3SProceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.006

6. Outcomes Based on a Low Back Pain Classification System

Greg McIntosh, MSC1, Hamilton Hall, MD2, Christina Boyle, BSC3;1Oakville, Ontario, Canada; 2Markdale, Ontario, Canada; 3Toronto,

Ontario, Canada

BACKGROUND CONTEXT: One goal of LBP assessment is to direct

clinicians to specific sub-groups that benefit from particular treatment ap-

proaches. The term ’non-specific’ LBP does not direct treatment or instil

confidence in patients.

PURPOSE: The purpose of this study was to compare outcomes in a con-

servative care setting between patients assessed and treated based on a di-

agnostic system of LBP classification and patients managed without

a classification system.

STUDY DESIGN/ SETTING: This prospective double-cohort study

investigated mechanical LBP cases who started conservative care rehabil-

itation at 15 clinics across Canada between February 2006 and August

2007.

PATIENT SAMPLE: The two cohorts were: a Comparison Group

(n5754) and a Classification Group (n51469). All patients in both groups

had mechanical LBP. The Comparison Group contained those attending

treatment at 8 clinics that did not use a classification based system of as-

sessment or treatment. The Classification Group (n51356) consisted of pa-

tients attending 7 clinics specifically trained to use a LBP classification

system that emphasizes mechanical assessment, pattern of pain recognition

and appropriate treatment direction.

OUTCOME MEASURES: Primary outcomes assessed were: 1) subjec-

tive global pain rating, 2) change in reported medication usage from as-

sessment to discharge, 3) change in Visual Analogue Scale (VAS) pain

rating from assessment to discharge, 4) change in perceived function from

assessment to discharge, based on score change from a modified version of

the Low Back Outcome Score (LBOS) and 5) total number of treatment

days.

METHODS: The classification system is purposely as inclusive as possi-

ble to include more than those who may get labelled with NSLBP; thus,

very little study exclusion criteria were necessary. Those over 65 years

of age and those with neurological, reflex or strength deficits were included

because there are specific categories for those where age or signs of nerve

root compromise contribute to their condition. Only minors, those with

previous spine surgery and those with suspected systemic disease or cases

resulting from trauma sufficient to produce severe bony injury or major

neurological sequelae were excluded. Patients were either self-referred

to the clinics or referred via general practice, family physicians or ortho-

paedic surgeons. All clinics involved in this study are primary access, con-

servative care, rehabilitation facilities.

RESULTS: For both Comparison and Classification Groups, the mean

age was 44.7 years (SD513.3, range518–89,), with 55.1% males. The

mean lagtime from symptom onset to treatment was 110.7 days

(SD5201.5), indicating a somewhat chronic sample; however, this vari-

able did not follow a normal distribution. Median values (32 days, inter-

quartile range59.5, 121.5 days) suggest a more subacute sample.

Treatment based on this classification system resulted in more pain reduc-

tion (p!0.001), higher functional improvement (p!0.001), less medica-

tion use (p!0.001) and fewer treatment days (p!0.001), compared to

a generic approach.

CONCLUSIONS: Outcome differences between the five classified

groups suggest that LBP is heterogeneous, and recognizable by clinical

patterns of patient characteristics. The results support the effectiveness

of a classification system that matches treatment to patient presentation

and pattern of pain. Classification-based treatment had a positive impact

on outcomes.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.007

7. Spinal Stenosis vs. Degenerative Spondylolisthesis: Comparison of

Baseline Characteristics and Outcomes

Adam Pearson, MD1, Emily Blood, MS2, Jon Lurie, MD1, Tor Tosteson,

PhD1, Alan Hillibrand, MD3, Keith Bridwell, MD4, James Weinstein, DO2;1Dartmouth College, Lebanon, NH, USA; 2Lebanon, NH, USA; 3Rothman

Institute, Philadelphia, PA, USA; 4Washington University in St. Louis, St.

Louis, MO, USA

BACKGROUND CONTEXT: Spinal stenosis (SpS) and degenerative

spondylolisthesis (DS) patients are often combined in clinical studies. This

study contrasts these two distinct cohorts from the Spine Patient Outcomes

Research Trial (SPORT).

PURPOSE: To compare baseline characteristics and surgical and non-op-

erative outcomes between SpS and DS patients.

STUDY DESIGN/ SETTING: The Spine Patient Outcomes Research

Trial (SPORT) included randomized and observational cohorts, with 13

participating institutions in 11 states.

PATIENT SAMPLE: 615 SpS and 591 DS patients.

OUTCOME MEASURES: SF-36 Bodily Pain and Physical Function

scores, Oswestry Disability Index , Sciatica Bothersomeness Index, and

Back Pain Bothersomeness.

METHODS: The SPORT SpS cohort included 634 patients (394

underwent surgery within two years), and the DS cohort included 601

patients (369 underwent surgery within two years). Baseline characteris-

tics were compared between the two groups. Changes from baseline for

surgical and non-operative outcomes were estimated using longitudinal

regression models including baseline covariates to control for

confounders.

RESULTS: The SpS patients included a higher proportion of males

(61% vs. 31%, p!0.001); were younger (64.6 years vs. 66.1 years,

p50.021); were less likely to report depression (11% vs. 16%,

p50.009); more likely to report heart (26% vs. 20%, p50.021) or gastro-

intestinal (14% vs. 7%, p!0.001) problems; and were more likely to

have stenosis at multiple levels (61% vs. 35%, p!0.001) compared to

the DS patients. There were no significant baseline differences on any

of the main outcome measures between the SpS and DS patients. SpS

patients undergoing surgery were less likely to be fused than DS patients

(11% vs 95%, p!0.001). SpS patients improved less with surgery than

DS patients on SF-36 physical function (+25.1 vs. +30.5, p50.002 at

1 yr; +25.9 vs. +31.2, p50.001 at 2 yrs) and bodily pain (+27.2 vs.

+32.5, p50.002 at 1 yr; +21.2 vs. +28.4, p!0.001 at 2 yrs) scores, Os-

westry Disability Index (�20.8 vs. �26.1, p!0.001 at 1 yr; �20.1 vs.

�24.8, p!0.001 at 2 yrs), and Sciatica Bothersomeness Index (�8.4

vs. �9.4, p50.05 at 1 yr; �7.9 vs. �8.9, p50.031 at 2 yrs). Back Pain

Bothersomeness improved less in SpS patients at 1 yr (�2.0 vs. �2.4,

p50.012), though the difference was no longer significant at 2 yrs

(�2.0 vs. �2–2, p50.21). In both cohorts, patients treated non-opera-

tively improved less than those treated surgically, and there were no sig-

nificant differences in non-operative outcomes between the two cohorts at

one or two years.

CONCLUSIONS: Overall, SpS and DS patients had similar baseline

characteristics. However, SpS patients improved less with surgery than

DS patients. These differences in surgical outcomes may be related to

different underlying disease processes, different operative treatments or

both. Future studies should not combine these heterogeneous patient

populations.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.008