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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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Past-month Pain and Cognitive-affective Smoking Processes Among Daily Smokers. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yarlas A, Miller K, Wen W, Lynch SY, Munera C, Dain B, Pergolizzi JV, Raffa R, Ripa SR. A Subgroup Analysis Found no Diminished Response to Buprenorphine Transdermal System Treatment for Chronic Low Back Pain Patients Classified with Depression. Pain Pract 2015; 16:473-85. [PMID: 25865734 DOI: 10.1111/papr.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/22/2014] [Accepted: 02/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic pain (CP) patients with depression typically exhibit worse post-treatment outcomes than nondepressed CP patients. The cause is often assumed to reflect a differential response to treatment, neglecting other potential explanations, such as the continuation of differences in pretreatment outcomes. This post hoc analysis examines whether worse post-treatment outcomes for depressed patients with chronic low back pain (CLBP) are driven by reduced treatment efficacy. METHODS Data were from opioid-naïve adult patients with moderate-to-severe CLBP who participated in a randomized, placebo-controlled, double-blind clinical trial of Butrans(®) (buprenorphine) Transdermal System (BTDS) for pain relief. Depression screening was based on baseline SF-36v2 Mental Health subscale scores. Patient-reported measures of pain severity, pain interference, quality of life, sleep problems, and functional disability were administered at screening and during the study. Differential treatment efficacy for each outcome was examined using analysis of covariance models that included interaction terms between treatment arm and depression status. RESULTS At baseline, patients classified as depressed showed greater pain interference, lower quality of life, more sleep problems, and greater functional disability than nondepressed patients; the two groups did not differ in pain severity. No statistically significant interactions between treatment arm and depression status were observed. The direction of improvement post-treatment favored the depressed group on nine of seventeen outcomes. CONCLUSIONS Results do not support a differential response to BTDS treatment between depressed and nondepressed CLBP patients across a variety of patient-reported outcomes. These findings raise the question of whether depressed mood actually moderates the effectiveness of treatment in CP patients.
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Affiliation(s)
| | | | - Warren Wen
- Purdue Pharma LP, Stamford, Connecticut, U.S.A
| | | | | | | | - Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, U.S.A.,Department of Anesthesiology, Georgetown University School of Medicine, Washington, District of Columbia, U.S.A.,Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Robert Raffa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania, U.S.A
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The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. 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 2013; 23:129-34. [PMID: 23880866 DOI: 10.1007/s00586-013-2896-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 06/20/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prevalence of depressive symptoms and disability pre-operatively, at 3 months and at 1 year after lumbar spine fusion surgery. METHODS Data was extracted from a dedicated lumbar spine fusion register, giving 232 patients (mean age 62 years, 158 females) who had undergone instrumented lumbar spine fusion. The frequency of depressive symptoms and disability was evaluated using the Depression Scale (DEPS) and Oswestry Disability Index (ODI). RESULTS Depressive symptoms were found in 34, 13, and 15 % of the patients pre-operatively, at 3 months and at 1 year after surgery, respectively. The mean DEPS score decreased from 16.2 to 8.6 (p < 0.001) in patients who had depressive symptoms pre-operatively, and from 6.1 to 3.8 (p < 0.001) in those patients without pre-operative depressive symptoms. The mean ODI values pre-operatively, at 3 months and at 1 year after surgery were 53, 30, and 23, respectively, in patients with pre-operative depressive symptoms and 41, 23, and 20 in those patients without pre-operative depressive symptoms. The differences between the groups were statistically significant at all time points (p < 0.001). CONCLUSIONS One-third of our patients with chronic back pain undergoing spinal fusion had depressive symptoms pre-operatively. The prevalence of depressive symptoms decreased after surgery. Although disability remained higher in those patients who had reported depressive symptoms pre-operatively, disability did decrease significantly in both groups post-operatively. Thus, there is no need to exclude depressive patients from operation, but screening measures and appropriate treatment practises throughout both pre-operative and post-operative periods are encouraged.
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Quality of life and sociodemographic data in patients after spine surgery. Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull 2012; 137:1065-93. [PMID: 21967450 DOI: 10.1037/a0025544] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Texas A&M University, College Station, USA.
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Instrumented posterior lumbar fusion outcomes for lumbar degenerative disorders in a southern European, semirural population. ACTA ACUST UNITED AC 2011; 23:444-50. [PMID: 20921872 DOI: 10.1097/bsd.0b013e3181c9828e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective, clinical study. OBJECTIVE This study compares the preoperative and postoperative status of patients with degenerative lumbar spine disorders, who underwent instrumented posterior lumbar fusion (IPLF), from the functional, economic and psychologic perspectives in a semirural population. SUMMARY OF BACKGROUND DATA IPLF is a common procedure in the treatment of a more common disorder, lumbar spine degeneration. It has been postulated that both the disorder and the surgical procedure may affect many aspects of patients' life. METHODS During a 2 years period, 46 patients underwent IPLF for degenerative disorders of the lumbar spine. The surgical procedure included posterior decompression of the affected segment(s) and stabilization by means of pedicle screws and rods in every case, and interbody implants in selected cases. The outcome measures included the Greek versions of (a) Visual Analogue Scale (VAS) for pain assessment, (b) Oswestry Disability Index (ODI) for back-related disability, (c) Prolo Scale for the functional and economic status and (d) Zung Depression Scale to screen for depression. Measurements were taken 1-week preoperatively, and 3 years after the procedure. The comparison of the preoperative and postoperative results was done using the paired-samples t test. RESULTS Thirty-nine patients (25 females, 14 males) with a mean age of 59 years were eligible for our study. Half of them worked in the agricultural sector. All developed solid, lumbar fusions. Instrumented posterior lumbar fusion decreased patient's somatic pain, as shown by the VAS (P<0.001) and improved function as indicated by the ODI (P<0.001), and allowed return to work (P<0.001). Nevertheless, the Zung Depression Scale revealed that the incidence of depression increased postoperatively (P<0.001). CONCLUSIONS IPLF in the treatment of degenerative disorders of the lumbar spine improves function and promotes the patients' complete or partial return to work. In contrast, degenerative lumbar spine disorders are chronic conditions and may negatively affect patients' psychology.
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Abstract
Symptomatic lumbar degenerative disk disease, or discogenic back pain, is difficult to treat. Patients often report transverse low back pain that radiates into the sacroiliac joints. Radicular or claudicatory symptoms are generally absent unless there is concomitant nerve compression. Physical examination findings are often unremarkable. Radiographic examination may reveal disk space narrowing, end-plate sclerosis, or vacuum phenomenon in the disk; magnetic resonance imaging is useful for revealing hydration of the disk, annular bulging, or lumbar spine end-plate (Modic) changes in the adjacent vertebral bodies. The use of diskography as a confirmatory study remains controversial. Recent prospective, randomized trials and meta-analyses of the literature have helped expand what is known about degenerative disk disease. In most patients with low back pain, symptoms resolve without surgical intervention; physical therapy and nonsteroidal anti-inflammatory drugs are the cornerstones of nonsurgical treatment. Intradiskal electrothermal treatment has not been shown to be effective, and arthrodesis remains controversial for the treatment of discogenic back pain. Nucleus replacement and motion-sparing technology are too new to have demonstrated long-term data regarding their efficacy.
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Badura-Brzoza K, Matysiakiewicz J, Piegza M, Rycerski W, Hese RT. Sense of coherence in patients after limb amputation and in patients after spine surgery. Int J Psychiatry Clin Pract 2008; 12:41-7. [PMID: 24916496 DOI: 10.1080/13651500701435947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective. To assess the score of SOC (sense of coherence), BDI (Beck Depression Scale), STAI ( State and Trait Anxiety Inventory) in three examined groups and correlation of SOC score with sociodemographic data, anxiety and depression. Methods. The SOC, BDI, STAI questionnaires were given to 51 patients after limb amputation, 65 patients after vertebral surgery because of chronic back pain and 40 persons in the control group. Results. Patients after limb amputation achieved the same level of SOC score as the control group. Patients who had higher results on the SOC score rarely suffered from phantom pain. Patients after spine surgery had a lower level on the SOC score than the control group. A lower score of SOC was observed in older, unemployed, poorer educated, subjects taking medicine, who did not report improvement after operation. Patients after limb amputation and patients after spinal surgery were more depressed and anxious than healthy people. Conclusion. Patients with higher SOC results, in both examined groups, were less depressed and anxious.
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Affiliation(s)
- Karina Badura-Brzoza
- Chair and Department of Psychiatry in Tarnowskie Góry, Medical University of Silesia, Katowice, Poland
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Slover J, Abdu WA, Hanscom B, Weinstein JN. The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery. Spine (Phila Pa 1976) 2006; 31:1974-80. [PMID: 16924216 DOI: 10.1097/01.brs.0000229252.30903.b9] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is an observational study of 3482 patients undergoing lumbar spine surgery from the National Spine Network. OBJECTIVES To explore the influence of medical and psychosocial comorbidities on the change in Short-form 36 (SF-36) general health survey and condition-specific Oswestry Disability Index (ODI) scores in patients undergoing lumbar spine surgery. SUMMARY OF BACKGROUND DATA It remains unclear as to which type of health instrument is more appropriate for monitoring improvement in patients who undergo lumbar spine surgery. Most clinicians would suspect that comorbidities (medical and psychosocial) play a significant role in the outcome of spine patients. Yet, it has been difficult to quantify specifically the impact of comorbidities on the responsiveness of traditional health status instruments for spine patients. METHODS Analysis of variance was performed to assess the difference in the change in survey scores across comorbidity groups for the population of National Spine Network patients who had undergone lumbar spine surgical intervention and completed 3-month and 1-year follow-up surveys. Multiple linear regressions were used to identify the most influential individual comorbidities on the change scores. RESULTS Comorbidities had a significant impact on the change in scores at 3 months and 1 year. The average change in bodily pain, physical function, physical component summary scores of the SF-36, as well as ODI scores decreased in response to surgery as the number of comorbidities increased. Psychosocial comorbidities such as an active compensation case, self-rated poor health, and smoking exerted large effects on the change in survey scores after surgery (P < 0.003). Medical disorders such as headaches, depression, and nervous system disorders were also highly influential (P < 0.05). CONCLUSIONS The negative impact of medical and psychosocial comorbidities on the change in SF-36 general health survey and condition-specific ODI scores, despite spine surgery, highlights the need for researchers and clinicians to consider these comorbidities when using these, and perhaps all, health survey instruments and interpreting these scores after surgery. Contrary to current assumptions regarding condition-specific health surveys, medical and psychosocial comorbidities similarly affect the generic SF-36 and condition-specific ODI. Further studiesare needed to determine if spine surgery outcomes can be improved by specifically addressing potentially modifiable comorbidities, which negatively impact survey scores, or whether comorbidity burden should play a role in the selection process for surgical intervention. Failure to incorporate consideration of medical and psychosocial comorbidities into preoperative discussions can be a failure to allow our patients (and ourselves) to have realistic expectations and, consequently, the best possible outcome from their treatment choice.
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Affiliation(s)
- James Slover
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Mariconda M, Galasso O, Imbimbo L, Lotti G, Milano C. Relationship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. 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 2006; 16:255-66. [PMID: 16835739 PMCID: PMC2200682 DOI: 10.1007/s00586-005-0036-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 09/06/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
Although the effect of physical workload on the occurrence of low back pain (LBP) has been extensively investigated, few quantitative studies have examined the morphological changes visualized via magnetic resonance imaging (MRI) in relation to occupational variables. The relationship between the severity of some abnormalities such as lumbar spinal stenosis or spondylolisthesis and physical or psychosocial occupational risk factors has not been investigated previously. In this cross-sectional study patients fulfilled the following inclusion criteria: (1) long-standing (minimum 1-year) LBP radiating down the leg (or not); (2) age more than 40 years; (3) willingness to undergo an MRI of the lumbar spine; and (4) ability to speak Italian. Primary objective of the study was to investigate the association between occupational exposure and morphological MRI findings, while controlling for the individual risk factors for LBP. Secondarily, we looked at the influence of this exposure and the degenerative changes in the lumbar spine on clinical symptoms and the related disability. Lumbar MRI scans from 120 symptomatic patients were supplemented by the results of structured interviews, which provided personal, medical, and occupational histories. All occupational factors were arranged on scales of increasing exposure, whereas pain and disability were assessed using ad hoc validated questionnaires. Evidence of intervertebral disc narrowing or herniation and the occurrence and severity of spinal stenosis and spondylolisthesis was obtained from the MRI scans and a summative degenerative score was then calculated. We detected a direct association between increasing age and the global amount of degenerative change, the severity of intervertebral disc height loss, the number of narrowed discs, stenosis, the number of stenotic levels, and spondylolisthesis. Physical occupational exposure was not associated with the presence of lumbar disc degeneration and narrowing per se, but a higher degree of such an exposure was directly associated with a higher degree of degeneration (P=0.017). Spondylolistesis and stenosis were positively related to heavy workload (P=0.014) and the manual handling of materials (P=0.023), respectively. Psychosocial occupational discomfort was directly associated to stenosis (P=0.041) and number of stenotic levels (P=0.019). A heavier job workload was the only occupational factor positively related to the degree of disability at the multivariate analysis (P=0.002). Total amount of degeneration in the lumbar spine directly influenced pain duration (P=0.011) and degree of disability (P=0.050). These results suggest that caution should be exercised when symptomatic subjects with evidence of degenerative changes on MRI scans engage in strenuous physical labor.
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Fritzell P, Strömqvist B, Hägg O. A practical approach to spine registers in Europe: the Swedish experience. 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 2005; 15 Suppl 1:S57-63. [PMID: 16328224 PMCID: PMC3454551 DOI: 10.1007/s00586-005-1051-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 10/23/2005] [Indexed: 11/26/2022]
Abstract
Today there is growing awareness among spine surgeons of the advantages in using registers to facilitate the analyses and reporting of treatment outcome. The Swedish Spine register is among the first to be used on a national scale and annual reports are published in international journals. In this paper we discuss our experiences and lessons learned from a paper-based version in 1993, to an online web-based solution in 2005. We emphasise the advantages of registers being owned by the national spine society, a support function available during working hours, online feedback to participating departments and professional assistance in designing a register program for web use. Hopefully, our experiences will be of help to colleagues who are planning to start registering.
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Affiliation(s)
- Peter Fritzell
- Department of Orthopaedics, Centre for Clinical Research Dalarna, Falun Hospital, 79182 Falun, Sweden.
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Bertagnoli R, Yue JJ, Shah RV, Nanieva R, Pfeiffer F, Fenk-Mayer A, Kershaw T, Husted DS. The treatment of disabling single-level lumbar discogenic low back pain with total disc arthroplasty utilizing the Prodisc prosthesis: a prospective study with 2-year minimum follow-up. Spine (Phila Pa 1976) 2005; 30:2230-6. [PMID: 16205353 DOI: 10.1097/01.brs.0000182217.87660.40] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [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, longitudinal minimum 2-year follow-up. OBJECTIVE To assess the efficacy and safety of the Prodisc implant in patients with disabling single-level discogenic low back pain (LBP). SUMMARY OF BACKGROUND DATA The treatment of debilitating discogenic LBP has been controversial and varied. To date, a longitudinal prospective study of the treatment of single-level incapacitating discogenic LBP using the Prodisc total disc arthroplasty technique has not been described. METHODS A prospective analysis was performed on 118 patients treated with single-level lumbar Prodisc total disc arthroplasty. Patients 18 to 60 years of age with disabling and recalcitrant discogenic LBP with or without radicular pain secondary to single-level discogenic LBP from L3 to S1 were included. Patients were assessed before surgery, and outcome measurements were after surgery administered at 3, 6, 12, and 24 months. RESULTS A total of 104 patients (88%) fulfilled all follow-up criteria. The median age of all patients was 47 years (range, 36-60 years). Statistical improvements in VAS, Oswestry, and patient satisfaction scores occurred 3 months postoperatively. These improvements were maintained at the 24-month follow-up. Radicular pain also decreased significantly. Full-time and part-time work rates increased from 10% to 35% and 3% to 24%, respectively. No additional fusion surgeries were necessary either at the affected or unaffected levels. Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.001) and an affected disc motion from 3 degrees to 7 degrees (P < 0.004). CONCLUSIONS Single-level Prodisc lumbar total disc arthroplasty is a safe and efficacious treatment method for debilitating lumbar discogenic LBP. Significant improvements in patient satisfaction and disability scores occurred after surgery by 3 months and were maintained at the 2-year follow-up. No device-related complications occurred. Patients with severe to moderate disc height loss as well as those with symptomatic posterior anular defects with minimal disc height loss achieve functional gains and significant pain relief. Careful and appropriate patient selection is essential in ensuring optimal surgical outcomes.
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Kara B, Tulum Z, Acar U. Functional results and the risk factors of reoperations after lumbar disc surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:43-8. [PMID: 15490256 PMCID: PMC3476671 DOI: 10.1007/s00586-004-0695-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Revised: 02/19/2004] [Accepted: 02/21/2004] [Indexed: 02/05/2023]
Abstract
Factors such as driving motor vehicles, sedentary occupations, vibration, smoking, previous full-term pregnancies, physical inactivity, increased body mass index (BMI), and a tall stature are associated with symptomatic disc herniations. Fitness and strength is postulated to protect an individual from disc rupture. The objective of our study was to determine the pain levels and differences of functional and economic situations of patients who had undergone one or more than one operation due to lumbar disc herniation and to put forward the effect of risk factors that may be potential, especially from the aspect of undergoing reoperation. Patients who had undergone one (n=46) or more than one operation (n=34) due to lumbar disc herniation were included in the study. It was a prospective study with evaluation on the day the patients were discharged and at second and sixth months after lumbar disc operation. The Oswestry Disability Index (ODI) was used in determining the functional disability associated with back pain; the Prolo Functional Economic Rating Scale (Prolo scale) was used in determining the effect of back pain on functional and economic situations. In the ODI measurements made in the postoperative second and sixth months, significant differences appeared in favor of patients who had undergone one operation (p<0.05). According to the Prolo scale, it was found that the economic situation was better in the sixth month and the functional situation was better in the second and sixth months in patients having undergone one operation (p<0.05). The logistic regression analysis demonstrated that the lack of regular physical exercise was a significant predictor for reoperation (OR, 4.595; CI, 1.38-15.28), whereas gender, age, BMI, occupation, or smoking did not indicate so much significance as regular exercise.
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Affiliation(s)
- Bilge Kara
- Dokuz Eylül University School of Physical Therapy, 35340 Inciralti, Izmir, Turkey.
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Fritzell P, Hägg O, Jonsson D, Nordwall A. Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 2004; 29:421-34; discussion Z3. [PMID: 15094539 DOI: 10.1097/01.brs.0000102681.61791.12] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cost-effectiveness study was performed from the societal and health care perspectives. OBJECTIVE To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. SUMMARY OF BACKGROUND DATA A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. PATIENTS AND METHODS A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector (direct costs), and costs associated with production losses (indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain (VAS), functional disability (Owestry), and return to work. RESULTS The societal total cost per patient (standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 (254,000) vs. SEK 636,000 (208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 (60,100) vs. 65,200 (38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio (ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 (600-5,900), for back pain: SEK 5,200 (1,100-11,500), for Oswestry: SEK 11,300 (1,200-48,000), and for return to work: SEK 4,100 (100-21,400). CONCLUSION For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.
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Affiliation(s)
- Peter Fritzell
- Department of Orthopedic Surgery, Falun Hospital, Falun, Sweden.
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Breckenridge J, Clark JD. Patient characteristics associated with opioid versus nonsteroidal anti-inflammatory drug management of chronic low back pain. THE JOURNAL OF PAIN 2003; 4:344-50. [PMID: 14622692 DOI: 10.1016/s1526-5900(03)00638-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic low back pain is both prevalent and costly in many industrialized nations. Although many modalities exist for the treatment of this condition, few are as commonly used or as controversial as the use of opioids. Many sets of guidelines exist for the prescription of opioids for chronic nonmalignant pain, but little evidence addresses what factors actually contribute to the decision to initiate and maintain patients on these drugs. In these studies we first identified 2 groups of 100 patients each, all with chronic low back pain. Group N patients received long-term nonsteroidal anti-inflammatory drug therapy for the treatment of their pain, whereas Group O received opioids long-term. The identities of the specific analgesics were tabulated. A list of variables including patient characteristics, healthcare utilization factors, and psychologic characteristics were extracted from their medical records. Regression analysis was performed, which resulted in the identification of 4 variables of age, depression, personality disorder, and history of substance abuse as being closely linked to the use of opioids for the treatment of back pain in preference to nonsteroidal anti-inflammatory drugs alone. By using the derived regression equation, 79% of patients could be correctly classified into Group O or Group N. Pain intensity did not predict opioid use. We present alternative explanations for these observations.
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Affiliation(s)
- James Breckenridge
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA
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