Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain

Andrew J. Haig, Henry C. Tong, Karen S J Yamakawa, Christopher Parres, Douglas J. Quint, Anthony Chiodo, Jennifer A. Miner, Vaishali Phalke, Julian T. Hoff, Michael E. Geisser

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

STUDY DESIGN. Longitudinal masked, double-controlled cohort study. OBJECTIVES. To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P <001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

Original languageEnglish (US)
Pages (from-to)2950-2957
Number of pages8
JournalSpine
Volume31
Issue number25
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Spinal Stenosis
Back Pain
Low Back Pain
Pain
Electromyography
Walking
Pathologic Constriction
Magnetic Resonance Imaging
Neurologic Manifestations
Physical Examination
Volunteers
Sleep
Cohort Studies

Keywords

  • Back pain
  • Electromyography
  • Magnetic resonance imaging
  • Prognosis
  • Spinal stenosis

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Haig, A. J., Tong, H. C., Yamakawa, K. S. J., Parres, C., Quint, D. J., Chiodo, A., ... Geisser, M. E. (2006). Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain. Spine, 31(25), 2950-2957. https://doi.org/10.1097/01.brs.0000247791.97032.1e

Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain. / Haig, Andrew J.; Tong, Henry C.; Yamakawa, Karen S J; Parres, Christopher; Quint, Douglas J.; Chiodo, Anthony; Miner, Jennifer A.; Phalke, Vaishali; Hoff, Julian T.; Geisser, Michael E.

In: Spine, Vol. 31, No. 25, 12.2006, p. 2950-2957.

Research output: Contribution to journalArticle

Haig, AJ, Tong, HC, Yamakawa, KSJ, Parres, C, Quint, DJ, Chiodo, A, Miner, JA, Phalke, V, Hoff, JT & Geisser, ME 2006, 'Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain', Spine, vol. 31, no. 25, pp. 2950-2957. https://doi.org/10.1097/01.brs.0000247791.97032.1e
Haig, Andrew J. ; Tong, Henry C. ; Yamakawa, Karen S J ; Parres, Christopher ; Quint, Douglas J. ; Chiodo, Anthony ; Miner, Jennifer A. ; Phalke, Vaishali ; Hoff, Julian T. ; Geisser, Michael E. / Predictors of pain and function in persons with spinal stenosis, low back pain, and no back pain. In: Spine. 2006 ; Vol. 31, No. 25. pp. 2950-2957.
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AU - Tong, Henry C.

AU - Yamakawa, Karen S J

AU - Parres, Christopher

AU - Quint, Douglas J.

AU - Chiodo, Anthony

AU - Miner, Jennifer A.

AU - Phalke, Vaishali

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AU - Geisser, Michael E.

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N2 - STUDY DESIGN. Longitudinal masked, double-controlled cohort study. OBJECTIVES. To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P <001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

AB - STUDY DESIGN. Longitudinal masked, double-controlled cohort study. OBJECTIVES. To determine prognosis and predictors of function and pain in persons with spinal stenosis. SUMMARY OF BACKGROUND DATA. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. METHODS. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. RESULTS. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P <001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. CONCLUSION. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.

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