationale of reporting functional patient outcome is to stress that the ultimate goal is not only the surgical procedure success but the return of the patients to daily and working life. Example outcome comparison is included to guide future treatment effectiveness comparison once TBC groups 1–6 are available. Results: A total of 32 patients underwent decompression alone and 30 patient's decompressions plus instrumental fusion. The mean scores for all SF-12 domains and the summary measures of pain, social, physical and mental components are reported. Conclusion: In the current study we report HRQoL for two degenerative spine presentations; lumbar spinal stenosis with and without significant back pain with two treatments; decompression with and without fusion. Owning to the complexity of degenerative spine, the current paper proposes reporting treatment effectiveness and outcome for 6 TBC groups surgically treated patient's subgroups with the aim of building a database from reported outcome studies that can use the TBC subgrouping model for guiding therapeutic selection for each individual patient. Keywords: Spine, Fusion, Lumbar, Laminectomy, Disc, Pain