Utility of Preoperative Whole-Body Imaging in Candidates for Lumbar Spine Surgery: The Impact of Concomitant Lower Extremity Osteoarthritis.

Study Design: Retrospective cohort study.

Objective: To assess the utility of whole-body imaging in diagnosing lower extremity osteoarthritis (LEOA), evaluate the association of LEOA with radiculopathy, and determine the impact of LEOA on postoperative recovery.

Summary Of Background Data: Whole-body imaging offers rapid, low-radiation assessment of both spinal and lower extremity pathology. This modality may be pivotal in helping clinicians better understand how lower extremity pathology influences clinical presentation and recovery among patients with degenerative lumbar conditions.

Methods: Patients with preoperative whole-body imaging who underwent lumbar spine surgery for degenerative conditions between 2017 and 2022 were included. The Kellgren and Lawrence (KL) score was implemented to grade joint osteoarthritis (OA) as mild (KL ≤2) or severe (KL ≥3). Length of stay (LOS) and side of radiculopathy were assessed. The Oswestry disability index (ODI), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS), visual analog scale (VAS), and Short Form-12 (SF-12) Physical/Mental Component Scales (PCS/MCS) were recorded at preoperative, early-postoperative (2, 6, 12 weeks), and late-postoperative (6, 12, 24 months) timepoints. The association of HOA/KOA with PROMs and minimum clinically important difference (MCID) was evaluated.

Results: Totally, 207 patients were included (HOA: n=130 mild, n=62 severe; KOA: n=141 mild, n=53 severe). Patients with severe OA were significantly older compared with patients with mild OA (P<0.05). OA laterality was not associated with side of radiculopathy. After controlling for age, LOS was ∼50% greater for severe HOA (P=0.031) and severe KOA (P=0.013) compared with mild OA. Severe KOA exhibited worse PROMIS at the early-postoperative timepoint (P=0.013), and worse PROMIS (P=0.049), VAS-back (P=0.009), and SF-12-PCS (P=0.025) at the late-postoperative timepoint. Severe HOA and KOA reduced the likelihood of achieving MCID for SF-12-PCS (OR: 0.44; P=0.049) and PROMIS (OR: 0.37; P=0.027), respectively.

Conclusions: Whole-body imaging may help improve patient-specific counseling on expectations after lumbar spine surgery.