The Impact of Surgical Chronology on Outcomes of Patients Receiving Lumbar Spine and Lower Extremity Joint Surgeries


Karam Atli, MS; Gabriel Smith, MD; Konrad Knusel, MS; Edward Benzel, MD; Ajit Krishnaney, MD; Michael Steinmetz, MD; Thomas Mroz, MD


The aging population and obesity epidemic indicate that increasingly more patients with lumbar spine pathology will likely also develop lower extremity joint (LEJ) disease (hip and/or knee). These patients may have co-existing lower back and extremity pain, the major source of which (spine vs. LEJ) is difficult to determine. There remains a lack of outcomes data of patients who receive surgeries for both an LEJ and the lumbar spine within a short period based on chronology of surgery type. This is the first report that evaluates the differences in surgical outcomes of patients receiving lumbar surgery following LEJ surgery compared to receiving lumbar surgery before LEJ surgery.


Retrospective chart review was performed of patients undergoing lumbar surgery between 2008-2015 and receiving hip/knee surgery within three years prior/ following lumbar surgery at a single institution. Pre- and post-operative outcome measures were assessed using the EuroQol five dimensions questionnaire (EQ5D) and Pain Disability Questionnaire (PDQ).


670 patients were included. Patients receiving lumbar surgery first were 4.75 times more likely to reach the minimal important difference in PDQ. Patients receiving LEJ surgery first had a higher mean Charlson Comorbidity Index. Male patients were 37% less likely to be readmitted within 90 days of either procedure.


Postoperatively, patients who received lumbar surgery before LEJ surgery had greater improvement than patients who received LEJ surgery before lumbar surgery. These findings suggest that in patients with a co-existing need for lumbar and LEJ surgery, greater consideration should be given to providing lumbar surgery before LEJ surgery. The findings of this study are applicable to multiple disciplines including primary care, orthopedics, and neurosurgery, and warrants further large-scale prospective investigation to determine the cause and generalizability of these surgical outcomes results.

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