Percutaneous Lumbar Decompression Improves Quality of Life in Veterans Suffering from Low Back and Leg Pain
Description
Objectives: Interspinous process decompression (IPD) is a procedure that restricts lumbar spine extension through implantation of a spacer between adjacent spinous processes to reduce neurogenic claudication symptoms associated with lumbar spinal stenosis (LSS). Our study aims to determine whether a minimally invasive IPD provides relief to United States Military Veterans who have undergone the procedure over the past year. To achieve this, a health survey and a secondary questionnaire will compare pre-operative and post-operative results. Methods: Patients were administered an SF-12v2 survey pre-operatively and at several intervals up to 1-year post-operatively to assess their quality of life over time; there is a score for Mental Component Summary (MCS) and Physical Component Summary (PCS). The patients were then administered a customized secondary questionnaire to specifically monitor their improvement in pain on a scale of 1-10 and their improvement in the number of blocks walked post-operatively. The patients were also questioned on whether they received any postoperative injections, lumbar surgeries, and IPD explants. Opioids taken chronically were measured before and after the procedure; our conversion of hydrocodone to morphine was 1:1, and oxycodone to morphine was 1.5:1. Additionally, the patients were asked whether they would recommend Vertiflex, IPD, to a fellow veteran based on the improvement in their low back and leg pain. 20 patients are currently participating in the study, and 16 patients have been assessed at the 1-year time mark. Results: Of the 16 patients administered the SF-12v2, patients saw an average increase of 6.56 in their MCS score (p=0.054, p>0.05), while the change recorded in the PCS score was insignificant (p>0.05) Regarding the secondary survey, patients had an average decrease of - 1.69 in their pain score on the standardized 10-point pain scale (p=0.078, p>0.05). Additionally, patients saw an average increase of 2.04 city blocks walked post-procedure when measured using the average size of a city block according to the City of New Orleans Department of Public works (p=0.087, p>0.05). Relief in pain and increase in the number of blocks walked was insignificant thus far in the study. Patients taking opiates before the procedure had an average decrease of -23.09 morphine milliequivalents post-op (p=0.024, p<0.05). Subsequently, only 7 (43.75%) patients received procedures after IPD, consisting of 1 (14.29%) patient with lumbar spine surgery, 6 (85.71%) of these patients receiving epidural steroid injections, and 0 patients undergoing an IPD explant. Overall, 9 patients would recommend Vertiflex to a fellow veteran, with 11.11% experiencing only back pain relief, 11.11% receiving only leg pain relief, and 77.78% experiencing both back and leg pain relief. 7 patients would not recommend Vertiflex to a fellow veteran because of lack of improvement. Conclusion: Percutaneous lumbar decompression with IPD increases the quality of life in Veterans. A significant decrease in chronic opioid use was seen after IPD. A majority of patients recommend IPD to fellow U.S. Veterans, and there were no complications
Percutaneous Lumbar Decompression Improves Quality of Life in Veterans Suffering from Low Back and Leg Pain
Objectives: Interspinous process decompression (IPD) is a procedure that restricts lumbar spine extension through implantation of a spacer between adjacent spinous processes to reduce neurogenic claudication symptoms associated with lumbar spinal stenosis (LSS). Our study aims to determine whether a minimally invasive IPD provides relief to United States Military Veterans who have undergone the procedure over the past year. To achieve this, a health survey and a secondary questionnaire will compare pre-operative and post-operative results. Methods: Patients were administered an SF-12v2 survey pre-operatively and at several intervals up to 1-year post-operatively to assess their quality of life over time; there is a score for Mental Component Summary (MCS) and Physical Component Summary (PCS). The patients were then administered a customized secondary questionnaire to specifically monitor their improvement in pain on a scale of 1-10 and their improvement in the number of blocks walked post-operatively. The patients were also questioned on whether they received any postoperative injections, lumbar surgeries, and IPD explants. Opioids taken chronically were measured before and after the procedure; our conversion of hydrocodone to morphine was 1:1, and oxycodone to morphine was 1.5:1. Additionally, the patients were asked whether they would recommend Vertiflex, IPD, to a fellow veteran based on the improvement in their low back and leg pain. 20 patients are currently participating in the study, and 16 patients have been assessed at the 1-year time mark. Results: Of the 16 patients administered the SF-12v2, patients saw an average increase of 6.56 in their MCS score (p=0.054, p>0.05), while the change recorded in the PCS score was insignificant (p>0.05) Regarding the secondary survey, patients had an average decrease of - 1.69 in their pain score on the standardized 10-point pain scale (p=0.078, p>0.05). Additionally, patients saw an average increase of 2.04 city blocks walked post-procedure when measured using the average size of a city block according to the City of New Orleans Department of Public works (p=0.087, p>0.05). Relief in pain and increase in the number of blocks walked was insignificant thus far in the study. Patients taking opiates before the procedure had an average decrease of -23.09 morphine milliequivalents post-op (p=0.024, p<0.05). Subsequently, only 7 (43.75%) patients received procedures after IPD, consisting of 1 (14.29%) patient with lumbar spine surgery, 6 (85.71%) of these patients receiving epidural steroid injections, and 0 patients undergoing an IPD explant. Overall, 9 patients would recommend Vertiflex to a fellow veteran, with 11.11% experiencing only back pain relief, 11.11% receiving only leg pain relief, and 77.78% experiencing both back and leg pain relief. 7 patients would not recommend Vertiflex to a fellow veteran because of lack of improvement. Conclusion: Percutaneous lumbar decompression with IPD increases the quality of life in Veterans. A significant decrease in chronic opioid use was seen after IPD. A majority of patients recommend IPD to fellow U.S. Veterans, and there were no complications