Long Term Functional Outcome of Patients
that Underwent Laminectomy, in Pakistani Population
Almas Ashraf1*, Zaheer-ud-Din Babar2, Zara Seemab1, Areeba Nasir1, Kedar Abu Bakr Bajwa1 and Hassan Mumtaz3
1Shifa International Hospital, Pakistan
2Department of Neurosurgery Neurosurgeron, Swat Medicial Complex, Pakistan
3Clinical Research Associate, Maroof International Hospital, Master’s in Public Health Health Services Academy, Pakistan
Submission: February 17, 2022;; Published: April 11, 2022
*Corresponding author: Almas Ashraf, Shifa International Hospital, H 8/4, Islamabad, 46000, Pakistan
How to cite this article: Long Term Functional Outcome of Patients that Underwent
Laminectomy, in Pakistani Population. Open Access J Neurol Neurosurg 2022; 17(1): 555952. DOI: 10.19080/OAJNN.2021.17.555952.
Objective: To measure long term functional outcome of patients that underwent laminectomy in Pakistani population.
Back pain is one of the most commonly presented health issue and reason of declined quality of life of patients, especially after surgical interventions. The main aim is to have long term follow up, to able to appreciate the functional outcome. The tool used is Oswestry Disability Index (ODI) in our study.
Materials and Methods: Patients that underwent laminectomy from 2010 to 2019, they were divided in to two groups, group A had 2010 to 2014 and group B had 2015 to 2019. They were called and asked questions from ODI Questionnaire.
Results: Out of total 565 patients in group A 103; and out of 273 from group B 51 patients answered the phone. 49% patient had ODI between 0-20 in group A and 65% in group B. There were no patients with bed bound disability, but crippled back pain was present in 2% in group A and 4% in group B patients. The mean ODI in group A is 23 and in Group B is 18.
Discussion: Oswestry scoring is considered more standardized and reliable. Normal ODI on average is around 10. For the patients the end outcome is decrease in pain so it does not limit daily activities, so can go back to the premorbid state. Reported surgery functional varies hugely from 49-90%. Several factors like age < 41-year-old; male-sex; duration of sciatica < 7 months; no previous lumbar surgery, less duration of presentation before surgery are good indicators of successful surgery.
Conclusion: Long term follow up is crucial to help to understand the effectiveness of surgery. Moreover, further studies are required to identify the causative factors of poor.
Keywords: Decompression-only laminectomy; Lumbar vertebrae; Decompression; Spinal fusion; Functional status
Back pain is considered one of the most commonly presented health issue for which physicians are consulted, and it has significant effect in declining quality of life of patients and affecting most of the part of their lives [1,2]. It could be due to multiple reasons including degenerative disc disease, spinal stenosis, spondylolisthesis. It is tried to treat the above-mentioned conditions without operation, but invasive procedures might be necessary considering that non-operative options did not help or that the symptoms have been worsened especially neurologically . After such interventions, long term of follow up of patients is not possible, until they have recurring symptoms or other
treatment they tried after recurrence have failed to relieve the
symptoms. Hence, patients’ perception can vary directly of how illness and treatment intervention affects their daily lives, and how it differs from the perception of their practitioners . There are many tools to assess the pain and one of the way to assess is through Oswestry Disability Index (ODI), which is considered one of the ideal instrument . One of the way pains is relieved is through posterior decompression that is laminectomy. It is considered as an effective intervention . This practice has also increased tremendously in past 2 decades. We set out to evaluate, using validated patient-assessed outcome measure ODI, the long term outcome of patients that underwent laminectomy.
Approval for the present study was obtained by the
Institutional Review Board of the Shifa International hospital,
Pakistan in December 2010 and the study conducted in January
and February 2021. List of the patients that underwent lumbar
decompression laminectomy from 2010 to 2019 were retrieved, in
this observational retrospective study. Participants were divided
into groups. Group A has from 2015 to 2019 and group B had from
2010 to 2014. They were approached through telephone. Verbal
informed consent for participating voluntarily in the study. They
were asked questions about back pain and their quality of life
from Oswestry Low Back Pain Questionnaire. The ODI version 2.0
is rated from 0 (best functional outcome) to 100 (worst functional
outcome). The questionnaire contains ten topics concerning
intensity of pain, lifting, ability to care for oneself, ability to walk,
ability to sit, sexual function, ability to stand, social life, sleep
quality, and ability to travel. Each topic category is followed by
6 statements scored on a scale of 0–5 with the first statement
being zero and indicating the least amount of disability and the
last statement is scored 5 indicating most severe disability. The
scores for all questions answered are summed, then multiplied by
two to obtain the index (range 0 to 100) . ODI index scale is as
followed: 0% –20% for minimal disability, 21%–40%: moderate
disability. 41%–60%: severe disability, 61%–80%: crippling back
pain and 81%–100% involve patients are either bed-bound or
have an exaggeration of their symptoms. Statistical analysis was
performed with statistical software SPSS (version 21) and data
Patients from both groups were approached through
telephone. Out of 273 from group A 51; and out of total 565
patients in group B 103 answered the phone and all gave consent
for the study. Among them, 22 (43%) were females and 29 (57%)
were males in group A. From group B, 40 (39%) were females and
63 (61%) were males. Participants ranged in age from 20 to 78
years (on average 54 years) of both groups. Table 1 shows 49%
patient had ODI between 0-20 in group A, and 65% in group B.
There were no patients with bed bound disability, but crippled
back pain was present in 2% in group A and 4% in group B
patients (Table 2). The mean ODI in group A is 23 and in Group
B is 18. Old group of patients between 2010 to 2014, reported
that 47% patients are still on pain medications and 10% patients
underwent redo surgery, while patients in other group, 69% are
on pain medications and 12.5% had redo surgery yet. (Tables 3 &
4) shows that no problem reported around 50% of patients in both
groups but decrease in sensation and weakness is still persisting
in some number of patients in both. Moreover, when correlation
was checked, pain is statistically significant in both groups; group
A (coefficient for ODI: 0.435 [P = 0.001]) and group B, score was
(coefficient 0.780 [P < 0.001]).
There are many tools available to assess functional outcome
after spinal surgery including Oswestry Disability Index (ODI),
the physical component summary (PCS) of the Short Form of
the Medical Outcomes Study (SF-36), Roland & Morris Disability
Questionnaire and Visual Analogue Scale (VAS) [8,9]. Oswestry
scoring is considered more standardized and reliable . The
score reported for a normal population where the ODI has been
reported at an average of around 10 . Higher scores have been
reported in various conditions of the spine with chronic back pain
and metastasis presenting the highest degree of disability with an
average score around 50 . Most of the studies in the literature
have used ODI scale.
For the patients the ultimate outcome is based on functional
outcome because that decides the satisfaction of the patient. In
spine disc diseases, pain is the predominant factor that limits the
quality of life and daily activities of the patients. The main goal of
management is to be able to go back to premorbid state. However,the surgery outcome varies hugely from 49-90% in different
studies, which can be due to huge number of factors .
Several factors like age < 41-year-old; male-sex; duration of
sciatica < 7 months; no previous lumbar surgery, less duration
of presentation before surgery are good indicators of successful
surgery . One of the main reasons of surgery is to be able
to return to work without any hassle. Numerous authors have
reported that 66.67% to 90% cases have returned to their original
vocation without any limitations by 6 months [14-20]. Whereas
multiple authors [14-18] have stated that 64% to 92% cases had
complete relief of pain, while our study observed 48% with no
issues. One study included Swedish Spine Registry, published by
Försth et al. included 5390 patients with lumbar stenosis and
study showed a statistically significant improvement of spine
surgery with functional outcome . Although, there is not
much evidence on long term functional effect after spinal surgery
on average mainly 2 years but there are few studies have been
published [22,23]. Our study also involves patients that had
surgery done between 2010 and 2019 and long term ODI has been
reported. The average ODI in our study is 20, compare to Imada
et. al had ODI of average 31.84 with mean follow up of 20 months
(range 12 to 40 months), which is lower than many studies that
are reported . Another study showed detailed review of ODI
postoperatively, after 1 year to up to 4 years. The average was 36.3
that after 1 year had difference of 22.2 and after 4 years 14.7.
The ODI is a reliable indicator to assess the outcome of
patients with spinal surgery, however, long term follow up is
crucial to help to understand the management of the patients.
Further studies are required to help to understand the patients
with poor functional outcome and identify the causative factors.