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Tang Y, Chen C, Jiang J, Zhou L. Predictors of return to work after spinal surgery : systematic review and Meta-analysis. J Orthop Surg Res 2024; 19:504. [PMID: 39182145 PMCID: PMC11344388 DOI: 10.1186/s13018-024-04988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE To analyze the situation and influencing factors of patients returning to work after spinal surgery, and to provide reference for clinical intervention measures of patients returning to work after spinal surgery. METHODS A computer search was conducted in Chinese and English database on the situation and influencing factors of patients returning to work after spinal surgery from the establishment of the database to February 2023. Meta-analysis was performed using RevMan 5.3 and StataMP 17.0 software. RESULTS A total of 10 literatures were included, involving 11,548 subjects. Meta-analysis results showed that 58% of patients returned to work after spinal surgery [95%CI (0.47-0.69)]. Gender [OR = 2.41, 95%CI (1.58-3.37)], age [OR = 1.32, 95%CI (1.03-1.51)], job nature [OR = 5.94, 95%CI (3.54-9.62)], education level [OR = 0.23, 95%CI (0.06-0.48)], fear of disease progression [OR = 0.82, 95%CI (0.84-0.95)], and social support [OR = 1.21, 95%CI (1.12-1.37)] were the influencing factors for patients returning to work after spinal surgery. CONCLUSION The rate of patients returning to work after spinal surgery is low, and is affected by many factors. Medical personnel should pay comprehensive attention to the above high-risk groups and give timely intervention and support.
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Affiliation(s)
- Yong Tang
- Department of Orthopedics, Affiliated People's Hospital of Ningbo University,Ningbo, zhejiang, China.
| | - Changwei Chen
- Department of Orthopedics, Affiliated People's Hospital of Ningbo University,Ningbo, zhejiang, China
| | - Jihong Jiang
- Department of Orthopedics, Affiliated People's Hospital of Ningbo University,Ningbo, zhejiang, China
| | - Lei Zhou
- Department of Orthopedics, Affiliated People's Hospital of Ningbo University,Ningbo, zhejiang, China
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Kilinc F, Setzer M, Prinz V, Jussen D, Marquardt G, Gessler F, Czabanka M, Freiman T, Dubinski D, Won SY, Haberland M, Behmanesh B. The Beneficial Effect of Preoperative Exercise on Postoperative Clinical Outcome, Quality of Life and Return to Work after Microsurgical Resection of Spinal Meningiomas. J Clin Med 2023; 12:jcm12082804. [PMID: 37109141 PMCID: PMC10146916 DOI: 10.3390/jcm12082804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE While outcomes of surgical treatment for spinal meningiomas are well-described within the literature, factors affecting early return to work as well as long-term health related quality of life remain unclear. METHODS In this retrospective study, patients with spinal meningioma and surgical treatment from two university-level neurosurgical institutions between 2008 and 2021 were analyzed. Time to return to work, physical activities and long-term health related quality of life (assessed by telephone interviews using the EQ-5D-5L health status measure and visual analogue scale (EQ VAS) were analyzed. RESULTS We identified a total of 196 patients who underwent microsurgical resection of spinal meningioma between January 2008 and December 2021. Of those, 130 patients of working age were included and analyzed. The median follow-up time was 96 months. All included patients returned to work. The median time of return to work was 45 days for the whole cohort. Patients who preoperatively performed physical activity returned to work significantly earlier compared to patients who did not (p < 0.001). Furthermore, younger age (p = 0.033) and absence of obesity (p = 0.023) correlated significantly with earlier return to work. Significant differences were also observed in all 5 EQ-5D-5L dimensions between patients with and without preoperative physical activity. CONCLUSIONS Despite the benign nature of spinal meningioma preoperative physical activity and physiological body weight are associated with favorable postoperative outcome, higher quality of life and early return to work.
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Affiliation(s)
- Fatma Kilinc
- Department of Neurosurgery, University Hospital Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Daniel Jussen
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Thomas Freiman
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Moritz Haberland
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
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Tufo T, Grande E, Bevacqua G, Di Muccio I, Cioni B, Meglio M, Ciavarro M. Long-term quality of life and functional outcomes in adults surgically treated for intramedullary spinal cord tumor. Front Psychol 2023; 14:1136223. [PMID: 37151327 PMCID: PMC10159049 DOI: 10.3389/fpsyg.2023.1136223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Intramedullary spinal cord tumors (IMSCTs) are rare but clinically significant entities that may cause severe neurological decline with progressive pain and motor or sensory deterioration. Beyond the beneficial effects of surgical treatment and the long-term progression-free survival, neurological deficits may still persist after surgery, and information about the long-term patients' health-related quality of life (QoL) is still lacking. In this study, we investigate the patients' health perception 15 years after the surgery in an overall patients' wellbeing framework. Methods Patients surgically treated for IMSCT over a period from 1996 to 2011 were selected. After a mean of 15 years from the surgery, patient's self-administered questionnaire on disability, pain, sleep quality, and QoL was collected and neurological postoperative evaluation at the chronic stage was reexamined. Results Neurological deficits are reported in half of the patients in the postoperative chronic phase. After 15 years of surgery, half of the patients still report mild or severe disability grades associated with significantly higher pain and poor sleep and QoL. In accordance, the neurological condition measured at the chronic stage is significantly related not only to disease-specific symptoms (i.e., pain) but even to sleep quality complaints and poor QoL, measured at 15 years follow-up. Conclusions Health-related QoL is an important secondary outcome in patients. Although the progression-free survival, worse postoperative neurological conditions could predict long-term sequelae reflecting patients' poor health perception. It suggests the importance of preserving patients' functional status and globally evaluating patients' wellbeing to handle disease-specific symptoms but even more general aspects of QoL.
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Affiliation(s)
- Tommaso Tufo
- Department of Neuroscience, Neurosurgery Institute, Policlinico A. Gemelli Foundation University Hospital I.R.C.C.S., Catholic University of the Sacred Heart, Rome, Italy
- Neurosurgery Unit, Fakeeh University Hospital, Dubai, United Arab Emirates
| | - Eleonora Grande
- Department of Neuroscience, Neurosurgery Institute, Policlinico A. Gemelli Foundation University Hospital I.R.C.C.S., Catholic University of the Sacred Heart, Rome, Italy
| | | | - Ines Di Muccio
- Department of Neurosurgery, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Beatrice Cioni
- Department of Neuroscience, Neurosurgery Institute, Policlinico A. Gemelli Foundation University Hospital I.R.C.C.S., Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Meglio
- Section of Neurosurgery, Department of Neurosciences Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - Marco Ciavarro
- I.R.C.C.S. Neuromed, Pozzilli, IS, Italy
- *Correspondence: Marco Ciavarro
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Hijikata Y, Ueda S, Yasuhara T, Umebayashi D, Endo T, Takami T, Mizuno M, Hida K, Hoshimaru M. Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan. Neurospine 2022; 19:1122-1129. [PMID: 36597646 PMCID: PMC9816577 DOI: 10.14245/ns.2244686.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs. METHODS The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts. RESULTS Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas. CONCLUSION A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.
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Affiliation(s)
- Yasukazu Hijikata
- Spine and Low Back Pain Center, Kitasuma Hospital, Kobe, Japan,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Corresponding Author Yasukazu Hijikata Spine and Low Back Pain Center, Kitasuma Hospital, 1-1, 1 Cho-me, Higashishirakawadai, Sma-ku, Kobe 654-0102, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Daisuke Umebayashi
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masaki Mizuno
- Department of Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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Skrap B, Tramontano V, Faccioli F, Meglio M, Pinna G, Sala F. Surgery for intramedullary spinal cord ependymomas in the neuromonitoring era: results from a consecutive series of 100 patients. J Neurosurg Spine 2022; 36:858-868. [PMID: 34891138 DOI: 10.3171/2021.7.spine21148] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The established treatment of intramedullary spinal cord ependymomas (ISCEs) is resection. Surgical series reporting treatment results often lack homogeneity, as these are collected over long time spans and their analysis is plagued by surgical learning curves and inconsistent use of intraoperative neurophysiological monitoring (IONM). The authors report the oncological and functional long-term outcomes in a modern series of 100 consecutive ISCEs that were resected between 2000 and 2015 by a surgically experienced team that consistently utilized IONM. METHODS In this retrospective study, the authors tailored surgical strategy and multimodal IONM, including somatosensory evoked potentials, muscle motor evoked potentials (mMEPs), and D-waves, with the aim of gross-total resection (GTR). Preservation of the D-wave was the primary objective, and preservation of mMEPs was the second functional objective. Functional status was evaluated using the modified McCormick Scale (MMS) preoperatively, postoperatively, and at follow-up. RESULTS Preoperatively, 89 patients were functionally independent (MMS grade I or II). A GTR was achieved in 89 patients, 10 patients had a stable residual, and 1 patient underwent reoperation for tumor progression. At a mean follow-up of 65.4 months, 82 patients were functionally independent, and 11 lost their functional independence after surgery (MMS grades III-V). Muscle MEP loss predicted short-term postoperative worsening (p < 0.0001) only, while the strongest predictors of a good functional long-term outcome were lower preoperative MMS grades (p < 0.0001) and D-wave preservation. D-wave monitorability was 67%; it was higher with lower preoperative MMS grades and predicted a better recovery (p = 0.01). CONCLUSIONS In this large series of ISCEs, a high rate of GTR and long-term favorable functional outcome were achieved. Short- and long-term functional outcomes were best reflected by mMEPs and D-wave monitoring, respectively.
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Affiliation(s)
- Benjamin Skrap
- 1Section of Neurosurgery, Department of Neurosciences Biomedicine and Movement Sciences, University Hospital, Verona
- 3Institute of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Vincenzo Tramontano
- 1Section of Neurosurgery, Department of Neurosciences Biomedicine and Movement Sciences, University Hospital, Verona
| | - Franco Faccioli
- 2Institute of Neurosurgery, University Hospital, Verona; and
| | - Mario Meglio
- 1Section of Neurosurgery, Department of Neurosciences Biomedicine and Movement Sciences, University Hospital, Verona
| | | | - Francesco Sala
- 1Section of Neurosurgery, Department of Neurosciences Biomedicine and Movement Sciences, University Hospital, Verona
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Butenschoen VM, Gloßner T, Hostettler IC, Meyer B, Wostrack M. Quality of life and return to work and sports after spinal ependymoma resection. Sci Rep 2022; 12:4926. [PMID: 35322104 PMCID: PMC8943200 DOI: 10.1038/s41598-022-09036-9] [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] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Till Gloßner
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Isabel C Hostettler
- Department of Neurosurgery, Kantonspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
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Fei X, Jia W, Gao H, Yang C, Li D, Qian Z, Han B, Wang D, Xu Y. Clinical characteristics and surgical outcomes of ependymomas in the upper cervical spinal cord: a single-center experience of 155 consecutive patients. Neurosurg Rev 2020; 44:1665-1673. [PMID: 32767042 DOI: 10.1007/s10143-020-01363-7] [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: 05/19/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
Ependymomas occurring in the upper cervical spinal cord (above the level of the C4 segment) are rare entities with great therapeutic challenges. This study was aimed to investigate the clinicoradiological characteristics and the prognosis in a large cohort of upper cervical ependymomas from a single institution. This retrospective study enrolled 155 patients with primary ependymomas in the upper cervical spinal cord. The pre- and post-operative clinical and magnetic resonance imaging profiles were collected. The neurological outcomes and survival events were evaluated, and potential independent risk factors were analyzed. There were 82 females and 73 males, with an average age of 43.1 ± 11.3 years. Immediately post-operatively, 118 (76.1%) patients experienced neurological deterioration and 32 (20.7%) patients remained unchanged. Three months after surgery, 61 (39.4%) patients showed deteriorated neurological functions compared to the pre-operative baseline levels. After an average follow-up period of 56.0 ± 24.7 months, the neurological functions were worse than the baseline status in 37 (23.9%) patients and improved in 33 (21.3%) patients, respectively. Logistic regression analysis identified that lower age (≤ 42 years) and lower pre-operative MMS (I-II) were independent protective factors for predicting favorable neurological functions. Multivariate Cox regression analysis revealed that incomplete resection was the only independent risk factor associated with a shorter progression-free survival. Age and pre-operative functional status affect the long-term neurological outcomes, and incomplete resection was associated with a shorter survival. Our findings indicate that gross total resection should be the goal of surgical treatment of upper cervical ependymomas.
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Affiliation(s)
- Xiaobin Fei
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China.,Department of Neurosurgery, The Affiliated Jiangyin People's Hospital of Southeast University Medical College, Wuxi, 214400, Jiangsu, China
| | - Wenqing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin People's Hospital of Southeast University Medical College, Wuxi, 214400, Jiangsu, China
| | - Chenlong Yang
- Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China
| | - Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China
| | - Bo Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China
| | - Dejiang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China
| | - Yulun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China.
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