Resolution of leg pain after surgical decompression: Results with and without TLIF and BMP

2011

SUMMARY

We analyzed 413 consecutive adults undergoing laminectomy with or without TLIF+BMP (Lami-70, TLIF-343); 266 were primary, 147 were revision. At 55 months follow-up, both groups achieved similar relief from radicular leg pain by 3 months, though TLIF was associated with more transient leg pain at 6 weeks. Maximum improvement occurred by 6 weeks for laminectomy, 1 year for TLIF. Post-op increase in buttock/thigh pain was transient. Post-op leg pain beyond 3 months is as likely after TLIF+BMP as after laminectomy.

INTRODUCTION

Patients with spinal stenosis reliably improve after decompression. If arthrodesis is required, fusion is often augmented by TLIF+BMP, which may cause post-op leg pain. This is the first study to analyze timing of leg pain resolution after laminectomy with and without TLIF using interbody BMP.

METHODS

Clinical and radiographic outcomes on 413 consecutive adults age 61 years (19-91 years) requiring laminectomy were reviewed; 154 were revisions. 343(TLIF group) required laminectomy 2.6 levels (1-6), posterior instrumented fusion 4.3 levels (2-17) and TLIF 1.7 levels(1-4). Diagnoses: degenerative-146, spondy-117, deformity-80. 70 patients (Lami group) had laminectomy 3 levels (1-5). Leg pain presence/distribution (buttock/thigh/past knee) was analyzed pre-op/6 wk/3 mo/6 mo/1 yr/2 yr. Excluded patients: laminotomy/discectomy, anterior-posterior fusion. VAS compared with the sign test. Oswestry (ODI) differences tested for normalcy using Anderson Darling, compared using paired t-tests. Outcomes evaluated with chi square.

RESULTS

At follow-up 55 months (24-105) Lami group VAS improved from 5.7 pre-op to 2.8 (p=0.026) at 6wk, 3.5 at 3mo(p=0.042) and remained stable. ODI improved from 49 pre-op to 25(p<0.001) at 6wk, 36 (p=0.049) at 2 years. Leg pain past the knee improved in 39/47 (83%) Lami patients at 6 wk and 44/47 (94%) at 2 years. TLIF group VAS improved from 6.2 pre-op to 3.9/3.4/3.1 at 6 mo/1 yr/2 yr(p<0.001); ODI improved from 49 pre-op to 28/26/28 at 6 mo/1 yr/2 yr (p<0.001). 212/271 (78%) TLIF patients reported relief of leg pain at 6 wk and 235/271(87%) at 2 years. Both groups achieved similar relief of radicular pain long-term (p=0.152). Transient increase in buttock/thigh pain at 6wk was seen in revision lami(26%), primary TLIF (1%), revision TLIF (12%), improving/resolving by 3 months.

CONCLUSIONS

Laminectomy with or without TLIF+BMP achieved similar relief from radicular leg pain by 3 months. TLIF was associated with more leg pain at 6 weeks. Max improvement in VAS, ODI occurs at 6 weeks for laminectomy and 1 year for TLIF. Post op buttock/thigh pain increase was transient.

SIGNIFICANCE

Post-op leg pain beyond 3 months is just as likely after TLIF+BMP as laminectomy.