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Toivonen L, Pekkanen L, Neva MH, Kautiainen H, Kyrölä K, Marttinen I, Häkkinen A. Disability, Health-Related Quality of Life and Mortality in Lumbar Spine Fusion Patients-A 5-Year Follow-Up and Comparison With a Population Sample. Global Spine J 2022; 12:1052-1057. [PMID: 33203243 PMCID: PMC9210235 DOI: 10.1177/2192568220972977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 Prospective follow-up study. OBJECTIVES We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. METHODS 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. RESULTS The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was -26 (95% CI: -24 to -28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. CONCLUSIONS Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population.
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Affiliation(s)
- Leevi Toivonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Leevi Toivonen, Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland.
| | - Liisa Pekkanen
- Department of Orthopedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Marko H. Neva
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Family Practice, Central Finland Health Care District, Jyväskylä, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Kati Kyrölä
- Department of Orthopedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Ilkka Marttinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Kim HJ, Yang JH, Chang DG, Suh SW, Jo H, Kim SI, Song KS, Cho W. Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases. J Clin Med 2021; 10:jcm10194475. [PMID: 34640493 PMCID: PMC8509257 DOI: 10.3390/jcm10194475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/17/2023] Open
Abstract
Concurrent knee osteoarthritis (KOA) and degenerative lumbar spinal disease (LSD) has increased, but the total knee arthroplasty (TKA) effect on degenerative LSD remains unclear. The aim of this study was to retrospectively analyze to compare radiological and clinical outcomes between spinal fusion only and preoperative TKA with spinal fusion for the patients with concurrent KOA and degenerative LSD. A total of 72 patients with concurrent KOA and degenerative LSDs who underwent spinal fusion at less than three levels were divided in two groups: non-TKA group (n = 50) and preoperative TKA group (n = 22). Preoperative lumbar lordosis (LL) was significantly lower in the preoperative TKA group than the non-TKA group (p < 0.05). Significantly higher preoperative pelvic incidence (PI), PI/LL mismatch, and pelvic tilt (PT) occurred in preoperative TKA group than non-TKA group (all p < 0.05). There was significant improvement of postoperative Oswestry Disability Index and leg Visual Analog Scale in the preoperative TKA group (all p < 0.01). Preoperative TKA could be a benefit for in proper correction of sagittal spinopelvic alignment by spinal fusion. Therefore, preoperative TKA could be considered a preceding surgical option for patients with severe sagittal spinopelvic parameters in concurrent KOA and degenerative LSD.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (H.J.)
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (H.J.)
- Correspondence: ; Tel.: +82-2-950-1284
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Korea; (J.H.Y.); (S.W.S.)
| | - Hoon Jo
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Korea; (H.J.K.); (H.J.)
| | - Sang-Il Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 06973, Korea;
| | - Woojin Cho
- Department of Orthopedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA;
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McIlroy S, Jadhakhan F, Bell D, Rushton A. Prediction of walking ability following posterior decompression for lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3307-3318. [PMID: 34351524 PMCID: PMC8550110 DOI: 10.1007/s00586-021-06938-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. METHODS An observational cohort study was conducted using data from the British Spine Registry (2017-2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. RESULTS 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. CONCLUSION Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.
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Affiliation(s)
- Suzanne McIlroy
- Physiotherapy Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK. .,School of Population Health & Environmental Sciences, King's College London, London, SE1 1UL, UK.
| | - Feroz Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain [CPR Spine], School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - David Bell
- Neurosurgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain [CPR Spine], School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,School of Physical Therapy, Western University, London, ON, Canada
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Crawford EJ, Ravinsky RA, Coyte PC, Rampersaud YR. Lifetime incremental cost-utility ratios for minimally invasive surgery for degenerative lumbar spondylolisthesis relative to failed medical management compared with total hip and knee arthroplasty for osteoarthritis. Can J Surg 2021; 64:E391-E402. [PMID: 34296707 PMCID: PMC8410474 DOI: 10.1503/cjs.015719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The objective of this study was to compare the cost-effectiveness of minimally invasive surgery (MIS) for patients with degenerative lumbar spondylolisthesis (DLS) relative to failed medical management with the cost-effectiveness of hip and knee arthroplasty for matched cohorts of patients with osteoarthritis. Methods: A cohort of patients with DLS undergoing MIS procedures with decompression alone or decompression and instrumented fusion between 2008 and 2014 was matched to cohorts of patients with hip osteoarthritis (OA) and knee OA undergoing total joint replacement. Incremental cost–utility ratios (ICURs) were calculated from the perspective of the Ontario Ministry of Health, using prospectively collected Short Form–6 Dimension utility data. Costs and quality-adjusted life years (QALYs) were discounted at 3% and sensitivity analyses were performed. Results: Sixty-six patients met the inclusion criteria for the DLS cohort (n = 35 for decompression alone), with a minimum follow-up time of 1 year (mean 1.7 yr). The mean age of patients in the DLS cohort was 64.76 years, and 45 patients (68.2%) were female. For each cohort, utility scores improved from baseline to follow-up and the magnitude of the gain did not differ by group. Lifetime ICURs comparing surgical with nonsurgical care were Can$7946/QALY, Can$7104/QALY and Can$5098/QALY for the DLS, knee OA and hip OA cohorts, respectively. Subgroup analysis yielded an increased ICUR for the patients with DLS who underwent decompression and fusion (Can$9870/QALY) compared with that for the patients with DLS who underwent decompression alone (Can$5045/QALY). The rank order of the ICURs by group did not change with deterministic or probabilistic sensitivity analyses. Conclusion: Lifetime ICURs for MIS procedures for DLS are similar to those for total joint replacement. Future research should adopt a societal perspective and potentially capture further economic benefits of MIS procedures.
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Affiliation(s)
- Eric J Crawford
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Crawford, Rampersaud); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Crawford, Coyte); the Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Ariz. (Ravinksy); the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); the Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); and the Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud)
| | - Robert A Ravinsky
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Crawford, Rampersaud); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Crawford, Coyte); the Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Ariz. (Ravinksy); the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); the Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); and the Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud)
| | - Peter C Coyte
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Crawford, Rampersaud); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Crawford, Coyte); the Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Ariz. (Ravinksy); the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); the Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); and the Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud)
| | - Y Raja Rampersaud
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Crawford, Rampersaud); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Crawford, Coyte); the Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Ariz. (Ravinksy); the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); the Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud); and the Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ont. (Rampersaud)
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Rowe E, Hassan E, Carlesso L, Astephen Wilson J, Gross DP, Fisher C, Hall H, Manson N, Thomas K, McIntosh G, Drew B, Rampersaud R, Macedo L. Predicting recovery after lumbar spinal stenosis surgery: A protocol for a historical cohort study using data from the Canadian Spine Outcomes Research Network (CSORN). CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:19-25. [PMID: 33987516 PMCID: PMC7942767 DOI: 10.1080/24740527.2020.1734918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Symptomatic lumbar spinal stenosis (SLSS) is a condition in which narrowing of the spinal canal results in entrapment and compression of neurovascular structures. Decompressive surgery, with or without spinal fusion, is recommended for those with severe symptoms for whom conservative management has failed. However, significant persistent pain, functional limitations, and narcotic use can affect up to one third of patients postsurgery. Aims: The aim of this study will be to identify predictors of outcomes 1-year post SLSS surgery with a focus on modifiable predictors. Methods: The Canadian Spine Outcomes Research Network (CSORN) is a large database of prospectively collected data on pre- and postsurgical outcomes among surgical patients. We include participants with a primary diagnosis of SLSS undergoing their first spine surgery. Outcomes are measured at 12 months after surgery and include back and leg pain, disability (Oswestry Disability Index, ODI), walking capacity (ODI item 4), health-related quality of life, and an overall recovery composite outcome (clinically important changes in pain, disability, and quality of life). Predictors include demographics (education level, work status, marital status, age, sex, body mass index), physical activity level, smoking status, previous conservative treatments, medication intake, depression, patient expectations, and other comorbidities. A multivariate partial least squares model is used to identify predictors of outcomes. Conclusion: Study results will inform targeted SLSS interventions, either for the selection of best candidates for surgery or the identification of targets for presurgical rehabilitation programs.
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Affiliation(s)
- Erynne Rowe
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Hassan
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Quebec, Canada
| | - Janie Astephen Wilson
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.,Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Fisher
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Neil Manson
- Canada East Spine Centre, Saint John, New Brunswick, Canada
| | - Ken Thomas
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Greg McIntosh
- Canadian Spine Society, Canadian Spine Outcomes Research Network, Toronto, Ontario, Canada
| | - Brian Drew
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Raja Rampersaud
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Cervera Irimia J, Tomé-Bermejo F, Piñera-Parrilla AR, Benito Gallo M, Bisaccia M, Fernández-González M, Villar-Pérez J, Fernández-Carreira JM, Orovio de Elizaga J, Areta-Jiménez FJ, Álvarez Galovich L, Rollo G, Caruso L, Meccariello L. Spinal fusion achieves similar two-year improvement in HRQoL as total hip and total knee replacement. A prospective, multicentric and observational study. SICOT J 2019; 5:26. [PMID: 31359861 PMCID: PMC6664676 DOI: 10.1051/sicotj/2019027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/16/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Total hip and knee arthroplasty (THA/TKA) are surgical procedures with proven benefits. Although the literature reports outcomes of fusion of the lumbar spine comparable to those of THA/TKA in general health-related quality-of-life (HRQoL) questionnaires, functional assessment is nevertheless needed for these results to be of use in clinical practice and management. Aim of our study was to prove that lumbar spinal fusion has similar if not better outcomes than THA/TKA using intervention-specific HRQoL questionnaires and functional assessment questionnaires. MATERIALS AND METHODS Observational, ambispective, multicentre study of three cohorts undergoing lumbar spinal fusion (n = 115), THA (n = 119) and TKA (n = 253). Patients were evaluated using the Short-Form-12 (SF-12), Harris-Hip-Score, Hospital for Special Surgery Scale (HSS) and Oswestry Low Back Pain Disability questionnaires. A minimum follow-up of two years was conducted. RESULTS The SF-12 showed significant improvement in all groups. The SF-12 physical component summary score indicated a more severe pre-operative status (p = 0.031) in the THA cohort. The mental component summary score indicated a less severe pre-operative status in the TKA cohort (p = 0.008) and greater post-operative improvement in the TKA and THA cohorts across follow-up (six months p = 0.021; one year p = 0.012; two years p = 0.042). Functional assessment indicated greater pre-operative disability in the THA group. At two years of follow-up, functional improvement according to the Harris, HSS and Oswestry questionnaires were 152.01%, 50.07% and 41.14% respectively. CONCLUSIONS This study demonstrates that lumbar spinal fusion and total knee and hip arthroplasty are comparable in terms of functional improvement when thoroughly studied with health, quality-of-life and functional assessment questionnaires.
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Affiliation(s)
- Javier Cervera Irimia
- Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Félix Tomé-Bermejo
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain - Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Angel R Piñera-Parrilla
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Marina Benito Gallo
- Department of Orthopaedic Surgery and Traumatology, Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400 Madrid, Spain
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delle Fratte, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | | | - Julio Villar-Pérez
- León University Health Care Centre, Campus de Vegazana, s/n, 24071 León, Spain
| | | | - Javier Orovio de Elizaga
- Catalonian General Hospital, Carrer Pedro i Pons, 1, Sant Cugat del Vallés, 08195 Barcelona, Spain
| | | | - Luis Álvarez Galovich
- Department of Spine, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Block A - V Floor, Piazzetta Muratore, 73100 Lecce, Italy
| | - Luigi Caruso
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia Hospital", S. Andrea delle Fratte, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Block A - V Floor, Piazzetta Muratore, 73100 Lecce, Italy
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7
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Burgess LC, Arundel J, Wainwright TW. The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review. Healthcare (Basel) 2019; 7:E48. [PMID: 30901875 PMCID: PMC6473918 DOI: 10.3390/healthcare7010048] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022] Open
Abstract
Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warranted.
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Affiliation(s)
- Louise C Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK.
| | - Joe Arundel
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK.
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK.
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8
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Chen HB, Chen M, Peng HH, Xu QF, Li XC, Bai B. Relationship between the benefits of paraspinal mapping and diffusion tensor imaging and the increase of decompression levels determined by conventional magnetic resonance imaging in degenerative lumbar spinal stenosis. J Orthop Surg Res 2019; 14:23. [PMID: 30670090 PMCID: PMC6341682 DOI: 10.1186/s13018-019-1065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In lumbar spinal stenosis (LSS), at most times, several levels are impaired and selecting the correct level remains a common problem for surgeons, as surgery remains invasive, and extended laminectomy may lead to secondary surgical complications. Therefore, helping to select the correct level may be useful for surgeons. The use of diffuse tensor imaging (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (MRI) may be helpful (Chen et al., J Orthop Surg Res 11:47, 2016). However, with decompression levels determined by conventional magnetic resonance imaging (MRI) increasing, whether the benefits of reducing decompression level of conventional MRI + (DTI or PM) will be more obvious is unknown. METHODS Reduced surgical levels that were different between levels determined by conventional MRI + (DTI or PM) and conventional MRI + neurogenic examination (NE) between groups were compared. Treatment outcome measures were performed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS The reduced levels of three groups showed no statistically significant differences between each other except for two levels and four levels (two levels/three levels, p = 0.085; two levels/four levels, p = 0.039; three levels/ four levels, p = 0.506, respectively). CONCLUSIONS With surgical levels determined by conventional MRI increasing, the benefits of DTI and PM will be uncertainly more obvious.
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Affiliation(s)
- Hua-Biao Chen
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China.
| | - Min Chen
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China
| | - Hong-Hui Peng
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China
| | - Qi-Feng Xu
- Department of Electromyography, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
| | - Xin-Chun Li
- Department of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
| | - Bo Bai
- Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China.,Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
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9
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Mannion AF, Impellizzeri FM, Leunig M, Jeszenszy D, Becker HJ, Haschtmann D, Preiss S, Fekete TF. EUROSPINE 2017 FULL PAPER AWARD: Time to remove our rose-tinted spectacles: a candid appraisal of the relative success of surgery in over 4500 patients with degenerative disorders of the lumbar spine, hip or knee. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:778-788. [PMID: 29460013 DOI: 10.1007/s00586-018-5469-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/06/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Studies comparing the outcome of spine surgery with that of large-joint replacement report equivocal findings. The patient-reported outcome measures (PROMs) used in such studies are typically generic and may not be sufficiently sensitive to the successes/failures of treatment. This study compared different indices of "success" in patients undergoing surgery for degenerative disorders of the lumbar spine, hip, or knee, using a validated, multidimensional, and joint-specific PROM. METHODS Preoperatively and 12 months postoperatively, 4594 patients (3937 lumbar spine, 368 hip, 269 knee) undergoing first-time surgery completed a PROM that included the Core Outcome Measures Index (COMI) for the affected joint. The latter comprises a set of single items on pain, function, symptom-specific well-being, quality of life, and disability-all in relation to the specified joint problem. Other single-item ratings of treatment success were made 12 months postoperatively. RESULTS In multiple regression analyses, controlling for confounders, the mean improvement in COMI at 12 months was greatest for the hip patients and lowest for those with degenerative spinal deformity (= the statistical reference group) (p < 0.05). Compared with spinal deformity, the odds of achieving "success" were: higher for hip (OR 4.6; 95% CI 2.5-8.5) and knee (OR 4.0; 95% CI 2.1-7.7) (no difference between spine subgroups) for "satisfaction with care"; higher for hip (OR 16.9; 95% CI 7.3-39.6), knee (OR 6.3; 95% CI 3.4-11.6), degenerative spondylolisthesis (OR 1.6; 95% CI 1.2-2.2), and herniated disc (OR 1.7; 95% CI 1.2-2.4) for "global treatment outcome"; and higher for hip (OR 13.8; 95% CI 8.8-21.6), knee (OR 5.3; 95% CI 3.6-7.8), degenerative spondylolisthesis (OR 1.6; 95% CI 1.3-2.1), and herniated disc (1.5; 95% CI 1.1-2.0) for "patient-acceptable symptom state". Patient-rated complications were the greatest in degenerative spinal deformity (29%) and the lowest in hip (18%). CONCLUSIONS The current study is the largest of its kind and the first to use a common, but joint-specific instrument to report patient-reported outcomes after surgery for degenerative disorders of the spine, hip, or knee. The findings provide a sobering account of the significantly poorer outcomes after spine surgery compared with large-joint replacement. Further work is required to hone the indications and patient selection criteria for spine surgery. The data should be used to lobby research funding-bodies, governmental agencies, industry, and charitable foundations to invest more in spine research/registries, in the hope of ultimately improving spine outcomes. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Franco M Impellizzeri
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Michael Leunig
- Department of Hip and Knee Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dezsö Jeszenszy
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Hans-Jürgen Becker
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Stefan Preiss
- Department of Hip and Knee Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamas F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Murphy ME, Maloney PR, McCutcheon BA, Rinaldo L, Shepherd D, Kerezoudis P, Gilder H, Ubl DS, Crowson CS, Freedman BA, Habermann EB, Bydon M. Predictors of Discharge to a Nonhome Facility in Patients Undergoing Lumbar Decompression Without Fusion for Degenerative Spine Disease. Neurosurgery 2017; 81:638-649. [DOI: 10.1093/neuros/nyx057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 01/25/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Patients recovering from decompressive laminectomy without fusion may require assistance with activities of daily living and physical/occupational therapy upon hospital discharge.
OBJECTIVE
To examine comorbidities and perioperative characteristics of patients undergoing lumbar decompression for associations with discharge status using a multicenter database.
METHODS
A multicenter database was used for this retrospective cohort analysis. Patients admitted from home with degenerative spine disease for lumbar decompression without fusion were included. Thirty-day outcomes and operative characteristics were compared as a function of patient discharge using chi-square and Wilcoxon Rank Sum tests. Multivariable logistic regression was used to determine factors associated with discharge to a nonhome facility.
RESULTS
Of the 8627 patients included for analysis, 9.7% were discharged to a nonhome facility. On multivariable analysis, age (85+ vs <65, odds ratio [OR] 13.59), number of levels of decompression (3+ vs 1, OR 1.75), African American race vs Non-Hispanic or Hispanic White (OR 1.87), female vs male gender (OR 1.97), body mass index (BMI) (40+ vs 18.5-24.9, OR 1.74), American Society of Anesthesiologists physical classification status (4 vs 1 or 2, OR 2.35), hypertension (OR 1.29), dependent functional status (OR 3.92), diabetes (OR 1.47), smoking (OR 1.40), hematocrit (<35 vs 35+, OR 1.76), international normalized ratio (≥1.3 vs <1.3, OR 2.32), and operative time (3+ h vs <1 h, OR 5.34) were significantly associated with an increased odds of discharge to nonhome facilities.
CONCLUSION
Preoperative status and operative course variables can influence discharge disposition in lumbar decompression patients. Identifying specific factors that contribute to a greater likelihood of dismissal to skilled facility or rehabilitation unit can further inform both surgeons and patients during preoperative counseling and disposition planning.
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Affiliation(s)
- Meghan E. Murphy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Lorenzo Rinaldo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Shepherd
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Hannah Gilder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel S. Ubl
- De-partment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cynthia S. Crowson
- De-partment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Lange T, Rataj E, Kopkow C, Lützner J, Günther KP, Schmitt J. Outcome Assessment in Total Knee Arthroplasty: A Systematic Review and Critical Appraisal. J Arthroplasty 2017; 32:653-665.e1. [PMID: 28341034 DOI: 10.1016/j.arth.2016.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. METHODS Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. RESULTS This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. CONCLUSION More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.
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Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Risk Factors for Reoperation in Patients Treated Surgically for Lumbar Stenosis: A Subanalysis of the 8-year Data From the SPORT Trial. Spine (Phila Pa 1976) 2016; 41:901-9. [PMID: 26656062 PMCID: PMC5521164 DOI: 10.1097/brs.0000000000001361] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective subgroup analysis was performed on surgically treated patients from the lumbar spinal stenosis (SpS) arm of the Spine Patient Outcomes Research Trial (SPORT), randomized, and observational cohorts. OBJECTIVE To identify risk factors for reoperation in patients treated surgically for SpS and compare outcomes between patients who underwent reoperation with those who did not. SUMMARY OF BACKGROUND DATA SpS is one of the most common indications for surgery in the elderly; however, few long-term studies have identified risk factors for reoperation. METHODS A post-hoc subgroup analysis was performed on patients from the SpS arm of the SPORT, randomized and observational cohorts. Baseline characteristics were analyzed between reoperation and no-reoperation groups using univariate and multivariate analysis on data 8 years postoperation. RESULTS Of the 417 study patients, 88% underwent decompression only, 5% noninstrumented fusion, and 6% instrumented fusion. At the 8-year follow-up, the reoperation rate was 18%; 52% of reoperations were for recurrent stenosis or progressive spondylolisthesis, 25% for complication or other reason, and 16% for new condition. Of patients who underwent a reoperation, 42% did so within 2 years, 70% within 4 years, and 84% within 6 years. Patients who underwent reoperation were less likely to have presented with any neurological deficit (43% reop vs. 57% no reop, P = 0.04). Patients improved less at follow-up in the reoperation group (P < 0.001). CONCLUSION In patients undergoing surgical treatment for SpS, the reoperation rate at 8-year follow-up was 18%. Patients with a reoperation were less likely to have a baseline neurological deficit. Patients who did not undergo reoperation had better patient reported outcomes at 8-year follow-up compared with those who had repeat surgery. LEVEL OF EVIDENCE 2.
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Abraham P, Rennert RC, Martin JR, Ciacci J, Taylor W, Resnick D, Kasper E, Chen CC. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials. Surg Neurol Int 2016; 7:38. [PMID: 27127703 PMCID: PMC4838923 DOI: 10.4103/2152-7806.180297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 12/17/2022] Open
Abstract
Low back pain (LBP) is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.
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Affiliation(s)
- Peter Abraham
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Joel R Martin
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Joseph Ciacci
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - William Taylor
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
| | - Daniel Resnick
- Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
| | - Ekkehard Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA, USA
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Abstract
STUDY DESIGN A longitudinal cohort. OBJECTIVE The aim of this study was to determine the extent of health care resource utilization decrease 2 years after lumbar spinal fusion. SUMMARY OF BACKGROUND DATA Despite the assumption that surgery will minimize the need for ongoing nonsurgical treatment, the impact of lumbar fusion on subsequent health care resource utilization has not been effectively studied. METHODS Patients who had continuous coverage by a major insurer during the year before decompression and posterolateral instrumented spinal fusion, and the 2 and a half years following were identified. All charges processed during this time-period were collected. Charges associated with the index surgery, the 90-day postoperative period, and those unrelated to spinal care were excluded. Associations with Oswestry Disability Index (ODI) score improvement at 2 years after surgery and health care resource utilization were determined. RESULTS Sixty-six patients were included in the analysis. The mean age was 59 years and 39% were males. There was a decrease in health care utilization costs 1 year after surgery ($3267.59) compared with pre-op ($4246.32), but this was not statistically significant (P = 0.197). There was a statistically significant decrease in costs during the second year after surgery ($1420.97) compared with either pre-op (P = 0.000) or 1-year costs (P = 0.001). No statistically significant correlations could be found between change in ODI scores and costs incurred at either year post-op. CONCLUSION Health care utilization decreased at 1 year and significantly at 2 years after lumbar fusion. However, there was no correlation between use of nonsurgical resources and clinical outcome based on ODI scores. This raises the question as to whether these resources were used in a rational manner. This cooperative study between a major insurer and a tertiary spine center provides improved insight into the cost profile of lumbar fusion surgery. Further study is needed to determine whether ongoing post-op treatment is necessary or simply established practice. LEVEL OF EVIDENCE 2.
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15
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Missios S, Bekelis K. Hospitalization cost after spine surgery in the United States of America. J Clin Neurosci 2015; 22:1632-7. [DOI: 10.1016/j.jocn.2015.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
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