Adult deformity surgical outcomes in patients with Fibromyalgia

2016

Summary

Prospective surgical outcomes from 314 consecutive adult deformity patients were divided: Fibromyalgia (FM) vs. No-Fibromyalgia (NFM), followed average 7 years. FM group had twice as many disorders of bowel/bladder, rheumatologic, circulatory, GI, and depression (38% vs 7%). Surgery was similar for both groups: 8 levels posterior fusion. Complications were similar. Both groups improved VAS, ODI with surgery, though improvements declined more over time in FM group. Pain relief gains were maintained better than long-term functional improvement in FM patients.

Hypothesis

Fibromyalgia (FM) patients would improve after deformity fusion surgery despite having more pain, comorbidities, and worse function than non-fibromyalgia (NFM).

Design

Prospective data from 293 consecutive adults who underwent posterior deformity arthrodesis 2002-2012 were divided into 2 groups: FM vs. NFM controls.

Introduction

FM complicates treatment decision for back pain; FM impact on outcomes after adult deformity is unknown.

Methods

Diagnoses: Degenerative scoliosis-133, Idiopathic scoliosis-81, Degenerative kyphoscoliosis-42, other kyphosis-58. Complications, pain medicine usage, clinical and radiographic outcomes were recorded pre-op, 1 yr, 2 yrs, and annually to latest followup. Subgroup analysis: Primary vs revision surgery.

Results

Followup average 7yrs (24-150mo). There was no difference between FM vs NFM for age, smoking, BMI, or diagnoses. FM group had more prior fusions (57% vs 11%), NFM group had more prior laminectomies (31% vs 5%). FM group had twice as many disorders of bowel/bladder, rheumatologic, circulatory, GI, and depression (38% vs 7%). More NFM patients had no co-morbidities (17% vs 0%). Both groups fusion avg 8 levels (2-16). FM group VAS and ODI were significantly worse at all time points; both groups improved with surgery, primary and revision (p<0.05); FM improved less than NFM patients. FM ODI fell more than NFM over time. Pain medication use followed similar trends. Complications were similar FM vs NFM.

Conclusions

FM patients had more co-morbidities, depression, need for pain medication, and lower functional scores than NFM patients at all time points. Surgery improved outcomes without increased complications though FM outcomes were worse than NFM. Over time, improvement in VAS was better maintained than ODI in FM patients.