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Hu H, Wu C, Tan L. Analysis of Factors Associated with Lumbar Degenerative Disease Complicated by Baastrup's Disease. World Neurosurg 2024; 185:e1192-e1198. [PMID: 38499242 DOI: 10.1016/j.wneu.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To investigate the factors associated with the occurrence of Baastrup's disease (BA) in patients with lumbar degenerative diseases (LDDs). METHODS A retrospective analysis was conducted on 168 patients with LDDs (including lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis) who were treated at our hospital from January 2020 to January 2023, comprising 95 males and 73 females, aged 48-84 years.Patients were divided into two groups based on the presence of Baastrup's disease: those with BA (Group A) and those without BA (Group B).Relevant patient factors were extracted, including age, gender, occupation, smoking history, alcohol consumption history, body mass index, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, endplate Modic changes, degree of intervertebral disc degeneration, and facet joint degeneration (Weishaupt grading).Statistical analysis was performed using, Statistical Package for the Social Sciences 26.0 software to compare the differences in these factors between the two groups, and statistically significant results were included in a multivariate logistic regression analysis. RESULTS Univariate analysis indicated that there were no statistically significant differences between the two groups in terms of gender, smoking history, alcohol consumption history, bone density, presence of internal diseases (diabetes, hypertension), lumbar lordosis angle, and endplate Modic changes (P>0.05),whereas age, occupation, body mass index, degree of intervertebral disc degeneration, and degree of facet joint degeneration showed statistically significant differences (P < 0.05).Multivariate logistic regression analysis revealed that age, degree of intervertebral disc degeneration, and degree of facet joint degeneration were independent risk factors for the occurrence of BA in patients with LDDs (P < 0.05). CONCLUSIONS BA is relatively common in patients with LDDs, and advanced age, severe intervertebral disc degeneration, and facet joint degeneration are its independent risk factors.
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Affiliation(s)
- Haigang Hu
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China.
| | - Chao Wu
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China
| | - Lun Tan
- Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, People's Republic of China
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Abel F, Garcia E, Andreeva V, Nikolaev NS, Kolisnyk S, Sarbaev R, Novikov I, Kozinchenko E, Kim J, Rusakov A, Mourad R, Lebl DR. An Artificial Intelligence-Based Support Tool for Lumbar Spinal Stenosis Diagnosis from Self-Reported History Questionnaire. World Neurosurg 2024; 181:e953-e962. [PMID: 37952887 DOI: 10.1016/j.wneu.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Symptomatic lumbar spinal stenosis (LSS) leads to functional impairment and pain. While radiologic characterization of the morphological stenosis grade can aid in the diagnosis, it may not always correlate with patient symptoms. Artificial intelligence (AI) may diagnose symptomatic LSS in patients solely based on self-reported history questionnaires. METHODS We evaluated multiple machine learning (ML) models to determine the likelihood of LSS using a self-reported questionnaire in patients experiencing low back pain and/or numbness in the legs. The questionnaire was built from peer-reviewed literature and a multidisciplinary panel of experts. Random forest, lasso logistic regression, support vector machine, gradient boosting trees, deep neural networks, and automated machine learning models were trained and performance metrics were compared. RESULTS Data from 4827 patients (4690 patients without LSS: mean age 62.44, range 27-84 years, 62.8% females, and 137 patients with LSS: mean age 50.59, range 30-71 years, 59.9% females) were retrospectively collected. Among the evaluated models, the random forest model demonstrated the highest predictive accuracy with an area under the receiver operating characteristic curve (AUROC) between model prediction and LSS diagnosis of 0.96, a sensitivity of 0.94, a specificity of 0.88, a balanced accuracy of 0.91, and a Cohen's kappa of 0.85. CONCLUSIONS Our results indicate that ML can automate the diagnosis of LSS based on self-reported questionnaires with high accuracy. Implementation of standardized and intelligence-automated workflow may serve as a supportive diagnostic tool to streamline patient management and potentially lower health care costs.
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Affiliation(s)
- Frederik Abel
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
| | | | - Vera Andreeva
- Federal State Budgetary Institution, Federal Center for Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, Cheboksary, Russia
| | - Nikolai S Nikolaev
- Federal State Budgetary Institution, Federal Center for Traumatology, Orthopedics and Arthroplasty, Ministry of Health of the Russian Federation, Cheboksary, Russia; Federal State Budgetary Educational Institution of Higher Education, Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
| | - Serhii Kolisnyk
- Department of Physical and Rehabilitation Medicine, Vinnitsa National Medical University, Vinnytsia, Ukraine
| | | | | | | | - Jack Kim
- Remedy Logic, New York, New York, USA
| | | | - Raphael Mourad
- University of Toulouse, CNRS, UPS, Toulouse, France; Remedy Logic, New York, New York, USA.
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
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Klukowska AM, Staartjes VE, Vandertop WP, Schröder ML. Predictors of five-repetition sit-to-stand test performance in patients with lumbar degenerative disease. Acta Neurochir (Wien) 2023; 165:107-115. [PMID: 36477416 PMCID: PMC9840589 DOI: 10.1007/s00701-022-05441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The five-repetition sit-to-stand test (5R-STS) has recently been validated as an objective measure of functional impairment in patients with lumbar degenerative disease (LDD). Knowledge of factors influencing 5R-STS performance is useful to correct for confounders, create personalized adjusted test times, and potentially identify prognostic subgroups. We evaluate factors predicting the 5R-STS performance in patients with LDD. METHODS Patients with LDD requiring surgery were included. Each participant performed the 5R-STS and completed a questionnaire that included their age, gender, weight, height, body mass index (BMI), smoking status, education level, employment type, ability to work, analgesic drug usage, history of previous spinal surgery, and EQ5D depression and anxiety domain. Surgical indication and index level of the spinal pathology were also recorded. Predictors of 5R-STS were identified through multivariable linear regression. RESULTS The cohort consisted of 240 patients, 47.9% being female (mean age, 47.7 ± 13.6 years). In the final multivariable model incorporating confounders, height (regression coefficient (RC), 0.08; 95% confidence interval (CI), 0.003/0.16, p = 0.042) and being an active smoker (RC, 2.44; 95%CI, 0.56/4.32, p = 0.012) were significant predictors of worse 5R-STS performance. Full ability to work (RC, - 2.39; 95%CI, - 4.39/ - 0.39, p = 0.020) was associated with a better 5R-STS performance. Age, height, surgical indication, index level of pathology, history of previous spine surgery, history of pain, analgesic drug use, employment type, and severity of anxiety and depression symptoms demonstrated confounding effect on the 5R-STS time. CONCLUSIONS Greater height, being an active smoker, and inability to work are significant predictors of worse 5R-STS performance in patients with LDD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03303300 and NCT03321357.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands.
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - W Peter Vandertop
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, Netherlands
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Cai XY, Lin JH, Huang WC, Wu JC, Chen PY, Chiu HY. Sensory Symptoms and effects on Health-related Quality of Life of Patients Undergoing Lumbar Spine Surgery. Pain Manag Nurs 2022; 24:216-221. [PMID: 36396530 DOI: 10.1016/j.pmn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with lumbar degenerative spine diseases (LDSDs) commonly report sensory symptoms before and after lumbar spine surgery. AIM To explore the changing patterns of sensory symptoms-namely pain, numbness, stinging, itching, and burning-and investigate the influences of sensory symptom changes on the health-related quality of life (HRQoL) of patients who experienced lumbar spine surgery. METHODS All sensory symptoms (i.e., pain, numbness, paresthesia) were measured using a visual analog scale. The Chinese versions of the Oswestry Disability Index, Pittsburgh Sleep Quality Index, Clinically Useful Depression Outcome Scale, and EuroQol-five dimensions (EQ-5D) Scale were used to assess patients 1 week prior to surgery and 6 weeks and 6 months after surgery. A generalized estimating equation was used for data analysis. RESULTS A total of 101 patients with mean age of 58.38 years were included. All sensory symptoms declined significantly over time (all p < .05) with the exception of itching (feeling on toes and thighs). Patients experiencing moderate-to-severe pain had poorer QoL over time, even after controlling for other sensory symptoms and potential confounders. CONCLUSIONS Sensory symptoms gradually declined after surgery, but itching symptom did not. Moderate-to-severe pain was the only sensory symptom that influenced HRQoL over time in patients with LDSDs.
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Affiliation(s)
- Xin-Yi Cai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jiann-Her Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Neural Regeneration, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial, Hospital, Keelung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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Staartjes VE, Joswig H, Corniola MV, Schaller K, Gautschi OP, Stienen MN. Association of Medical Comorbidities With Objective Functional Impairment in Lumbar Degenerative Disc Disease. Global Spine J 2022; 12:1184-1191. [PMID: 33334183 PMCID: PMC9210248 DOI: 10.1177/2192568220979120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Analysis of a prospective 2-center database. OBJECTIVES Medical comorbidities co-determine clinical outcome. Objective functional impairment (OFI) provides a supplementary dimension of patient assessment. We set out to study whether comorbidities are associated with the presence and degree of OFI in this patient population. METHODS Patients with degenerative diseases of the spine preoperatively performed the timed-up-and-go (TUG) test and a battery of questionnaires. Comorbidities were quantified using the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiology (ASA) grading. Crude and adjusted linear regression models were fitted. RESULTS Of 375 included patients, 97 (25.9%) presented at least some degree of medical comorbidity according to the CCI, and 312 (83.2%) according to ASA grading. In the univariate analysis, the CCI was inconsistently associated with OFI. Only patients with low-grade CCI comorbidity displayed significantly higher TUG test times (p = 0.004). In the multivariable analysis, this effect persisted for patients with CCI = 1 (p = 0.030). Regarding ASA grade, patients with ASA = 3 exhibited significantly increased TUG test times (p = 0.003) and t-scores (p = 0.015). This effect disappeared after multivariable adjustment (p = 0.786 and p = 0.969). In addition, subjective functional impairment according to ODI, and EQ5D index was moderately associated with comorbidities according to ASA (all p < 0.05). CONCLUSION The degree of medical comorbidities appears only weakly and inconsistently associated with OFI in patients scheduled for degenerative lumbar spine surgery, especially after controlling for potential confounders. TUG testing may be valid even in patients with relatively severe comorbidities who are able to complete the test.
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Affiliation(s)
- Victor E. Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Holger Joswig
- Department of Neurosurgery, Health and Medical University Potsdam, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marco V. Corniola
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Oliver P. Gautschi
- Neuro- und Wirbelsäulenzentrum Zentralschweiz, Klinik St.Anna, Luzern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland,Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland,Martin N. Stienen, MD/FEBNS, Department of Neurosurgery, Kantonsspital St.Gallen, Rorschacher Str. 95, 9007 St.Gallen, Switzerland.
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Application of enhanced recovery after surgery care protocol in the perioperative care of patients undergoing lumbar fusion and internal fixation. J Orthop Surg Res 2022; 17:240. [PMID: 35436890 PMCID: PMC9014593 DOI: 10.1186/s13018-022-03099-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background To explore the effects and deficiencies of the enhanced recovery after surgery (ERAS) care protocol on patients undergoing lumbar fusion and internal fixation in perioperative care. Methods A total of 166 patients with lumbar fusion and internal fixation were collected and divided into two groups, among which 86 patients received ERAS care protocol were attributed into ERAS group, while the other 80 patients received traditional perioperative care protocol were assigned to control group. Then, the degree of pain, self-care ability and the degree of recovery were assessed using the visual analogue scale (VAS), Barthel index (BI) rating scale and the Sino-version Oswestry Disability Index (ODI) questionnaire, respectively. Moreover, further analysis was performed based on patients’ different age, gender, body mass index (BMI) and education of patients in ERAS group. Results The hospitalization time and the incidence of complication in the ERAS group were obviously lower than those in control group (both, P < 0.05). There was no significant difference in hospitalization expenses between the two groups (P > 0.05). The BI score of the ERAS group was higher than that of the control group (P < 0.05), and the percentage of ODI score in ERAS group was significantly downregulated in comparison with that in control group (P < 0.05). Intra-group analysis in ERAS showed that, compared with older patients, younger patients had higher BI scores (P < 0.05) and lower ODI scores (P < 0.05); meanwhile, overweight patients had lower BI scores (P < 0.05), and the ODI score decreased with the increase in education level of the patients. Conclusions ERAS care protocol can significantly shorten the hospitalization time and reduce the occurrence of postoperative complications of patients, significantly enhance the self-care ability of patients after discharge and promote the rapid recovery of patients after surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03099-0.
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Maldaner N, Sosnova M, Ziga M, Zeitlberger AM, Bozinov O, Gautschi OP, Weyerbrock A, Regli L, Stienen MN. External Validation of the Minimum Clinically Important Difference in the Timed-up-and-go Test After Surgery for Lumbar Degenerative Disc Disease. Spine (Phila Pa 1976) 2022; 47:337-342. [PMID: 34033596 DOI: 10.1097/brs.0000000000004128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational cohort study. OBJECTIVE The aim of this study was to provide external validation of the minimum clinically important difference (MCID) of the Timed-up-and-go (TUG) test. SUMMARY OF BACKGROUND DATA The TUG test is one of the best explored and most frequently applied objective task-based functional outcome measure in patients with lumbar degenerative disc disease (DDD). The increased use of the TUG test is based on its solid psychometric properties; however, an external validation of the originally determined MCID is lacking. METHODS Forty-nine patients with lumbar DDD, scheduled for elective spine surgery, were assessed pre- and 6-weeks (W6) postoperative. MCID values were calculate for raw TUG test times (seconds) and standardized TUG z scores using three different computation methods and the following established patient-reported outcome measures (PROMs) as anchors: Visual Analog Scales (VAS), Core Outcome Measures Index Back, Zurich Claudication Questionnaire (ZCQ). RESULTS The three computation methods generated a range of MCID values, depending on the PROM used as anchor, from 0.9 s (z score of 0.3) based on the VAS leg pain to 3.0 seconds (z score of 2.7) based on the ZCQ physical function scale. The average MCID of the TUG test across all anchors and computation methods was 2.1 s (z score of 1.5). According to the average MCID of raw TUG test values or TUG z scores, 41% and 43% of patients classified as W6 responders to surgery, respectively. CONCLUSION This study confirms the ordinally reported TUG MCID values in patients undergoing surgery for lumbar. A TUG test time change of 2.1 seconds (or TUG z score change of 1.5) indicates an objective and clinically meaningful change in functional status. This report facilitates the interpretation of TUG test results in clinical routine as well as in research.Level of Evidence: 3.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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Iorio-Morin C, Fisher CG, Abraham E, Nataraj A, Attabib N, Paquet J, Hogan TG, Bailey CS, Ahn H, Johnson M, Richardson EA, Manson N, Thomas K, Rampersaud YR, Hall H, Dea N. Low-back pain after lumbar discectomy for disc herniation: what can you tell your patient? J Neurosurg Spine 2021; 35:715-721. [PMID: 34450579 DOI: 10.3171/2021.2.spine201625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar discectomy (LD) is frequently performed to alleviate radicular pain resulting from disc herniation. While this goal is achieved in most patients, improvement in low-back pain (LBP) has been reported inconsistently. The goal of this study was to characterize how LBP evolves following discectomy. METHODS The authors performed a retrospective analysis of prospectively collected patient data from the Canadian Spine Outcomes and Research Network (CSORN) registry. Patients who underwent surgery for lumbar disc herniation were eligible for inclusion. The primary outcome was a clinically significant reduction in the back pain numerical rating scale (BPNRS) assessed at 12 months. Binary logistic regression was used to model the relationship between the primary outcome and potential predictors. RESULTS There were 557 patients included in the analysis. The chief complaint was radiculopathy in 85%; 55% of patients underwent a minimally invasive procedure. BPNRS improved at 3 months by 48% and this improvement was sustained at all follow-ups. LBP and leg pain improvement were correlated. Clinically significant improvement in BPNRS at 12 months was reported by 64% of patients. Six factors predicted a lack of LBP improvement: female sex, low education level, marriage, not working, low expectations with regard to LBP improvement, and a low BPNRS preoperatively. CONCLUSIONS Clinically significant improvement in LBP is observed in the majority of patients after LD. These data should be used to better counsel patients and provide accurate expectations about back pain improvement.
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Affiliation(s)
- Christian Iorio-Morin
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec
| | - Charles G Fisher
- 2Division of Spine Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia
| | - Edward Abraham
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick
- 4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Andrew Nataraj
- 5Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta
| | - Najmedden Attabib
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick
- 4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Jerome Paquet
- 6Department of Neurological Sciences, Université Laval, Quebec
| | - Thomas Guy Hogan
- 7Department of Orthopedic Surgery, Memorial University, St. John's, Newfoundland
| | - Christopher S Bailey
- 8Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Henry Ahn
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Michael Johnson
- 10Section of Orthopaedic Surgery, Health Science Centre, Winnipeg, Manitoba
| | - Eden A Richardson
- 11Canadian Spine Outcomes and Research Network, Ontario; and
- 11Canadian Spine Outcomes and Research Network, Ontario; and
| | - Neil Manson
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick
- 4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia
- 7Department of Orthopedic Surgery, Memorial University, St. John's, Newfoundland
| | - Ken Thomas
- 12Department of Surgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Y Raja Rampersaud
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Hamilton Hall
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Nicolas Dea
- 2Division of Spine Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia
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Huang Y, Zhang Z, Wang J, Shen S, Yao T, Xu Y, Chen Z, Fang B, Ma J. circSPG21 protects against intervertebral disc disease by targeting miR-1197/ATP1B3. Exp Mol Med 2021; 53:1547-1558. [PMID: 34611269 PMCID: PMC8568895 DOI: 10.1038/s12276-021-00674-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/24/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022] Open
Abstract
The abnormal expression of circular RNAs (circRNAs) is associated with numerous human diseases. This study investigated the mechanism by which circRNA acts as competitive endogenous RNA in the regulation of degenerative intervertebral disc disease (IVDD). Decreased expression of circSPG21 was detected in degenerated nucleus pulposus cells (NPCs), the function of circSPG21 in NPCs was explored and verified, and the downstream target of circSPG21 was investigated. The interaction between circSPG21 and miR-1197 and its target gene (ATP1B3) was studied by online database prediction and molecular biological verification. Finally, the circSPG21/miR-1197/ATP1B3 axis was verified in the mouse tail-looping model. The expression of circSPG21 in the nucleus pulposus in IVDD was directly related to an imbalance of anabolic and catabolic factors, which affected cell senescence. circSPG21 was found to play a role in human NPCs by acting as a sponge of miR-1197 and thereby affecting ATP1B3. The regulation of circSPG21 provides a potentially effective therapeutic strategy for IVDD.
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Affiliation(s)
- Yizhen Huang
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Zhenlei Zhang
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Jianle Wang
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Shuying Shen
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Teng Yao
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Yining Xu
- grid.412551.60000 0000 9055 7865Shaoxing University School of Medicine, Shaoxing, China
| | - Zizheng Chen
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
| | - Bin Fang
- grid.412449.e0000 0000 9678 1884Department of Spine Surgery, Shaoxing Central Hospital, China Medical University, Shaoxing, China
| | - Jianjun Ma
- grid.13402.340000 0004 1759 700XDepartment of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China ,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang, China
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Stienen MN, Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Weyerbrock A, Bozinov O, Gautschi OP. External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease. Neurosurgery 2021; 88:E142-E149. [PMID: 33040156 DOI: 10.1093/neuros/nyaa441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Timed Up and Go (TUG) test is the most commonly applied objective measure of functional impairment in patients with lumbar degenerative disc disease (DDD). OBJECTIVE To demonstrate external content validity of the TUG test. METHODS Consecutive adult patients, scheduled for elective lumbar spine surgery, were screened for enrollment into a prospective observational study. Disease severity was estimated by patient-reported outcome measures (PROMs; Visual Analog Scales [VAS], Core Outcome Measures Index [COMI] back, Zurich Claudication Questionnaire [ZCQ]) and the TUG test. Pearson correlation coefficients (PCCs) were used to describe the relationship between logarithmic TUG test raw values and PROMs. RESULTS A total of 70 patients (mean age 55.9 ± 15.4 yr; 38.6% female; 27.1% previous spine surgery; 28.6% lower extremity motor deficits) with lumbar disc herniation (50%), lumbar spinal stenosis (34.3%), or instability requiring spinal fusion (15.7%) were included. The mean TUG test time was 10.8 ± 4.4 s; age- and sex-adjusted objective functional impairment (OFI) T-score was 134.2 ± 36.9. A total of 12 (17.1%) patients had mild, 14 (20%) moderate, and 9 (12.9%) severe OFI, while 35 (50%) had TUG test results within the normal population range (no OFI). PCCs between TUG test time and VAS back pain were r = 0.37 (P = .002), VAS leg pain r = 0.37 (P = .002), COMI back r = 0.50 (P < .001), ZCQ symptom severity r = 0.41 (P < .001), and ZCQ physical function r = 0.36 (P = .002). CONCLUSION This external validation demonstrated similar OFI rates and PCCs between logarithmic TUG test results and PROMs compared to the original article from 2016. These findings support the TUG test being a quick, easy-to-use objective test, which provides the physician with a robust estimate of pain and functional impairment.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Weyerbrock A, Stienen MN. Evaluation of the 6-minute walking test as a smartphone app-based self-measurement of objective functional impairment in patients with lumbar degenerative disc disease. J Neurosurg Spine 2020; 33:779-788. [PMID: 32764182 DOI: 10.3171/2020.5.spine20547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Digital transformation enables new possibilities to assess objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). This study examines the psychometric properties of an app-based 6-minute walking test (6WT) and determines OFI in patients with lumbar DDD. METHODS The maximum 6-minute walking distance (6WD) was determined in patients with lumbar DDD. The results were expressed as raw 6WDs (in meters), as well as in standardized z-scores referenced to age- and sex-specific values of spine-healthy volunteers. The 6WT results were assessed for reliability and content validity using established disease-specific patient-reported outcome measures. RESULTS Seventy consecutive patients and 330 volunteers were enrolled. The mean 6WD was 370 m (SD 137 m) in patients with lumbar DDD. Significant correlations between 6WD and the Core Outcome Measures Index for the back (r = -0.31), Zurich Claudication Questionnaire (ZCQ) symptom severity (r = -0.32), ZCQ physical function (r = -0.33), visual analog scale (VAS) for back pain (r = -0.42), and VAS for leg pain (r = -0.32) were observed (all p < 0.05). The 6WT revealed good test-retest reliability (intraclass correlation coefficient 0.82), and the standard error of measurement was 58.3 m. A 4-tier severity stratification classified patients with z-scores > -1 (no OFI), -1 to -1.9 (mild OFI), -2 to -2.9 (moderate OFI), and ≤ -3 (severe OFI). CONCLUSIONS The smartphone app-based self-measurement of the 6WT is a convenient, reliable, and valid way to determine OFI in patients with lumbar DDD. The 6WT app facilitates the digital evaluation and monitoring of patients with lumbar DDD.
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Affiliation(s)
- Nicolai Maldaner
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | | | | | - Michal Ziga
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | - Oliver P Gautschi
- 3Neurological and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
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12
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Maldaner N, Stienen MN. Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:183-199. [DOI: 10.1002/acr.24210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Nicolai Maldaner
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - Martin Nikolaus Stienen
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Stanford University Hospital and Clinics Stanford California
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13
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Evaluating the Minimal Clinically Important Difference of EQ-5D-3L in Patients With Degenerative Lumbar Spinal Stenosis: A Swiss Prospective Multicenter Cohort Study. Spine (Phila Pa 1976) 2020; 45:1309-1316. [PMID: 32205700 DOI: 10.1097/brs.0000000000003501] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of a prospective, multicenter cohort study. OBJECTIVE The aim of our study was to compare thresholds of published minimal clinically important differences (MCID) for the three-level EuroQol-5D health survey (EQ-5D-3L) summary index (range -0.53 to 1.00) with our anchor-based estimate and evaluate how useful these thresholds are in determining treatment success in patients undergoing surgery for degenerative lumbar spinal stenosis (DLSS). SUMMARY OF BACKGROUND DATA MCID values for EQ-5D-3L are specific to the underlying disease and only three studies have been published for DLSS patients reporting different values. METHODS Patients of the multicenter Lumbar Stenosis Outcome Study with confirmed DLSS undergoing first-time decompression or fusion surgery with 12-month follow-up were enrolled in this study. To calculate MCID we used the Spinal Stenosis Measure satisfaction subscale as anchor. RESULTS For this study, 364 patients met the inclusion criteria; of these, 196 were very satisfied, 72 moderately satisfied, 43 somewhat satisfied, and 53 unsatisfied 12 months after surgery. The MCID calculation estimated for EQ-5D-3L a value of 0.19. Compared with published MCID values (ranging from 0.30 to 0.52), our estimation is less restrictive. CONCLUSIONS In patients with LSS undergoing surgery, we estimated an MCID value for EQ-5D-3L summary index of 0.19 with the help of the average change anchor-based method, which we find to be the most suitable method for assessing patient change scores. LEVEL OF EVIDENCE 3.
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14
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Tosic L, Goldberger E, Maldaner N, Sosnova M, Zeitlberger AM, Staartjes VE, Gadjradj PS, Eversdijk HAJ, Quddusi A, Gandía-González ML, Sayadi JJ, Desai A, Regli L, Gautschi OP, Stienen MN. Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures. J Neurosurg Spine 2020; 33:480-489. [PMID: 32470938 DOI: 10.3171/2020.3.spine2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements. METHODS The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs. RESULTS The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001). CONCLUSIONS This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.
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Affiliation(s)
- Lazar Tosic
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Elior Goldberger
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Pravesh S Gadjradj
- 3Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ayesha Quddusi
- 5Center for Neuroscience, Queens University, Kingston, Ontario, Canada
| | | | - Jamasb Joshua Sayadi
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Atman Desai
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Oliver P Gautschi
- 8Neuro and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
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Yang L, Kong J, Qiu Z, Shang T, Chen S, Zhao R, Raucci MG, Yang X, Wu Z. Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease. Regen Biomater 2020; 7:181-193. [PMID: 32296537 PMCID: PMC7147368 DOI: 10.1093/rb/rbz044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/27/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
As a minimally invasive surgery, percutaneous cement discoplasty (PCD) is now contemplated to treat lumbar disc degeneration disease in elder population. Here, we investigated whether the osteogenic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) cement could be a suitable material in PCD surgery. Injectability, hydrophilicity and mechanical properties of the MC-modified PMMA (PMMA-MC) was characterized. The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation. Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress. Then, PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA. Three months after implantation, micro-computed tomography analysis revealed a 36.4% higher circumferential contact index between PMMA-MC and bone, as compared to PMMA alone. Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone, while the PMMA was covered by fibrous tissue. The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation. Therefore, the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro. We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages. Moreover, expressions of fibroblast-stimulating growth factors, insulin-like growth factor, basic fibroblast growth factor and tumor necrosis factor-β were significantly down-regulated in the macrophages cocultured with PMMA-MC. Together, the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.
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Affiliation(s)
- Long Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Jianjun Kong
- Department of Orthopaedics, Orthopaedic Hospital of Xingtai, Xingtai 054000, China
- Department of Orthopedic Laboratory, Xingtai Institute of Orthopaedics, Xingtai 054000, China
| | - Zhiye Qiu
- Beijing Allgens Medical Science and Technology Co., Ltd, Beijing 102609, China
- School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Tieliang Shang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Siyu Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Rui Zhao
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Maria Grazia Raucci
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Naples 80125, Italy
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Zhanyong Wu
- Department of Orthopaedics, Orthopaedic Hospital of Xingtai, Xingtai 054000, China
- Department of Orthopedic Laboratory, Xingtai Institute of Orthopaedics, Xingtai 054000, China
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Stienen MN, Maldaner N, Sosnova M, Joswig H, Corniola MV, Regli L, Hildebrandt G, Schaller K, Gautschi OP. Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures. Neurospine 2020; 17:270-280. [PMID: 32054148 PMCID: PMC7136100 DOI: 10.14245/ns.1938368.184] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.
Methods We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.
Results One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.
Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.
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Affiliation(s)
- Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Holger Joswig
- Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marco Vincenzo Corniola
- Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Gerhard Hildebrandt
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Psychological predictors of quality of life and functional outcome in patients undergoing elective surgery for degenerative lumbar spine disease. 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; 29:349-359. [PMID: 31414288 DOI: 10.1007/s00586-019-06106-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/08/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To quantify the correlation between patients' psychopathological predisposition, disability and health-related quality of life (QOL) after surgery for degenerative lumbar spine disease. METHODS We prospectively included patients undergoing decompression for degenerative lumbar spinal stenosis, spondylolisthesis or disc herniation with additional fusion of up to two segments. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State Trait Anxiety Inventory-State Anxiety and State Trait Anxiety Inventory-Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol 5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. RESULTS In total, 245 patients between March 2013 and November 2017 received surgery, of which 180 (73.5%) fully completed follow-up after 3 months and 12 months. QOL scores significantly increased by 3 months (EQ: +0.2; p < 0.001; SF-36 PCS: +7.0; p < 0.001; SF-36 MCS: +3.3; p = 0.018), a benefit which was retained at 12 months, without statistically significant difference between fused and non-fused patients. Depressed patients exhibited impaired mean scores of EQ (0.58 vs. 0.36; p < 0.001) and ODI mean scores (35.5 vs. 51.9; p < 0.001) at baseline, which significantly improved and converged with scores of non-depressed patients after 12 months. Linear regression analysis identified statistically significant predictors in age, STAI-T and SF-36 MCS for post-operative QOL and disability. CONCLUSION Despite exhibiting pronounced psychological distress preoperatively, patients may significantly benefit from surgery with an outcome equal to psychologically healthy patients after 12 months. These slides can be retrieved under Electronic Supplementary Material.
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Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Kudo D, Kijima H, Kimura R, Ono Y, Takahashi Y, Shimada Y. Lumbar spinal stenosis associated with progression of locomotive syndrome and lower extremity muscle weakness. Clin Interv Aging 2019; 14:1399-1405. [PMID: 31496667 PMCID: PMC6689136 DOI: 10.2147/cia.s201974] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the association between the early stages of lumbar spinal stenosis (LSS) and the risk of locomotive syndrome, as well as its effect upon muscle strength of the back, upper extremities, and lower extremities. Patients and methods LSS was diagnosed with a self-administered, self-reported history questionnaire. Participants (n=113) who agreed to be tested by the diagnostic support tool for LSS underwent three risk tests for locomotive syndrome: a stand-up test, a two-step test, and a 25-question Geriatric Locomotive Function Scale (GLFS-25), as well as measurements of the strength of their grip, back extensor, hip flexor, and knee extensor muscles. Results Twenty-three participants were diagnosed with LSS by the questionnaire. Results of the stand-up test in the LSS group were significantly worse than those in the no-LSS group (P=0.003). The results of the two-step test and the total score on the GLFS-25 in the LSS group were significantly worse than those in the no-LSS group (P=0.002 and P<0.0001, respectively). The stages of locomotive syndrome assessed by the stand-up test, two-step test, and the GLFS-25 were significantly worse in the LSS group than in the no-LSS group (P=0.0004, P=0.0007, and P<0.0001, respectively). Hip flexor and knee extensor strength, but not grip and back extensor strength, in the LSS group were significantly lower than that in the no-LSS group. Conclusions LSS diagnosed using the self-reported support tool worsened the stage of locomotive syndrome in older people. Furthermore, participants with LSS had significant lower extremity weakness.
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Affiliation(s)
- Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuichi Ono
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasuhiro Takahashi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Moreno JL, Nabity PS, Kanzler KE, Bryan CJ, McGeary CA, McGeary DD. Negative Life Events (NLEs) Contributing to Psychological Distress, Pain, and Disability in a U.S. Military Sample. Mil Med 2019; 184:e148-e155. [PMID: 30395305 DOI: 10.1093/milmed/usy259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/13/2018] [Indexed: 11/14/2022] Open
Abstract
Introduction The objective was to explore how negative life events (NLEs, e.g., litigation related to pain and disability, failing most recent physical fitness test, and financial difficulties) are related to pain coping and psychological adjustment to pain in active duty military personnel. Materials and Methods Data were gathered as part of the Evaluation of Suicidality, Cognitions, and Pain Experience study, a DoD-funded cross-sectional assessment of chronic pain and emotional coping among a cohort of military members. The investigators examined data from 147 respondents with complete survey and pain assessment data. Results The sample was active duty, male (62.6%), in a relationship or married (83.0%), and had children (68.7%). The majority of the sample endorsed zero NLEs (72.0%); 23.8% endorsed one NLE, 4.2% endorsed two NLEs, and no one endorsed all three NLEs. A significantly higher proportion of participants endorsing one or more NLEs reported suicidal ideation compared to those who reported no NLEs (χ2(2) = 8.61, p = 0.014). A higher number of endorsed NLEs coincided with higher symptom severity related to psychosocial distress (depression, thwarted belongingness, perceived burdensomeness, PTSD, and suicide cognitions) and poor pain coping (rumination, helplessness, and less acceptance of chronic pain). Conclusions Findings revealed that NLEs may impart a significant burden on military pain sufferers. Greater numbers of endorsed NLEs are associated with increased psychosocial distress and poor pain coping. Future longitudinal studies examining long-term psychosocial distress/poor pain coping as related to NLEs would help to elaborate the long-term consequences of NLEs on pain coping and psychosocial distress.
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Affiliation(s)
- Jose L Moreno
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 1670 Upham Drive, Columbus, OH
| | - Paul S Nabity
- Department of Psychiatry, University of Texas Health San Antonio, 8300 Floyd Curl Dr., San Antonio, TX
| | - Kathryn E Kanzler
- Department of Psychiatry, University of Texas Health San Antonio, 8300 Floyd Curl Dr., San Antonio, TX
| | - Craig J Bryan
- National Center for Veterans Studies, 260 S Central Campus Dr., Suite 3525, Salt Lake City, UT
- Department of Psychology, The University of Utah, 380 S 1530 E Beh S 502, Salt Lake City, UT
| | - Cindy A McGeary
- Department of Psychiatry, University of Texas Health San Antonio, 8300 Floyd Curl Dr., San Antonio, TX
| | - Donald D McGeary
- Department of Psychiatry, University of Texas Health San Antonio, 8300 Floyd Curl Dr., San Antonio, TX
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Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J 2019; 19:1276-1293. [PMID: 30831316 DOI: 10.1016/j.spinee.2019.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT The accurate determination of a patient's functional status is necessary for therapeutic decision-making and to critically appraise treatment efficacy. Current subjective patient-reported outcome measure (PROM)-based assessments have limitations and can be complimented by objective measures of function. PURPOSE To systematically review the literature and provide an overview on the available objective measures of function for patients with degenerative diseases of the lumbar spine. STUDY DESIGN/SETTING Systematic review of the literature. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently searched the PubMed, Web of Science, EMBASE, and SCOPUS databases for permutations of the words "objective," "assessment," "function," "lumbar," and "spine" including articles on human subjects with degenerative diseases of the lumbar spine that reported on objective measures of function, published until September 2018. Risk of bias was not assessed. No funding was received. The authors report no conflicts of interest. RESULTS Of 2,389 identified articles, 82 were included in the final analysis. There was a significant increase of 0.12 per year in the number of publications dealing with objective measures of function since 1989 (95% CI 0.08-0.16, p<.001). Some publications studied multiple diagnoses and objective measures. The United States was the leading nation in terms of scientific output for objective outcome measures (n=21; 25.6%), followed by Switzerland (n=17; 20.7%), Canada, Germany, and the United Kingdom (each n=6; 7.3%). Our search revealed 21 different types of objective measures, predominantly applied to patients with lumbar spinal stenosis (n=67 publications; 81.7%), chronic/unspecific low back pain (n=28; 34.2%) and lumbar disc herniation (n=22; 26.8%). The Timed-Up-and-Go test was the most frequently applied measure (n=26 publications; 31.7%; cumulative number of reported subjects: 5,181), followed by the Motorized Treadmill Test (n=25 publications; 30.5%, 1,499 subjects) and with each n=9 publications (11.0%) the Five-Repetition Sit-To-Stand test (955 subjects), as well as accelerometry analyses (336 subjects). The reliability and validity of many of the less-applied objective measures was uncertain. There was profound heterogeneity in their application and interpretation of results. CONCLUSIONS Clinical studies on patients with lumbar degenerative diseases increasingly employ objective measures of function, which offer high potential for improving the quality of outcome measurement in patient-care and research. This review provides an overview on available options. Our findings call for an agreement and standardization in terms of test selection, conduction and analysis to facilitate comparison of results across cohorts. PROSPERO REGISTRATION NUMBER CRD42019122622.
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Tang Z, Hu B, Zang F, Wang J, Zhang X, Chen H. Nrf2 drives oxidative stress-induced autophagy in nucleus pulposus cells via a Keap1/Nrf2/p62 feedback loop to protect intervertebral disc from degeneration. Cell Death Dis 2019; 10:510. [PMID: 31263165 PMCID: PMC6602960 DOI: 10.1038/s41419-019-1701-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
Intervertebral disc (IVD) degeneration is known to aggravate with age and oxidative stress is implicated in the pathogenesis of many age-related diseases. Nuclear factor (erythroid-derived-2)-like 2 (Nrf2) can confer adaptive protection against oxidative and proteotoxic stress in cells. In this study, we assessed whether Nrf2 can protect against oxidative stress in nucleus pulposus (NP) cells. In addition, we investigated Nrf2 expression in NP tissue samples from patients with different degrees of IVD degeneration and a mouse model of aging and IVD degeneration and the influence of H2O2-induced oxidative stress on autophagic pathways in NP cells. Autophagy was assessed by measuring levels of autophagy-related protein (ATG) family members and the autophagic markers, p62 and LC3. We found that expression of Nrf2 progressively decreased in human NP tissue samples of patients with increasing degrees of IVD degeneration. Nrf2 deficiency leads to the degeneration of IVDs during aging. Nrf2 knockout also aggravates IVD degeneration and reduces autophagic gene expression in an induced mouse model of IVD degeneration. The detrimental effects of H2O2-induced oxidative stress were increased in autophagy-deficient cells via reduced expression of Atg7 and the Keap1–Nrf2–p62 autophagy pathway. Taken together, these results suggest that excessive oxidative stress causes the upregulation of autophagy, and autophagy acts as an antioxidant feedback response activated by a Keap1-Nrf2-p62 feedback loop in IVD degeneration.
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Affiliation(s)
- Zehan Tang
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Hu
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fazhi Zang
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianxi Wang
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xingda Zhang
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huajiang Chen
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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22
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Stienen MN, Maldaner N, Joswig H, Corniola MV, Bellut D, Prömmel P, Regli L, Weyerbrock A, Schaller K, Gautschi OP. Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus 2019; 46:E4. [DOI: 10.3171/2019.2.focus18618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the “Timed Up and Go” (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS).METHODSA prospective two-center database was reviewed to identify patients with LSS who underwent lumbar decompression with or without fusion. The subjective functional status was estimated using PROMs for pain (visual analog scale [VAS]), disability (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQoL; 12-Item Short-Form Physical Component Summary [SF-12 PCS] and the EQ-5D) preoperatively, as well as on postoperative day 3 (D3) and week 6 (W6). Objective functional impairment (OFI) was measured using age- and sex-standardized TUG test results.RESULTSSixty-four patients (n = 32 [50%] male, mean age 66.8 ± 11.7 years) were included. Preoperatively, they reported a mean VAS back pain score of 4.1 ± 2.7, VAS leg pain score of 5.4 ± 2.7, RMDI of 10.4 ± 5.3, ODI of 41.9 ± 16.2, SF-12 PCS score of 32.7 ± 8.3, and an EQ-5D index of 0.517 ± 0.226. The preoperative rates of severe, moderate, and mild OFI were 4.7% (n = 3), 12.5% (n = 8), and 7.8% (n = 5), respectively, and the mean OFI T-score was 116.3 ± 23.7. At W6, 60 (93.8%) of 64 patients had a TUG test result within the normal population range (no OFI); 3 patients (4.7%) had mild and 1 patient (1.6%) severe OFI. The mean W6 OFI T-score was significantly decreased (103.1 ± 13.6; p < 0.001). Correspondingly, the PROMs showed a decrease in subjective VAS back pain (1.6 ± 1.7, p < 0.001) and leg pain (1.0 ± 1.8, p < 0.001) scores, disability (RMDI 5.3 ± 4.7, p < 0.001; ODI 21.3 ± 16.1, p < 0.001), and increase in HRQoL (SF-12 PCS 40.1 ± 8.3, p < 0.001; EQ-5D 0.737 ± 0.192, p < 0.001) at W6. The W6 responder status (clinically meaningful improvement) ranged between 81.3% (VAS leg pain) and 29.7% (EQ-5D index) of patients.CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.
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Affiliation(s)
- Martin N. Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Holger Joswig
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - Marco V. Corniola
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - David Bellut
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | - Peter Prömmel
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Karl Schaller
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
| | - Oliver P. Gautschi
- 3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and
- 4Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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23
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Elsayed G, McClugage SG, Erwood MS, Davis MC, Dupépé EB, Szerlip P, Walters BC, Hadley MN. Association between payer status and patient-reported outcomes in adult patients with lumbar spinal stenosis treated with decompression surgery. J Neurosurg Spine 2019; 30:198-210. [PMID: 30485189 DOI: 10.3171/2018.7.spine18294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: Insurance disparities can have relevant effects on outcomes after elective lumbar spinal surgery. The aim of this study was to evaluate the association between private/public payer status and patient-reported outcomes in adult patients who underwent decompression surgery for lumbar spinal stenosis. METHODS: A sample of 100 patients who underwent surgery for lumbar spinal stenosis from 2012 to 2014 was evaluated as part of the prospectively collected Quality Outcomes Database at a single institution. Outcome measures were evaluated at 3 months and 12 months, analyzed in regard to payer status (private insurance vs Medicare/Veterans Affairs insurance), and adjusted for potential confounders. RESULTS: At baseline, patients had similar visual analog scale back and leg pain, Oswestry Disability Index, and EQ-5D scores. At 3 months postintervention, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.11, p < 0.001) and more leg pain (mean difference 1.26, p = 0.05). At 12 months, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.14, p < 0.001). There were no significant differences at 3 months or 12 months between groups for back pain (p = 0.14 and 0.43) or disability (p = 0.19 and 0.15). Across time points, patients in both groups showed improvement at 3 months and 12 months in all 4 functional outcomes compared with baseline (p < 0.001). CONCLUSIONS: Both private and public insurance patients had significant improvement after elective lumbar spinal surgery. Patients with public insurance had slightly less improvement in quality of life after surgery than those with private insurance but still benefited greatly from surgical intervention, particularly with respect to functional status.
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Affiliation(s)
- Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Samuel G McClugage
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew S Erwood
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew C Davis
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Esther B Dupépé
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Paul Szerlip
- Department of Computer Science, University of Central Florida, Orlando, Florida
| | - Beverly C Walters
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Mark N Hadley
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
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Lehmann AE, Scangas GA, Sethi RKV, Remenschneider AK, El Rassi E, Metson R. Impact of Age on Sinus Surgery Outcomes. Laryngoscope 2018; 128:2681-2687. [DOI: 10.1002/lary.27285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ashton E. Lehmann
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - George A. Scangas
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Rosh K. V. Sethi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Aaron K. Remenschneider
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Edward El Rassi
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
| | - Ralph Metson
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts
- Department of Otolaryngology; Massachusetts Eye and Ear; Boston Massachusetts U.S.A
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Development of a Virtual Reality Preoperative Planning System for Postlateral Endoscopic Lumbar Discectomy Surgery and Its Clinical Application. World Neurosurg 2018; 123:e1-e8. [PMID: 30144600 DOI: 10.1016/j.wneu.2018.08.082] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Percutaneous endoscopic lumbar discectomy is an effective way to treat lumbar disc herniation. Traditional preoperative planning based on a 2-dimensional method by magnetic resonance/computed tomography may cause inaccuracy of puncture during surgery. We used virtual reality to stimulate a surgery environment and measured relevant 3-dimensional data. We then explored its applicability for increasing puncture accuracy during actual surgeries. METHODS A prospective randomized trial of lumbar disc herniation was conducted. Both conventional and virtual reality methods were used for preoperative planning and relevant data (planned puncture point and entry angle) were measured. Data were used during surgery and adjusted to complete the operation. The final entry point and entry angle were recorded and compared with relevant planned data statistically. Fluoroscopic times and location time also were included to access the puncture accuracy during surgery. RESULTS Thirty cases were included in our study. Both groups achieved good results after surgery, except for 1 case of postoperative dysesthesia in the traditional planning group and 1 case of residual disc in the virtual reality group. The use of virtual reality can predict a surgery-related angle and distance accurately except for depth. Compared with the traditional planning group, the fluoroscopic time (13.18 ± 4.191 vs. 32.00 ± 4.52) and location time (17.91 ± 4.74 vs. 33.22 ± 3.90) were statistically different, which indicates that this method can increase puncture accuracy. CONCLUSIONS A virtual reality planning system is an accurate preoperative planning method that can significantly improve the puncture accuracy of percutaneous endoscopic lumbar discectomy and reduce fluoroscopic and location times.
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Stienen MN, Joswig H, Chau I, Neidert MC, Bellut D, Wälchli T, Schaller K, Gautschi OP. Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study. J Neurosurg Spine 2018; 28:291-299. [DOI: 10.3171/2017.6.spine161372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy.METHODSThis study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6.RESULTSFifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066).CONCLUSIONSIntraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective cohort trial; evidence: Class II.
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Affiliation(s)
| | - Holger Joswig
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen; and
| | - Ivan Chau
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen; and
| | | | - David Bellut
- 1Department of Neurosurgery, University Hospital Zürich
| | - Thomas Wälchli
- 1Department of Neurosurgery, University Hospital Zürich
- 3Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland
| | - Karl Schaller
- 3Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland
| | - Oliver P. Gautschi
- 3Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Switzerland
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27
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Thakral M, Shi L, Foust JB, Patel KV, Shmerling RH, Bean JF, Leveille SG. Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain. Geriatr Nurs 2018; 39:450-456. [PMID: 29477646 DOI: 10.1016/j.gerinurse.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
Abstract
Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.
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Affiliation(s)
- Manu Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA.
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Janice B Foust
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H Shmerling
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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Abstract
Zusammenfassung. Zur exakten Erfassung von Schmerzen, funktionellen Einschränkungen und gesundheitsbezogener Lebensqualität bei Patienten mit degenerativen Wirbelsäulenerkrankungen existiert eine Reihe validierter Messinstrumente. Neben der Beurteilung durch den Therapeuten sowie «subjektiven» patientenorientierten Messmethoden (PROMs) wurde in den vergangenen Jahren der «Timed Up and Go»(TUG)-Test systematisch untersucht und als krankheitsspezifisches Messinstrument validiert. Heute kann eine objektive funktionelle Einschränkung (OFI = Objective Functional Impairment) in wenigen Sekunden und kostenfrei mithilfe einer Smartphone-Applikation bestimmt werden. Die Bestimmung von Z- oder T-Werten, die TUG-Testergebnisse in Relation zur Populationsnorm setzen, ermöglichen eine alters- und geschlechtsadjustierte Ergebnisinterpretation. Diese Übersichtsarbeit fasst die aktuellen Erkenntnisse zu objektiven Messmethoden bei degenerativen Wirbelsäulenpathologien inklusive deren Vor- und Nachteile zusammen und vergleicht sie mit den bisherigen Beurteilungsmethoden für funktionelle Outcomes.
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Affiliation(s)
| | - David Bellut
- 1 Klinik für Neurochirurgie, Universitätsspital Zürich
| | - Luca Regli
- 1 Klinik für Neurochirurgie, Universitätsspital Zürich
| | - Oliver N Hausmann
- 2 Neuro- und Wirbelsäulenzentrum, Hirslanden Klinik St. Anna, Luzern
| | - Oliver P Gautschi
- 2 Neuro- und Wirbelsäulenzentrum, Hirslanden Klinik St. Anna, Luzern
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Song J, Wang HL, Ma XS, Xia XL, Lu FZ, Zheng CJ, Jiang JY. The value of radiographic indexes in the diagnosis of discogenic low back pain: a retrospective analysis of imaging results. Oncotarget 2017; 8:60558-60567. [PMID: 28947993 PMCID: PMC5601161 DOI: 10.18632/oncotarget.18652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/23/2017] [Indexed: 01/01/2023] Open
Abstract
To explore value of different radiographic indexes in the diagnosis of discogenic low back pain (LBP). A total number of 120 cases (60 patients diagnosed with discogenic LBP and 60 healthy people) were retrospectively analysed to identify factors in the diagnosis of discogenic LBP by using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve was drew to show the predictive accuracy of the finally enrolled factors. Among all the included patients, 60 were strictly admitted in the discogenic LBP group while the other 60 were enrolled in the control group. Five results shows significant differences between discogenic LBP and control groups, including Cobb angle, lumbar stability, height of the disc, Modic change and High intense zone (HIZ) based on the results of univariate analysis; lumbar stability, Modic change and HIZ show high value in the diagnosis of lumbar discogenic pain based on the multivariate logistic analysis. The ROC curve shows that good diagnostic accuracy was obtained from the enrolled diagnostic factors including lumbar stability (Angular motion, more than 14.35°), Modic change and HIZ.
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Affiliation(s)
- Jian Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Hong-Li Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiao-Sheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xin-Lei Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Fei-Zhou Lu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Chao-Jun Zheng
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jian-Yuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, 200040, China
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30
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Stienen MN, Smoll NR, Joswig H, Corniola MV, Schaller K, Hildebrandt G, Gautschi OP. Validation of the baseline severity stratification of objective functional impairment in lumbar degenerative disc disease. J Neurosurg Spine 2017; 26:598-604. [DOI: 10.3171/2016.11.spine16683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Timed Up and Go (TUG) test is a simple, objective, and standardized method to measure objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). The objective of the current work was to validate the OFI baseline severity stratification (BSS; with levels of “none,” “mild,” “moderate,” and “severe”).METHODSData were collected in a prospective IRB-approved 2-center study. Patients were assessed with a comprehensive panel of scales for measuring pain (visual analog scale [VAS] for back and leg pain), functional impairment (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQOL; EQ-5D and SF-12). OFI BSS was determined using age- and sex-adjusted cutoff values.RESULTSA total of 375 consecutive patients scheduled for lumbar spine surgery were included. Each 1-step increase on the OFI BSS corresponded to an increase of 0.53 in the back pain VAS score, 0.69 in the leg pain VAS score, 1.81 points in the RMDI, and 5.93 points in the ODI, as well as to a decrease in HRQOL of −0.073 in the EQ-5D, −1.99 in the SF-12 physical component summary (PCS), and −1.62 in the SF-12 mental component summary (MCS; all p < 0.001). Patients with mild, moderate, and severe OFI had increased leg pain by 0.90 (p = 0.044), 1.54 (p < 0.001), and 1.94 (p < 0.001); increased ODI by 7.99 (p = 0.004), 12.64 (p < 0.001), and 17.13 (p < 0.001); and decreased SF-12 PCS by −2.57 (p = 0.049), −3.63 (p = 0.003), and −6.23 (p < 0.001), respectively.CONCLUSIONSThe OFI BSS is a valid measure of functional impairment for use in daily clinical practice. The presence of OFI indicates the presence of significant functional impairment on subjective outcome measures.
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Affiliation(s)
- Martin N. Stienen
- 1Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva
| | - Nicolas R. Smoll
- 2School of Medicine and Public Health, University of Newcastle, Australia
| | - Holger Joswig
- 3Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland; and
| | - Marco V. Corniola
- 1Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva
| | - Karl Schaller
- 1Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva
| | | | - Oliver P. Gautschi
- 1Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva
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Joswig H, Stienen MN, Smoll NR, Corniola MV, Chau I, Schaller K, Hildebrandt G, Gautschi OP. Effects of Smoking on Subjective and Objective Measures of Pain Intensity, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disk Disease. World Neurosurg 2017; 99:6-13. [DOI: 10.1016/j.wneu.2016.11.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/16/2022]
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Joswig H, Stienen MN, Smoll NR, Corniola MV, Chau I, Schaller K, Hildebrandt G, Gautschi OP. Patients' Preference of the Timed Up and Go Test or Patient-Reported Outcome Measures Before and After Surgery for Lumbar Degenerative Disk Disease. World Neurosurg 2017; 99:26-30. [DOI: 10.1016/j.wneu.2016.11.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Stienen MN, Joswig H, Smoll NR, Corniola MV, Schaller K, Hildebrandt G, Gautschi OP. Influence of Body Mass Index on Subjective and Objective Measures of Pain, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disc Disease. World Neurosurg 2016; 96:570-577.e1. [DOI: 10.1016/j.wneu.2016.09.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 12/28/2022]
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