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I live in a small town in a rural state. I know I need surgery for a severe problem with lumbar stenosis. According to my local doc here, I would probably have a laminectomy and/or spinal fusion. How do I go about finding a place to go for this? There are "spine centers" listed on-line in two states near me. Does it make a difference which one I go to -- or is this the kind of problem that is treated the same everywhere so there's no need to look around?

According to a recent study called Spine Patient Outcomes Research Trial (SPORT), patients who have spine surgery (laminectomy and/or fusion) have different results depending on where the surgery was done. These are the findings of a recent review of data collected from 13 spine centers in 11 different cities across the United States. Naturally, the reasons for these differences in outcomes are of interest but will have to wait for another study. For now, this study shows that patients with stenosis (narrowing of the spinal canal) or degenerative spondylolisthesis (age-related fracture and slippage of the vertebra) who have the same surgery may not get the same results. Most of the time this type of surgery is successful with good postoperative outcomes. But there are cases where there is no change in painful, limiting symptoms, and the patient ends up having another surgery. There are many different reasons why some patients don't fare well after these procedures. Sometimes the patient was misdiagnosed or the surgical technique failed. In other cases, the spine was unstable and this problem wasn't addressed during the surgery. Many studies have shown that over time, adjacent segment disease (breakdown of the spinal segment next to the fusion site) is a problem. In each of the nearly 800 similar cases, surgery performed varied slightly and the number of levels operated on was anywhere from one to three or more. Events associated with the procedures (e.g., length of time in the operating room, amount of blood lost, number of dural tears) varied from center to center. And there were significantly different reports on how long patients stayed in the hospital and the number of wound infections. Long-term results (measured at one, two, three, and four years after surgery) were also significantly different across the spinal centers involved. For example, the number of patients who required another surgery ranged from five to 21 per cent. The level of pain and physical function reported by patients was also different. The data was collected and analyzed in such a way as to make sure that these differences were directly linked with the effect of the center rather than being due to patient factors such as age, size, smoking history, socioeconomic status, or level of preoperative exercise. Factors that may be important (but as yet unproven) include: surgeon preference for certain techniques, patient genetics, neurobiological responses to the underlying condition, and differences in patient response to pain. This study cannot answer the "why" of differences in response to surgery for these two conditions. But it does support the idea that there are broad ranges of patient outcomes across centers for the same conditions using similar surgical approaches. When looking for a surgeon/center where you can get the best results, it may be best to consult with your local surgeon. He or she may have contact or association with a surgeon of good repute who can help you. The information from this study may give you some idea as to what questions to ask and what to look for when finding a surgeon or center with good outcomes for this particular procedure.

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