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Kadhim AA, Hakim WS, Aljanabi AS. Factors determining postoperative and outpatient follow-up period in patients undergoing single lumbar disc herniation. J Med Life 2023; 16:1452-1455. [PMID: 38313164 PMCID: PMC10835567 DOI: 10.25122/jml-2023-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
The precise evaluation of postoperative outcomes in patients with lumbar disc surgery is quite difficult since the pre-operative factors and patient responses differ. Several questionnaires assess the outcome of herniated lumbar disc surgeries. However, the clinical outcome may vary widely, indicating the significance of precise preoperative assessments to ensure better outcome prediction. Previous long-term studies suggest fewer positive outcomes in cases with prolonged preoperative history. In the present retrospective study, we aimed to assess the outcome of patients with lumbar discectomy in Iraqi patients by evaluating the surgical outcome. This research was performed in the orthopedic center of the Teaching Hospital of Adiwaniyah Province, Iraq. The study was based on retrieving hospital records of patients who were subjected to surgical intervention for lumbar disc herniation from 2018 to 2022. The sample consisted of patients with lumbar disc herniation who were subjected to discectomy at one level even in cases where both approaches were used. Age, gender, income, education level, and degree of disc involvement did not significantly correlate with the type of surgical approach (p>0.05); however, there were significant positive correlations to body mass index and duration of disease (p<0.05). Therefore, the body mass index and duration of disease are significant predictors of prolonged postoperative follow-up and hospital stay duration.
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Affiliation(s)
- Abbas Abdulameer Kadhim
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Qadisiyyah Province, Iraq
| | - Wissam Saleh Hakim
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Qadisiyyah Province, Iraq
| | - Ali Saleh Aljanabi
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Qadisiyyah Province, Iraq
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2
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Angadi SP, Ramachandran K, Shetty AP, Kanna RM, Shanmuganathan R. Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery - a prospective observational study. Spine J 2023; 23:1306-1313. [PMID: 37220813 DOI: 10.1016/j.spinee.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND CONTENT The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSE The primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries. STUDY DESIGN Prospective, observational study. PATIENT SAMPLE Sixty patients requiring a single-level lumbar fusion surgery. OUTCOME MEASURES Postoperative pain intensity and the amount of postoperative analgesics consumption. METHODS In our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3. RESULTS The average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics. CONCLUSION Preoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.
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Affiliation(s)
- Sachin P Angadi
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India.
| | - Rishi M Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
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3
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Suzuki H, Tahara S, Mitsuda M, Funaba M, Fujimoto K, Ikeda H, Izumi H, Yukata K, Seki K, Uranami K, Ichihara K, Nishida N, Sakai T. Reference intervals and sources of variation of pressure pain threshold for quantitative sensory testing in a Japanese population. Sci Rep 2023; 13:13043. [PMID: 37563245 PMCID: PMC10415310 DOI: 10.1038/s41598-023-40201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
Quantitative sensory testing (QST) is useful when analysing musculoskeletal pain disorders. A handheld algometer is most commonly used for pressure pain threshold (PPT) tests. However, reference intervals for PPTs are not elucidated. We assessed reference intervals of PPTs for QST in 158 healthy adult Japanese with no history of musculoskeletal or neurological problems. A handheld algometer was used to record PPT at five different assessment sites on the body: lumbar paravertebral muscle, musculus gluteus maximus, quadriceps, tibialis anterior muscle, and anterior talofibular ligament. Multiple regression analysis was performed to explore sources of variation of PPT according to sex, age, body mass index, UCLA Activity Level Rating, and Tegner Activity Score. Reference intervals were determined parametrically by Gaussian transformation of PPT values using the two-parameter Box-Cox formula. Results of multiple regression analysis revealed that age was significantly associated with PPT of lumbar paravertebral muscle and musculus gluteus maximus. In females, body mass index showed significant positive correlation with PPT of anterior talofibular ligament, and UCLA Activity Level Rating also showed significant positive association with tibialis anterior muscle and anterior talofibular ligament. Site-specific reference intervals of PPTs for Japanese are of practical relevance in fields of pain research using a handheld algometer.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan.
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan.
| | - Shu Tahara
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Mao Mitsuda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hiroaki Ikeda
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hironori Izumi
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kiminori Yukata
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kazushige Seki
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kota Uranami
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
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Raak CK, Ostermann T, Schönenberg-Tu AL, Fricke O, Martin DD, Robens S, Scharbrodt W. No Gender Differences in Pain Perception and Medication after Lumbar Spine Sequestrectomy—A Reanalysis of a Randomized Controlled Clinical Trial. J Clin Med 2022; 11:jcm11092333. [PMID: 35566458 PMCID: PMC9105259 DOI: 10.3390/jcm11092333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 01/20/2023] Open
Abstract
Background: Gender issues have received increasing attention in clinical research of the past years, and biological sex has been introduced as a moderating variable in experimental pain perception. However, in clinical studies of acute pain and gender, there are conflicting results. In particular, there are limited data on the impact of gender differences after spinal sequestrectomy. The aim of this work is to examine gender differences in postoperative pain and pain medication consumption in an inpatient clinical setting. Methods: Data of a completed double-blind RCT was subdivided by gender and reanalyzed by means of an analysis of variance in repeated measures. Outcomes included pain severity measured on a VAS, affective (SES-A) and sensory pain perception (SES-S) and morphine equivalent doses (MED) of analgesics after spinal sequestrectomy. Results: In total, 42 female (47.73%) and 46 male (52.27%) patients were analyzed. No differences in pain severity (VAS: Gender × Time F = 0.35; (df = 2, 86); p = 0.708), affective and sensory pain perception (SES-A: Gender × Time F = 0.08; (df = 2, 86); p = 0.919; SES-S: Gender × Time F = 0.06; (df = 2, 86); p = 0.939) or post-operative opioid use between men and women (MEDs: Gender × Time F = 1.44; (df = 2, 86); p = 0.227) could be observed. Conclusions: This reanalysis of an RCT with respect to gender differences is to our knowledge the first attempt to investigate the role of gender in pain perception and medication after lumbar spine sequestrectomy. In contrast to other studies, we were not able to show significant differences between male and female patients in all pain-related outcomes. Apart from well-established pain management, psychological reasons such as gender-specific response biases or the observer effect might explain our results. Trial registration: The study was registered as a regulatory phase IV study at the German Clinical Trials Register (DRKS), an open-access online register for clinical trials conducted in Germany (Reg-No: DRKS00007913).
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Affiliation(s)
- Christa K. Raak
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany; (O.F.); (D.D.M.); (W.S.)
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, 58313 Herdecke, Germany;
- Correspondence:
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58448 Witten, Germany; (T.O.); (S.R.)
| | - Anna-Li Schönenberg-Tu
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, 58313 Herdecke, Germany;
| | - Oliver Fricke
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany; (O.F.); (D.D.M.); (W.S.)
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Witten/Herdecke University, 58313 Herdecke, Germany
| | - David D. Martin
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany; (O.F.); (D.D.M.); (W.S.)
| | - Sibylle Robens
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58448 Witten, Germany; (T.O.); (S.R.)
| | - Wolfram Scharbrodt
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany; (O.F.); (D.D.M.); (W.S.)
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, 58313 Herdecke, Germany;
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5
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Lener S, Wipplinger C, Hartmann S, Rietzler A, Thomé C, Tschugg A. Gender-Specific Differences in Presentation and Management of Spinal Infection: A Single-Center Retrospective Study of 159 Cases. Global Spine J 2021; 11:430-436. [PMID: 32875875 PMCID: PMC8119926 DOI: 10.1177/2192568220905804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN A retrospective single-center analysis of 159 cases. OBJECTIVE To investigate differences between male and female patients, as spinal infection (SI) represents a life-threatening condition and numerous factors may facilitate the course and outcome of SI, including patients' age and comorbidities, as well as gender. To date, no comparative data investigating sex differences in SI is available. Thus, the purpose of the present retrospective trial was to investigate differences between male and female patients. METHODS A total of 159 patients who were treated for a spinal infection between 2010 and 2016 at our department were included in the analysis. The patients were categorized into 2 groups based on gender. Evaluation included magnetic resonance imaging, laboratory values, clinical outcome, and conservative/operative management. RESULTS Male patients suffered from SI significantly more often than female patients (n = 101, 63.5% vs n = 58, 36.5%, P = .001). However, female patients were initially affected more severely, as infection parameters were significantly higher (P = .032) and vertebral destruction was more serious (P = .018). Furthermore, women suffered from intraoperative complications more often (P = .024) and received erythrocyte concentrates more frequently (P = .01). Nevertheless, mortality rates and outcome were comparable. Pain scales were significantly higher in female patients at 12-month follow-up (P = .042). CONCLUSION Although male patients show a higher incidence for SI, the course of disease and the management is more challenging in female patients. Nevertheless, outcome after 12 months is comparably good. Underlying mechanisms may include a better immune response and dissimilar effects of antibiotic treatment in women. Pain management in female patients is still unsatisfactory after 12 months.
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Affiliation(s)
- Sara Lener
- Medical University of
Innsbruck, Innsbruck, Austria,Sara Lener, Clinical Department of
Neurosurgery, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck,
Austria.
| | | | | | | | | | - Anja Tschugg
- Medical University of
Innsbruck, Innsbruck, Austria
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6
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MacLean MA, Touchette CJ, Han JH, Christie SD, Pickett GE. Gender differences in the surgical management of lumbar degenerative disease: a scoping review. J Neurosurg Spine 2020; 32:799-816. [PMID: 32005013 DOI: 10.3171/2019.11.spine19896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis). METHODS A systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected. RESULTS Thirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females. CONCLUSIONS Female patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.
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Affiliation(s)
- Mark A MacLean
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Charles J Touchette
- 2Division of Neurosurgery, Universitaire de Sherbrooke, Centre de recherche du Centre Hospitalier, Sherbrooke, Quebec, Canada
| | - Jae H Han
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Sean D Christie
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Gwynedd E Pickett
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
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7
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The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases. Neurosurg Rev 2019; 43:1297-1303. [PMID: 31414196 PMCID: PMC7515935 DOI: 10.1007/s10143-019-01151-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 07/24/2019] [Indexed: 12/28/2022]
Abstract
The negative impact on spinal diseases may apply not only to obesity but also to smoking. To investigate the influence of obesity and smoking on the development and recovery of lumbar disc herniation in young adults. Retrospective analysis of 97 patients who presented with lumbar disc herniation at the authors' department between 2010 and 2017. Data were collected using the patients' digital health records including demographics, clinical and neurological characteristics, treatment details, and outcomes. Ninety-seven patients between 17 and 25 years were included in this retrospective analysis. Patients were categorized into two groups according to their body mass index: obese (O, ≥ 30 kg/m2) and non-obese (NO, < 30 kg/m2). The proportion of obese patients in our cohort vs. in the overall population differed significantly (19.4% vs. 3.8-7.1%, RR 3.17; p < 0.01). Group NO showed a trend toward faster recovery of motor deficits (p = 0.067) and pain (p = 0.074). Also, the proportion of regular smokers differed significantly from the numbers of known smokers of the same age (62.4% vs. 30.2%, RR 2.0; p = 0.01). Obesity plus smoking showed a significantly negative impact on motor deficits postoperatively (p = 0.015) and at discharge (p = 0.025), as well as on pain values (p = 0.037) and on analgesic consumption (p = 0.034) at 6 weeks follow-up. The negative impact of obesity and smoking on the occurrence of lumbar disc herniation could be demonstrated for individuals aged 25 or younger. Furthermore, a trend to earlier recovery of motor deficits and significantly lower pain scales for non-obese and non-smoking patients could be shown.
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De Prá SDT, Antoniazzi CTDD, Ferro PR, Kudsi SQ, Camponogara C, Fialho MFP, Rigo FK, Gomez MV, Bochi GV, Moresco RN, Oliveira SM, Trevisan G. Nociceptive mechanisms involved in the acute and chronic phases of a complex regional pain syndrome type 1 model in mice. Eur J Pharmacol 2019; 859:172555. [PMID: 31326377 DOI: 10.1016/j.ejphar.2019.172555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/04/2023]
Abstract
Complex regional pain syndrome I (CRPS-I) is a chronic painful pathology still undertreated. CTK 01512-2 is a recombinant version of the spider peptide Phα1β, and it functions as a voltage-gated calcium channel blocker and a transient receptor potential ankyrin 1 (TRPA1) antagonist with antinociceptive effect in different pain models. Here, we investigate the mechanisms involved in the acute and chronic nociceptive phases of a model of CPRS-I in mice and assess the antinociceptive effect of CTK 01512-2 using this model. Adult male and female mice C57BL/6 (20-30 g) were used to determine mechanical (von Frey test) or cold (acetone test) allodynia induction. Inflammatory parameters (serum and tibial nerve lactate levels, hind paw temperature and edema, or tissue cell infiltration) were evaluated after chronic post-ischemia pain (CPIP, a model of CPRS-I) induction. Anti-inflammatory and anti-neuropathic drugs or CTK 01512-2 were tested. First, we detected that CPIP-induced mechanical and cold allodynia in male and female mice in a similar way. In the acute phase (1 day after CPIP), an increase in inflammatory parameters were observed, as well as the anti-allodynic effect of anti-inflammatory compounds. In the chronic phase (17 days after CPIP), mice exhibited mechanical and cold allodynia, and anti-neuropathic drugs induced antinociception, while no inflammatory alterations were found. CTK 01512-2 reversed the CPIP allodynic effect in both nociceptive phases. Thus, this CPRS-I model can be used to understand the mechanisms involved in CPRS-I induced pain and inflammation. Besides, we observed that CTK 01512-2 has a valuable antinociceptive effect in this pain model.
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Affiliation(s)
- Samira Dal Toé De Prá
- Graduated Program in Health Sciences, University of the Extreme South of Santa Catarina (Unesc), 88006-000, Criciúma (SC), Brazil
| | | | - Paula Ronsani Ferro
- Graduated Program in Health Sciences, University of the Extreme South of Santa Catarina (Unesc), 88006-000, Criciúma (SC), Brazil
| | - Sabrina Qader Kudsi
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Camila Camponogara
- Graduated Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Maria Fernanda Pessano Fialho
- Graduated Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Flávia Karine Rigo
- Graduated Program in Health Sciences, University of the Extreme South of Santa Catarina (Unesc), 88006-000, Criciúma (SC), Brazil
| | - Marcus Vinícius Gomez
- Teaching and Research Institute, Santa Casa de Misericórdia de Belo Horizonte, 30150-240, Belo Horizonte, MG, Brazil
| | - Guilherme Vargas Bochi
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Rafael Noal Moresco
- Graduated Program in Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Sara Marchesan Oliveira
- Graduated Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil
| | - Gabriela Trevisan
- Graduated Program in Health Sciences, University of the Extreme South of Santa Catarina (Unesc), 88006-000, Criciúma (SC), Brazil; Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), 97105-900, Santa Maria (RS), Brazil.
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9
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Tschugg A, Lener S, Hartmann S, Fink V, Neururer S, Wildauer M, Löscher WN, Thome C. Extraforaminal Lumbar Disk Herniations Lead To Neuroplastic Changes: a Study Using Quantitative Sensory Testing. Muscle Nerve 2018; 58:676-680. [DOI: 10.1002/mus.26184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sara Lener
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sebastian Hartmann
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Valentin Fink
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Matthias Wildauer
- Department of Neuroradiology; Innsbruck Medical University; Innsbruck Austria
| | | | - Claudius Thome
- Department of Neurosurgery; Innsbruck Medical University; Anichstrasse 35, A-6020 Innsbruck Austria
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Her Y, Kang SH, Cho YJ, Yang JS, Jeon JP, Choi HJ. Factors Associated With Longer Postoperative Outpatient Follow-up Duration in Patients With Single Lumbar Disc Herniation: A Noncomplicated Patient Cohort Study. Neurospine 2018; 15:225-230. [PMID: 30157584 PMCID: PMC6226128 DOI: 10.14245/ns.1836006.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022] Open
Abstract
Objective Many reports have described the outcomes of surgical treatment of lumbar disc herniation (LDH). However, few reports have investigated the treatment period after lumbar disc surgery. If no complications occur, how long should an ordinary patient be treated? Which factors are associated with the outpatient follow-up period (OFP)? To answer these questions, we reviewed the medical records of patients who underwent lumbar disc surgery, calculated their average OFP, and sought to identify factors associated with the OFP.
Methods Patients who underwent surgical treatment of single-level LDH from July 2005 to December 2011 were enrolled in this study. Patients who had no pain or required no further treatment did not receive follow-up. Patients’ medical records were reviewed retrospectively. Cases of recurrent LDH, postoperative infections, instrumentation, cauda equina syndrome, postoperative hematoma, trauma-associated herniation, and spondylolisthesis were excluded. We reviewed the postoperative hospitalization period (PHP) and the OFP. Sex, age, operation year, surgical approach, the operating surgeon, disc level, and insurance type were investigated as associated factors.
Results In total, 611 patients underwent surgical treatment for single-level LDH by 4 surgeons. Their average age was 44.3 ± 15.1 years. There were 377 male and 234 female patients. The average PHP was 4.4 ± 3.2 days, the average OFP was 112.3 ± 198.6 days, and the 95% confidence interval for the OFP among the enrolled patients was between 96.5 and 128.1 days.
Conclusion Although this is a single-institute report, most LDH patients showed an OFP of less than 4 months after surgical treatment. In this study, sex, age, and insurance type seemed to be related with the OFP.
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Affiliation(s)
- Yunsuk Her
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Suk-Hyung Kang
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Jun Cho
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Gender differences in degenerative spine surgery: Do female patients really fare worse? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2427-2435. [PMID: 30132176 DOI: 10.1007/s00586-018-5737-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Prior data has set the precedent that female patients fare somewhat worse than men after spine surgery. We aimed to evaluate the effect of gender on patient-reported outcomes after lumbar spine surgery for degenerative pathologies. METHODS We identified a consecutive cohort of patients from a prospective registry. Absolute values, as well as change scores for back and leg pain severity (numeric rating scale [NRS]), functional disability (Oswestry disability index [ODI]), and health-related quality of life (HRQOL) as assessed by EQ-5D were compared among male and female patients. RESULTS Of the 3279 included patients, 1543 (47%) were female. At baseline, women reported higher NRS for back and leg pain, higher ODI, but equal HRQOL (all p < 0.05). Otherwise, both groups had comparable baseline data. The absolute differences in patient-reported outcomes persisted at the 6-week, 12- and 24-months follow-up, with women now additionally reporting worse HRQOL as assessed by EQ-5D (all p < 0.05). For all outcome measures, change scores were equal among male and female patients, as were the incidences of complications and reoperations (all p > 0.05). Clinical success was achieved in 82% of men and 79% of women (p = 0.34). CONCLUSIONS Female patients are generally scheduled for surgery with a more advanced disease state. While women seem to report more severe symptoms at long-term follow-up, the degree of improvement is equal among men and women. Female patients may thus fare worse in terms of absolute scores, but enjoy the same benefit from surgery in relative terms. These slides can be retrieved under Electronic Supplementary Material.
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Tang C, Li J, Tai WL, Yao W, Zhao B, Hong J, Shi S, Wang S, Xia Z. Sex differences in complex regional pain syndrome type I (CRPS-I) in mice. J Pain Res 2017; 10:1811-1819. [PMID: 28831269 PMCID: PMC5548282 DOI: 10.2147/jpr.s139365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sex differences have been increasingly highlighted in complex regional pain syndrome (CRPS) in clinical practice. In CRPS type I (CRPS-I), although inflammation and oxidative stress have been implicated in its pathogenesis, whether pain behavior and the underlying mechanism are sex-specific is unclear. In the present study, we sought to explore whether sex differences have an impact on inflammation, oxidative stress, and pain sensitivity in CRPS-I. METHODS Chronic post-ischemia pain (CPIP) was established in both male and female mice as an animal model of CRPS-I. Edema and mechanical allodynia of bilateral hind paws were assessed after reperfusion. Blood samples were analyzed for serum levels of oxidative stress markers and inflammatory cytokines. RESULTS Both male and female mice developed edema. Male mice developed CPIP at day 3 after reperfusion; female mice developed CPIP at day 2 after reperfusion. Female mice displayed significantly earlier and higher mechanical allodynia in the ischemic hind paw, which was associated with higher serum levels of IL-2, TNF-α, isoprostanes, 8 OhdG, and malondialdehyde at day 2 after reperfusion. Moreover, female mice showed significantly lower SOD and IL-4 compared to male mice at day 2 after reperfusion. CONCLUSION Our results indicate that sex differences in inflammatory and oxidative stress states may play a central role in the sex-specific nociceptive hypersensitivity in CRPS-I, and offer a new insight into pharmacology treatments to improve pain management with CRPS.
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Affiliation(s)
- Chaoliang Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province
| | - Juan Li
- Department of Anesthesiology, Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui Provence
| | - Wai Lydia Tai
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province
| | - Bo Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province
| | - Junmou Hong
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Si Shi
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province
| | - Song Wang
- Department of Anesthesiology, Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui Provence
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province
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