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Tan YCJ, Chen JYQ, Tay DKJ, Lo NN, Yeo SJ, Liow MHL. Patient Acceptable Symptom State Thresholds for the Knee Society Score, Oxford Knee Score, and 36-Item Short Form Survey Ten Years Following Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:1480-1486. [PMID: 38081552 DOI: 10.1016/j.arth.2023.12.013] [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: 10/04/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The patient acceptable symptom state (PASS) refers to a cutoff value on any patient-reported outcome measures (PROMs) scale, beyond which patients consider themselves as having achieved an acceptable outcome. This study aimed to identify PASS thresholds for knee-specific and generic PROMs at 10 years post-unicompartmental knee arthroplasty (UKA). METHODS There were 269 patients who underwent UKA for medial osteoarthritis from 2004 to 2007 at a single institution and were surveyed preoperatively and 10 years postoperatively using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), 36-Item Short Form Survey (SF-36) Mental Component Score (MCS), and SF-36 Physical Component Score (PCS). Treatment outcomes and expectations were assessed using an anchor question, and PASS attainment was determined using the Youden index on a receiver operating characteristic (ROC) curve. Also, a similar study that identified 2-year long-term PROM PASS thresholds for UKA was referenced and compared. RESULTS Overall, 91.1% reported acceptable outcomes. The area under the curve for ROCs of KSKS, OKS, and PCS were 0.80, 0.75, and 0.71, respectively. The area under the curve for ROCs of KSFS and MCS were both 0.64. The PASS thresholds were 67.5 for KSFS, 70.5 for KSKS, 39.5 for OKS, 44.6 for PCS, and 43.8 for MCS. Patients who achieved a PASS were at least 3 times more likely to have satisfactory outcomes. CONCLUSIONS To our knowledge, this is the first study that identified 10-year long-term PROM PASS thresholds for UKA. Accounting for our finding that a decade-long follow-up yielded lower PASS thresholds, time-specific UKA PROM PASS thresholds should be considered. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y C Jeremy Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Q Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren K J Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - M H Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Yang S, Chen C, Tang Y, Li K, Yu X, Tan J, Zhang C, Rong Z, Xu J, Luo F. The effects of back extensor strength in different body positions on health-related quality of life in patients with degenerative spinal deformity. J Back Musculoskelet Rehabil 2024; 37:503-511. [PMID: 38143335 DOI: 10.3233/bmr-230206] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Degenerative spinal deformity (DSD) is believed to originate from degeneration of the discs and facet joints and vertebral wedging. Currently, the nosogeny of DSD is not yet fully clarified and there has been no systematic study on the impact of their lower back muscle strength on quality of life. OBJECTIVE To determine the characteristics of back extensor strength (BES) in different body positions and examine their correlations with health-related quality of life (HQOL) in degenerative spinal deformity (DSD) patients. METHODS Participants comprised 60 DSD patients and 40 healthy volunteers. Maximal isometric BES was evaluated by dynamometers with the subject in three different positions (standing, prone, sitting). The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMQ), and 36-item Short Form Health Survey (SF-36) score were used to evaluate patient HQOL. Correlations between the BES in different body positions and HQOL were analysed. RESULTS The BES values in three body positions were significantly smaller in DSD patients than healthy subjects (P< 0.05). The standing BES was found to be negatively associated with ODI and RMQ (R= 0.313, p< 0.05 and R= 0.422, p< 0.01, respectively). A negative relationship between sitting BES and RMQ was also seen (R= 0.271, p< 0.05). In addition, the standing and prone BES were positively correlated with the physical functioning score of the SF-36 (R= 0.471, p< 0.01 and R= 0.289, p< 0.05, respectively), and the sitting BES was positively correlated with the role-physical score of the SF-36 (R= 0.436, p< 0.01). CONCLUSION The results indicate that the back extensor muscle is compromised in DSD patients and there are differences in predicting the severity of disability and physical HQOL scores with BES in different positions. Standing BES was the most reliable contributor to HQOL among three body positions.
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Affiliation(s)
- Sen Yang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
- Department of Medical Research, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
- Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Kai Li
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhigang Rong
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
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Cushnie D, Soroceanu A, Stratton A, Dea N, Finkelstein J, Bailey CS, Weber MH, Paquet J, Glennie A, Hall H, Rampersaud R, Ahn H, Kelly A, Christie S, Nataraj A, Johnson M, Abraham E, Attabib N, Fisher C, Manson N, Thomas K. Outcome of spine surgery in patients with depressed mental states: a Canadian spine outcome research network study. Spine J 2022; 22:1700-1707. [PMID: 35671946 DOI: 10.1016/j.spinee.2022.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Depression is higher among spine patients than among the general population. Some small studies, but not others, have suggested that depression may be a predictor of worse outcome after surgery. PURPOSE Determination whether there is an association between depression and worse response to surgery among spine patients. STUDY DESIGN/SETTING The national, prospective, Canadian Spine Outcome Research Network (CSORN) surgical outcome registry. PATIENT SAMPLE All patients in the CSORN registry who received surgery for thoracic or lumbar degenerative deformity, stenosis, spondylolisthesis, disc disease, or disc herniation with a minimum of 12 months follow-up postoperation (n = 2310). OUTCOME MEASURES Oswestry Disability Index (ODI), SF12 Physical Component Score (PCS), European Quality of Life (EuroQoL), and pain scales. METHODS Change in preoperative to 12-month postoperative ODI, and secondary measures, were compared to assess if there was an association between preoperative depression, as measured by PHQ9, and smaller response to surgery. Multivariate regression analysis was used to search for preoperative factors which might interact with PHQ9 to predict ODI outcome. RESULTS Patients with PHQ9<5, associated with minimal to no depression, had the smallest ODI improvement (-16.8 [95%CI -18.1 to -15.3]) and patients with severe preoperative depression (PHQ9 ≥ 10) had the largest ODI improvement (-22.8 [95%CI -24.1 to -21.5]; p<.00001). Similar findings were found in the EQ5D and PCS. Pain improvement was not different between depression levels. Multivariate modeling found worse baseline PHQ9 and ODI, greater age, nicotine use, more operative levels, and worse American Society of Anesthesiology score was predictive of worse ODI outcomes. CONCLUSIONS Depressed patients have similar or better relative improvements in disability, quality of life, and pain, when compared to nondepressed patients, although their preoperative and postoperative levels of disability are higher. Surgeons should not be concerned that depression will reduce the patient-reported beneficial response to surgical intervention.
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Affiliation(s)
| | | | | | - Nicolas Dea
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | - Henry Ahn
- University of Toronto, Toronto, Ontario, Canada
| | - Adrienne Kelly
- Northern Ontario School of Medicine, Sault Ste. Marie, Ontario, Canada
| | | | | | | | - Ed Abraham
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Charles Fisher
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Manson
- Dalhousie University, Halifax, Nova Scotia, Canada
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Tamai K, Suzuki A, Toyoda H, Terai H, Hoshino M, Takahashi S, Hori Y, Yabu A, Nakamura H. Improvements in Mental Well-Being and its Predictive Factors in Patients who Underwent Cervical versus Lumbar Decompression Surgery. Spine Surg Relat Res 2022; 6:10-16. [PMID: 35224241 PMCID: PMC8842360 DOI: 10.22603/ssrr.2021-0060] [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: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Mental well-being is essential for patient satisfaction. Therefore, a better understanding of the changes in the mental well-being of patients following spinal surgery can be useful to surgeons. We compared the 2-year postoperative change in the mental well-being of patients who underwent cervical and lumbar decompression surgery. Additionally, the predictive factors for improvement in mental well-being associated with both methods were evaluated. Methods The patients who underwent spinal decompression surgery and were followed >2 years postoperatively were enrolled (lumbar cohort: n=111, cervical cohort: n=121). The 36-item Short-Form Health Survey (SF-36) mental component summary (MCS) was set as the mental well-being parameter, and the minimal clinically important difference (MCID) was defined as 4.0. After adjusting the cervical and lumbar cohorts using propensity scores, the improvements in the MCS were compared between the groups using a mixed-effect model. To identify predictors for improvements, the correlation between the MCS changes and preoperative clinical scores was evaluated. Subsequently, multivariate linear regression was applied, which included variables with p<0.10 in the former analysis as explanatory variables, and the change of MCS as the objective variable. Results There were no significant differences in the MCS improvement between the adjusted cervical and lumbar cohorts; 47% and 49%, respectively, had MCS improvement score >MCIDs. However, predictors for the improvement were different between the two cohorts: SF-36 Social functioning in cervical surgery and lower back pain and SF-36 Role physical in lumbar surgery. Conclusions Although there was no significant difference in the improvement in the mental well-being between patients who underwent either cervical or lumbar decompression surgery, less than half of the patients in both groups achieved a meaningful improvement. Preoperative back pain and personal activity were independent predictors in the lumbar cohort, while social functioning was the only predictor in the cervical cohort. Level of evidence: III
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Affiliation(s)
- Koji Tamai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Yusuke Hori
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedics, Osaka City University Graduate School of Medicine
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Zhang X, Yuan L, Zeng Y, Liu Y, Chen Z, Li W. Evaluation of lumbar stiffness after long-level fusion for degenerative lumbar scoliosis via a Chinese version of the lumbar stiffness disability index. Spine J 2021; 21:1881-1889. [PMID: 34174436 DOI: 10.1016/j.spinee.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Long-level spinal fusion for degenerative lumbar scoliosis (DLS)seeks to eliminate spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impairs the performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activity, but this index might not be fully applicable to the elderly Chinese population given several specific lifestyle characteristics. PURPOSE To evaluate lumbar stiffness in patients with DLS after long-level fusion by Chinese-LSDI (C-LSDI). STUDY DESIGN A retrospective study. PATIENT SAMPLE A total of 129 DLS patients who underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up from June 2009 to September 2017 were retrospectively included. OUTCOME MEASURES The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) based on elderly Chinese lifestyles and the internal consistency and retest repeatability of the patient-reported outcome questionnaire in the measurement of the impact of lumbar stiffness on functional abilities was assessed. METHODS The radiographic parameters including Cobb angle, apical vertebral translation (AVT), coronal vertical axis (CVA), sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and PI-LL, and clinical symptoms including visual analogue scale (VAS) for back and low extremity pain; Oswestry disability index (ODI), Japanese Orthopedic Association-29 (JOA-29), Scoliosis Research Society⁃22 (SRS-22), 36⁃Item short form survey (SF-36), physical component scores (PCS) and mental component scores (MCS) were measured preoperatively and at the last follow-up. RESULTS Compared with LSDI and K-LSDI, the C-LSDI demonstrated higher internal consistency (Cronbach's alpha=0.902) and retest reliability (Internal consistency coefficients, ICC=0.904) in the elderly Chinese population. All patients showed increased lumbar stiffness and significant improvement in pain and deformity postoperatively. Regarding items, such as performing personal hygiene after toileting and getting out of a car, people reported more inconvenience with increasingly fixed levels. CONCLUSIONS This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients who underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.
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Affiliation(s)
- Xinling Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China.
| | - Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
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Lafage R, Ang B, Schwab F, Kim HJ, Smith JS, Shaffrey C, Burton D, Ames C, Mundis G, Hostin R, Bess S, Klineberg E, Passias P, Lafage V. Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients. Spine (Phila Pa 1976) 2021; 46:447-456. [PMID: 33337685 DOI: 10.1097/brs.0000000000003886] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospective multicenter database. OBJECTIVE The aim of this study was to investigate how preoperative mental status affects preoperative and postoperative disability and health scores in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA The relationship between health-related quality of life (HRQOL) and depression has previously been documented. However, the influence of depression on clinical outcomes among ASD patients is not well understood. METHODS ASD patients with minimum 2-year follow-up were stratified based on preoperative mental health measured by Short Form 36 (SF-36) mental component score (MCS). Patients with MCS in the 25th and 75th percentile of the cohort were designated as having low and high MCS, respectively. After matching by preoperative demographics and deformity, pre- and post-HRQOL were compared between the two groups. Further analysis was performed to identify individualized questions on the SF-36 that could potentially screen for patients with low MCS. RESULTS Five hundred thirteen patients were assessed (58.4 years' old, 79% women, mean MCS 45.5). Thresholds for low and high MCS cohorts were 35.0 and 57.3, respectively. After matching by preoperative alignment, low MCS patients had worse Oswestry Disability Index (ODI) (52.3 ± 17.0 vs. 35.7 ± 14.6, P < 0.001) and Scoliosis Research Society-22R scores for all domains (all P < 0.001) compared to high MCS patients. Similar results were maintained at 2-year postop, with low MCS patients having a worse ODI (35.2 ± 20.2 vs. 19.7 ± 18.6, P < 0.001) and MCS (42.4 ± 13.5 vs. 58.6 ± 7.1, P < 0.001). Despite similar preoperative Physical Component Score (PCS), low MCS patients were less likely to reach MCID for PCS (46.1% vs. 70.6%, P < 0.01) and had a lower satisfaction at 2-year follow-up (3.88 ± 1.07 vs. 4.39 ± 0.94, P < 0.001). Questions 5a, 9d, and 9f on the SF-36 were found to be independent predictors of low MCS. CONCLUSION ASD patients with low MCS are more likely to experience functional limitations before and after surgery and are less likely to be satisfied postoperatively, even when similar clinical goals are achieved. Incorporating psychological factors may assist in decision making.Level of Evidence: 3.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Bryan Ang
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA
| | | | - Douglas Burton
- Department of Orthopedics, University of Kansas Medical Center, Kansas City, KS
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, CA
| | | | - Richard Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Dallas, TX
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Peter Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
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Jeon CH, Chung NS, Chung HW, Yoon HS, Lee HD. Prospective investigation of Oswestry Disability Index and short form 36 subscale scores related to sagittal and coronal parameters in patients with degenerative lumbar scoliosis. 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 2021; 30:1164-1172. [PMID: 33715073 DOI: 10.1007/s00586-021-06740-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study investigated relationships of Oswestry Disability Index (ODI) and Short Form 36 (SF-36) total and subscale scores with global spinal parameters in patients with degenerative lumbar scoliosis (DLS). METHODS This was a prospective single-center study of 126 consecutive patients with DLS. Disability was evaluated using the ODI and SF-36 total and subscale scores. Sagittal and coronal parameters were measured. Pearson's correlation analysis was performed to determine relationships between disability and radiographic parameters. RESULTS The study population included 76 women and 15 men (mean age, 70.2 ± 8.4 years). Mean Cobb angle was 18.9° ± 8.0°. The ODI total score and SF-36 physical component score were only correlated with coronal parameters. ODI pain intensity, personal care, lifting, sitting, and sex life domains were only correlated with coronal parameters. The walking, standing, social life, and traveling domain scores were correlated with coronal and sagittal parameters. The SF-36 bodily pain and vitality domain scores were only correlated with coronal parameters. The SF-36 physical function domain score was correlated with both coronal and sagittal parameters. Among the clinical and radiographic parameters, the personal care score and the coronal vertical-axis had the strongest correlation (r = 0.425), although the r2 value was only 0.18. CONCLUSIONS ODI total score and most of the subscale scores were significantly, but weakly correlated with coronal parameters. Sagittal parameters were only correlated with some of the ODI and SF-36 subscale scores. Analysis using ODI and SF-36 subscale scores may aid in understanding and treatment of disability in patients with DLS.
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Affiliation(s)
- Chang-Hoon Jeon
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164, World Cup rd, Yeongtong-gu, Suwon, Republic of Korea
| | - Nam-Su Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164, World Cup rd, Yeongtong-gu, Suwon, Republic of Korea
| | - Hee-Woong Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164, World Cup rd, Yeongtong-gu, Suwon, Republic of Korea
| | - Ha Seung Yoon
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164, World Cup rd, Yeongtong-gu, Suwon, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, 164, World Cup rd, Yeongtong-gu, Suwon, Republic of Korea.
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Yang S, Chen C, Du S, Tang Y, Li K, Yu X, Tan J, Zhang C, Rong Z, Xu J, Wu W, Luo F. Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity. BMC Musculoskelet Disord 2020; 21:827. [PMID: 33298028 PMCID: PMC7724710 DOI: 10.1186/s12891-020-03844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Background A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL. Methods In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed. Results When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05). Conclusions We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.
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Affiliation(s)
- Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 83nd Group Army Hospital of the People's Liberation Army (PLA 371 Central Hospital), Xinxiang Medical College, 210 Wenhua Street, Hongqi district, Xinxiang, 453000, Henan, China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Shiyu Du
- War Wounded Medical Service Research Office (Department of War Injury and Rescue Service), Army Specialty Medical Center of the People's Liberation Army (Daping Hospital, Third Military Medical University), Chongqing, 400042, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 72nd Group Army Hospital of the People's Liberation Army, Huzhou University, Huzhou, 313000, Zhejiang, China
| | - Kai Li
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Zhigang Rong
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.
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Tang Y, Yang S, Chen C, Luo K, Chen Y, Wang D, Tan J, Dai Q, Zhang C, Wu W, Xu J, Luo F. Assessment of the association between paraspinal muscle degeneration and quality of life in patients with degenerative lumbar scoliosis. Exp Ther Med 2020; 20:505-511. [PMID: 32509021 PMCID: PMC7271738 DOI: 10.3892/etm.2020.8682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to determine the characteristics of multifidus, erector spinae and psoas major degeneration in elderly patients with degenerative lumbar scoliosis (DLS) and the correlation between asymmetric changes and patient quality of life. A total of 49 patients with lumbar scoliosis (DLS group) and 38 healthy individuals (control group) were prospectively examined. The functional cross-sectional area, cross-sectional area difference index (CDI) and fat infiltration rate (FIR) of the multifidus, erector spinae and psoas major at the apical vertebral level were measured using MRI. The visual analogue scale (VAS) score, Oswestry Disability Index (ODI) and 36-item Short Form Health Survey (SF-36) score were used to evaluate patient quality of life. Correlations between the degree of asymmetric muscular degeneration and quality of life were analysed. The CDI of the multifidus, erector spinal and psoas major was higher in the DLS group compared with that in the control group. The CDI of the multifidus was found to be positively associated with the Cobb angle of lumbar scoliosis. Similar results were obtained for fat infiltration between the two groups. In addition, the CDI and FIR difference index of the multifidus was positively correlated with the VAS score and ODI but negatively correlated with the SF-36 score. The quality of life significantly decreased with increasing asymmetric atrophy and fat infiltration in the multifidus. Thus, strategies to enhance the function of the multifidus may have a positive impact on quality of life (Chinese Clinical Trial Registry, registration date, 2018.11.12; registration no. ChiCTR1800019459.).
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Affiliation(s)
- Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China.,Department of Orthopaedics, The 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Keyu Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Yueqi Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Donggui Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Qijie Dai
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
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Yanik EL, Kelly MP, Lurie JD, Baldus CR, Shaffrey CI, Schwab FJ, Bess S, Lenke LG, LaBore A, Bridwell KH. Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts. J Neurosurg Spine 2020; 33:17-26. [PMID: 32114531 DOI: 10.3171/2020.1.spine191288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adult symptomatic lumbar scoliosis (ASLS) is a common and disabling condition. The ASLS-1 was a multicenter, dual-arm study (with randomized and observational cohorts) examining operative and nonoperative care on health-related quality of life in ASLS. An aim of ASLS-1 was to determine patient and radiographic factors that modify the effect of operative treatment for ASLS. METHODS Patients 40-80 years old with ASLS were enrolled in randomized and observational cohorts at 9 North American centers. Primary outcomes were the differences in mean change from baseline to 2-year follow-up for the SRS-22 subscore (SRS-SS) and the Oswestry Disability Index (ODI). Analyses were performed using an as-treated approach with combined cohorts. Factors examined were prespecified or determined using regression tree analysis. For each potential effect modifier, subgroups were created using clinically relevant cutoffs or via regression trees. Estimates of within-group and between-group change were compared using generalized linear mixed models. An effect modifier was defined as a treatment effect difference greater than the minimal detectable measurement difference for both SRS-SS (0.4) and ODI (7). RESULTS Two hundred eighty-six patients were enrolled and 256 (90%) completed 2-year follow-up; 171 received operative treatment and 115 received nonoperative treatment. Surgery was superior to nonoperative care for all effect subgroups considered, with the exception of those with nearly normal pelvic incidence-lumbar lordosis (PI-LL) match (≤ 11°). Male patients and patients with more (> 11°) PI-LL mismatch at baseline had greater operative treatment effects on both the SRS-SS and ODI compared to nonoperative treatment. No other radiographic subgroups were associated with treatment effects. High BMI, lower socioeconomic status, and poor mental health were not related to worse outcomes. CONCLUSIONS Numerous factors previously related to poor outcomes with surgery, such as low mental health, lower socioeconomic status, and high BMI, were not related to outcomes in ASLS in this exploratory analysis. Those patients with higher PI-LL mismatch did improve more with surgery than those with normal alignment. On average, none of the factors considered were associated with a worse outcome with operative treatment versus nonoperative treatment. These findings may guide future prospective analyses of factors related to outcomes in ASLS care.
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Affiliation(s)
- Elizabeth L Yanik
- 1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael P Kelly
- 1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jon D Lurie
- 2Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
| | - Christine R Baldus
- 1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Shay Bess
- 3Denver International Spine Center, Denver, Colorado
| | - Lawrence G Lenke
- 6Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Adam LaBore
- 1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Keith H Bridwell
- 1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Effect of Perioperative Mental Status on Health-related Quality of Life in Patients With Adult Spinal Deformities. Spine (Phila Pa 1976) 2020; 45:E76-E82. [PMID: 31389866 DOI: 10.1097/brs.0000000000003186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE We aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Limited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD. METHODS We enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA). RESULTS We found correlations between the preoperative SRS-22r total score and preoperative ODI (r = -0.692, P < 0.01) and postoperative ODI (r = -0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = -0.561, P ≤ 0.01) and postoperative ODI (r = -0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from -17.3 to -10.2 from preoperative to postoperative periods. CONCLUSION Diminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important. LEVEL OF EVIDENCE 3.
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Mental health status and sagittal spinopelvic alignment correlate with self-image in patients with adult spinal deformity before and after corrective 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 2019; 29:63-72. [DOI: 10.1007/s00586-019-06200-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/13/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023]
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Development of Deployable Predictive Models for Minimal Clinically Important Difference Achievement Across the Commonly Used Health-related Quality of Life Instruments in Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2019; 44:1144-1153. [PMID: 30896589 DOI: 10.1097/brs.0000000000003031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively-collected, multicenter adult spinal deformity (ASD) databases. OBJECTIVE To predict the likelihood of reaching minimum clinically important differences in patient-reported outcomes after ASD surgery. SUMMARY OF BACKGROUND DATA ASD surgeries are costly procedures that do not always provide the desired benefit. In some series only 50% of patients achieve minimum clinically important differences in patient-reported outcomes (PROs). Predictive modeling may be useful in shared-decision making and surgical planning processes. The goal of this study was to model the probability of achieving minimum clinically important differences change in PROs at 1 and 2 years after surgery. METHODS Two prospective observational ASD cohorts were queried. Patients with Scoliosis Research Society-22, Oswestry Disability Index , and Short Form-36 data at preoperative baseline and at 1 and 2 years after surgery were included. Seventy-five variables were used in the training of the models including demographics, baseline PROs, and modifiable surgical parameters. Eight predictive algorithms were trained at four-time horizons: preoperative or postoperative baseline to 1 year and preoperative or postoperative baseline to 2 years. External validation was accomplished via an 80%/20% random split. Five-fold cross validation within the training sample was performed. Precision was measured as the mean average error (MAE) and R values. RESULTS Five hundred seventy patients were included in the analysis. Models with the lowest MAE were selected; R values ranged from 20% to 45% and MAE ranged from 8% to 15% depending upon the predicted outcome. Patients with worse preoperative baseline PROs achieved the greatest mean improvements. Surgeon and site were not important components of the models, explaining little variance in the predicted 1- and 2-year PROs. CONCLUSION We present an accurate and consistent way of predicting the probability for achieving clinically relevant improvement after ASD surgery in the largest-to-date prospective operative multicenter cohort with 2-year follow-up. This study has significant clinical implications for shared decision making, surgical planning, and postoperative counseling. LEVEL OF EVIDENCE 4.
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