Usefulness of the STarT Back Screening Tool to predict pain problems after lumbar spine surgery.

INTRODUCTION: The Subgroups for Targeted Treatment (STarT) Back Screening Tool is used in general practice to stratify patients with acute back pain into either a low, medium or a high risk of developing complex pain. This study determines if the STarT Back Screening Tool can identify patients who are at a high risk of developing complex pain after spine surgery.

METHODS: The STarT Back Screening Tool was administered pre-operatively to a consecutive series of patients who had lumbar spine surgery between 29 October 2012 and 1 February 2013. A visual analogue scale (VAS, 0-100) for back and leg pain was determined pre-operatively and also on the first day after surgery, at discharge, at 4 to 12 weeks after surgery, and one year after surgery. Patients were stratified into those who underwent decompression only for lumbar disc herniation or stenosis and those who underwent decompression and fusion for spondylolisthesis.

RESULTS: In the decompression group, high-risk patients had poorer pre-operative back and leg pain scores, but similar length of stay, improvements in back or leg pain at 4-12 week and at the one-year follow-up compared with the other groups. The high-risk group experienced a significantly greater improvement in leg pain on the first post-operative day and on the day of discharge. In the decompression and fusion group, high-risk patients had poorer pre-operative back and leg pain scores than the other groups. There were no significant differences in back or leg pain improvement among the three groups at any time point during follow-up.

CONCLUSIONS: The results of this study show that the STarT Back Screening Tool may be useful for identifying patients who are at a high risk of developing complex pain after spine surgery.

FUNDING: none.

TRIAL REGISTRATION: not relevant.