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Takenaka H, Kamiya M, Sugiura H, Nishihama K, Suzuki J, Hanamura S. Recovery of the Japanese orthopedic association back pain evaluation questionnaire score and walking ability following lumbar spinal stenosis surgery. 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 2024; 33:2222-2233. [PMID: 38584242 DOI: 10.1007/s00586-024-08238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE We investigated the recovery of the Japanese orthopedic association back pain evaluation questionnaire (JOABPEQ) scores and 6 min walk distance (6MWD) in patients after surgery for lumbar spinal stenosis and identified the items among 25 questions of JOABPEQ that showed recovery. METHODS A total of 227 patients (average age 71.5 years; SD: 7.5; 121 men) were included from a single center. The outcome measures were JOABPEQ, visual analog scale (VAS), and 6MWD and obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Mixed-model repeated measures were used to compare the variables at each time point between the surgery groups. RESULTS The JOABPEQ, VAS, and 6MWD scores generally improved at 1 month postoperatively compared with those obtained preoperatively, and some parameters further improved at 3 months. However, improvement in the lumbar spine dysfunction item of JOABPEQ was delayed, showing improvement at 3 months postoperatively for decompression surgery (average score: pre, 64.6; 3 months, 78.5) and 6 months postoperatively for fusion surgery (average score: Pre, 64.3; 6 months, 77.1). Responses to the individual JOABPEQ questions generally improved after surgery. No significant changes in lumbar spine dysfunction occurred in the fusion group. CONCLUSION Our results demonstrated the early postoperative recovery course of JOABPEQ and 6MWD. In the fusion group, significant changes in lumbar spine dysfunction started at 6 months postoperatively. These findings could help medical staff explain postoperative recovery to patients after lumbar spinal stenosis surgery and in their decision making regarding surgery.
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Affiliation(s)
- Hiroto Takenaka
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan.
- Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan.
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Shizuoka, 431-2102, Japan.
| | - Mitsuhiro Kamiya
- Department of Orthopedic Surgery, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Hideshi Sugiura
- Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan
| | - Kasuri Nishihama
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Junya Suzuki
- Department of Rehabilitation, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
| | - Shuntaro Hanamura
- Department of Orthopedic Surgery, Kasugai Orthopedics Asahi Hospital, 2090 Higashino-Cho, Kasugai, Aichi, 486-0819, Japan
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The prognostic value of fear-avoidance beliefs on postoperative pain and dysfunction for lumbar degenerative disk disease: a meta-analysis. Int J Rehabil Res 2023; 46:3-13. [PMID: 36652201 DOI: 10.1097/mrr.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity ( I ² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76-3.00] and back-specific function (OR 3.13; 95% CI, 3.02-3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73-3.86) and function (OR 2.81; 95% CI, 2.57-3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.
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Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study. Spine J 2023; 23:261-270. [PMID: 36343913 DOI: 10.1016/j.spinee.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/CONTEXT Some patients do not improve after surgery for lumbar spinal stenosis (LSS), and surgical treatment implies a risk for complications and deterioration. Patient selection is of paramount importance to improve the overall clinical results and identifying predictive factors for failure is central in this work. PURPOSE We aimed to explore predictive factors for failure and worsening after surgery for LSS. STUDY DESIGN /SETTING Retrospective observational study on prospectively collected data from a national spine registry with a 12-month follow-up. PATIENT SAMPLE We analyzed 11,873 patients operated for LSS between 2007 and 2017 in Norway, included in the Norwegian registry for spine surgery (NORspine). Twelve months after surgery, 8919 (75.1%) had responded. OUTCOME MEASURES Oswestry Disability Index (ODI) 12 months after surgery. METHODS Predictors were assessed with uni- and multivariate logistic regression, using backward conditional stepwise selection and a significance level of 0.01. Failure (ODI>31) and worsening (ODI>39) were used as dependent variables. RESULTS Mean (95%CI) age was 66.6 (66.4-66.9) years, and 52.1% were females. The mean (95%CI) preoperative ODI score was 39.8 (39.4-40.1). All patients had decompression, and 1494 (12.6%) had an additional fusion procedure. Twelve months after surgery, the mean (95%CI) ODI score was 23.9 (23.5-24.2), and 2950 patients (33.2%) were classified as failures and 1921 (21.6%) as worse. The strongest predictors for failure were duration of back pain > 12 months (OR [95%CI]=2.24 [1.93-2.60]; p<.001), former spinal surgery (OR [95%CI]=2.21 [1.94-2.52]; p<.001) and age>70 years (OR (95%CI)=1.97 (1.69-2.30); p<.001). Socioeconomic variables increased the odds of failure (ORs between 1.36 and 1.62). The strongest predictors for worsening were former spinal surgery (OR [95%CI]=2.04 [1.77-2.36]; p<.001), duration of back pain >12 months (OR [95%CI]=1.83 [1.45-2.32]; p<.001) and age >70 years (OR [95%CI]=1.79 [1.49-2.14]; p<.001). Socioeconomic variables increased the odds of worsening (ORs between 1.33-1.67). CONCLUSIONS After surgery for LSS, 33% of the patients reported failure, and 22% reported worsening as assessed by ODI. Preoperative duration of back pain for longer than 12 months, former spinal surgery, and age above 70 years were the strongest predictors for increased odds of failure and worsening after surgery.
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Tonelli Enrico V, Schneider M, Haas M, Vo N, Huang W, McFarland C, Weber N, Sowa G. The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT. BMC Musculoskelet Disord 2022; 23:1059. [PMID: 36471334 PMCID: PMC9721012 DOI: 10.1186/s12891-022-06027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/24/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common musculoskeletal condition and a major cause of disability worldwide. Previous studies have found associations of biomarkers with pain and pain-related disability in LBP patients. This study aimed to explore the association between serum biomarkers and pain and disability in patients with acute or subacute axial LBP. METHODS This study was ancillary to a parent randomized controlled trial. Enrolled participants were randomized into three intervention groups: one of two types of spinal manipulation or medical care. In the parent study, 107 adults who experienced a new episode of LBP within 3 months prior to enrollment were recruited. For this study, 90 of these 107 participants consented to have blood samples obtained, which were drawn immediately before the beginning of treatment. Seven biomarkers were chosen based on previous literature and analyzed. Clinical outcomes were pain and Oswestry Disability Index (ODI) evaluated at baseline and 4 weeks. Spearman's |r| was used to study the association of initial levels of each biomarker with pain and ODI scores at baseline and with changes in outcome scores from baseline to 4 weeks (end of treatment) within each intervention group. RESULTS At baseline, 4 of 7 biomarkers had an association with pain that was |r| ≥ .20: neuropeptide Y (NPY) (r = 0.23, p = .028), E-Selectin (r = 0.22, p = .043), vitamin D ((r = - 0.32, p = .002), and c-reactive protein (CRP) (r = 0.37, p = .001). No baseline biomarker had an association with disability that was |r| ≥ 0.20. For the correlations of baseline biomarkers with 4-week change in outcomes, vitamin D showed a correlation with change in disability and/or pain (|r| ≥ 0.20, p > .05) in manipulation-related groups, while CRP, NPY, and E-selectin along with TNFα, Substance P and RANTES showed at least one correlation with change in pain or disability (|r| ≥ 0.20, p > .05) in at least one of the treatment groups. CONCLUSIONS In 90 LBP patients, the analyzed biomarkers, especially vitamin D, represent a small set of potential candidates for further research aimed at individualizing patient care. Overall, the associations investigated in the current study are an initial step in identifying the direct mechanisms of LBP and predicting outcomes of manipulation-related treatments or medical care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01211613, Date of Registration: September 29, 2010, https://clinicaltrials.gov/ct2/show/NCT01211613?term=schneider&cond=Low+Back+Pain&cntry=US&state=US%3APA&draw=2&rank=1.
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Affiliation(s)
- Valerio Tonelli Enrico
- grid.21925.3d0000 0004 1936 9000Ferguson Laboratory for Orthopaedic and Spine Research, Department of Orthopaedic Surgery, University of Pittsburgh, 200 Lothrop Street, Room E1612, BST, Pittsburgh, PA 15261 USA ,grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, University of Pittsburgh, 100 Technology Dr, Pittsburgh, PA 15219 USA
| | - Michael Schneider
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, University of Pittsburgh, 100 Technology Dr, Pittsburgh, PA 15219 USA ,grid.21925.3d0000 0004 1936 9000Clinical and Translational Science Institute, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA 15213 USA
| | - Mitchell Haas
- grid.17635.360000000419368657Integrative Health & Wellbeing Program, University of Minnesota, MMC 505; 420 Delaware Street S.E, Minneapolis, MN 55455 USA
| | - Nam Vo
- grid.21925.3d0000 0004 1936 9000Ferguson Laboratory for Orthopaedic and Spine Research, Department of Orthopaedic Surgery, University of Pittsburgh, 200 Lothrop Street, Room E1612, BST, Pittsburgh, PA 15261 USA
| | - Wan Huang
- grid.21925.3d0000 0004 1936 9000Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Kaufmann Medical Building, Suite 910; 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - Christine McFarland
- grid.21925.3d0000 0004 1936 9000Department of Physical Therapy, University of Pittsburgh, 100 Technology Dr, Pittsburgh, PA 15219 USA
| | - Nick Weber
- grid.280535.90000 0004 0388 0584Shirley Ryan AbilityLab, Chicago, 355 E Erie St, Chicago, IL 60611 USA ,grid.16753.360000 0001 2299 3507Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Dr #1022, Chicago, IL 60611 USA
| | - Gwendolyn Sowa
- grid.21925.3d0000 0004 1936 9000Ferguson Laboratory for Orthopaedic and Spine Research, Department of Orthopaedic Surgery, University of Pittsburgh, 200 Lothrop Street, Room E1612, BST, Pittsburgh, PA 15261 USA ,grid.21925.3d0000 0004 1936 9000Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Kaufmann Medical Building, Suite 910; 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
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Tegner H, Garval M, Rolving N, Esbensen BA, Bech-Azeddine R, Henriksen M. Physiotherapists’ prognosis of 1-year outcome after lumbar spinal fusion - A prospective cohort study. Physiother Theory Pract 2022:1-12. [DOI: 10.1080/09593985.2022.2042880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Heidi Tegner
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Glostrup, Denmark
| | - Mette Garval
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nanna Rolving
- Central Denmark Region, DEFACTUM, Corporate Quality, Aarhus C, Denmark
| | - Bente Appel Esbensen
- Copenhagen Spine Research Unit, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Rachid Bech-Azeddine
- Copenhagen Spine Research Unit, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Marius Henriksen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- The Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark
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MEMİÇ-İNAN C, SÖKÜLMEZ-KAYA P, AKAR S. Frequency of vitamin d deficiency in patients with lumbar spinal stenosis and its relationship with obesity, depression, and pain intensity: a cross-sectional study. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Objective This study was conducted to determine the frequency of vitamin D deficiency in patients with lumbar spinal stenosis and to define the relationship between vitamin D levels and obesity, depression, and pain intensity. Methods This study was conducted with 69 patients (Male = 32, Female = 37) diagnosed with lumbar spinal stenosis. The participants’ 25(OH)D levels were measured by radioimmunoassay. In addition, bone metabolic status, including bone mineral density and bone turnover markers, was also evaluated. The Beck Depression Inventory was used to determine the depression statuses of the patients, while the McGill Melzack Pain Questionnaire was administered to measure pain intensity. The results were evaluated at a significance level of p<0.05. Results Vitamin D deficiency (<20 ng/mL) was found in 76.8% of the patients. Binary logistic regression analysis showed a significantly higher frequency of vitamin D deficiency in patients who: 1) had higher body mass indexes (OR 3.197, 95% CI 1.549-6.599); 2) fared higher in Beck’s depression score (OR 1.817, 95% CI 1.027–3.217); and 3) were female rather than male (OR 1.700, 95% CI 0.931-3.224) (p<0.05). Conclusion In this study, vitamin D deficiency was prevalent in lumbar spinal stenosis patients. In addition, obese, depressed, and female individuals have higher risks of vitamin D deficiency.
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