COMMENTARY

Leg Pain as Predictor of Spinal Surgery Outcome

Joseph K. Lee, MD

Disclosures

February 28, 2011

Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results From the Spine Patient Outcomes Research Trial (SPORT)

Pearson A, Blood E, Lurie J, et al.
Spine (Phila Pa. 1976) 2011;36:219-229.

Article Summary

Recent literature has supported the common notion that patients with spinal pain who experience leg pain more than back pain benefit more from surgery than those whose predominant complaint is back pain.[1,2] In this substudy from SPORT (Spine Patient Outcomes Research Trial), patients with degenerative spondylolisthesis and spinal stenosis were categorized according to the predominant area of pain (leg vs back) and then underwent either surgery (laminectomy with or without fusion) or conservative care. Patients were then followed for 2 years. In patients with leg-predominant pain, surgery resulted in greater improvement than in those with back-predominant or equal leg and back pain. All surgical groups had greater improvement than those receiving conservative care.

Viewpoint

This study lends quantitative evidence to support the popular idea that patients with degenerative spondylolisthesis and spinal stenosis improve more with surgical intervention than those who have primarily axial back pain. Major limitations to the study, as noted by the authors, include a high rate of protocol nonadherence, lack of patient randomization, data analysis by means of as-treated methodology, and study power. Furthermore, choosing a predominant pain location was not required, and approximately 40% of patients were classified as having equal back and leg pain. Another issue is that patients received common but nonstandardized conservative care, which did not include available treatment options such as epidural steroid injections.

Abstract

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