VA wants to make better-informed decisions about lumbar stenosis surgery for veterans

According to the National Institutes of Health Interview Survey in 2014, 33 percent of veterans had reported significant back pain in the prior three months. And they are more likely to have severe back pain compared to non-veterans.

Spinal stenosis is one cause of lower back pain suffered by veterans. It occurs when spaces in the spine narrow and create pressure on the spinal cord and nerve roots. The spinal cord is a thick bundle of nerves that comes out of the base of the brain running down the center of the spine, and the nerve roots are branches that come out from the cord.

In the common form of spinal stenosis, the narrowing usually occurs over time. Depending on the location of the spinal stenosis, symptoms can include pain, numbness, and weakness in legs, feet, arms, and hands.1

Common among elderly veterans
“This is a common condition among elderly veterans,” said Minneapolis VA Medical Center Chief of Neurosurgery, Cornelius Lam, MD, PhD. “It’s a degenerative disease similar to arthritis elsewhere in the body.”

Treatments for lumbar spinal stenosis could be nonsurgical or surgical. If the latter is the best option, the United States Veterans Health Administration is interested in how veterans fare going into and following this kind of spine surgery. As a result, it instituted a multi-center study titled, Lumbar Spinal Stenosis Surgery Program, based out of Boston, MA. The Minneapolis VA Health Care System was one of the first in the country to participate. “We have been actively involved for more than a year,” said Lam.

Well poised to do this
“Part of the issue is that we don’t have good criteria concerning indications and outcome measures for this type of spinal surgery,” he added. “The VA is well poised to do this kind of work because veterans are often afflicted with low back pain and they tend to stay within the VA system for their care.”

The goal is to have at least 20 VA Medical Centers participating in the study, which according to Lam, is designed, “to create a detailed database that draws from lumbar stenosis patient electronic health records to include everything from their backgrounds to their outcomes, complications, and comorbidities. We want to capture as much information as we can.”

The study is funded for five years, subject to annual reviews (and changes in the political environment). “It will give us information about back pain in general, creating a foundation for evidence-based protocols to help determine whether a veteran should have lumbar stenosis surgery and what outcomes should be expected,” said Lam. “It will also give us clinical material for future research.”


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