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Chauhan D, Ahmad HS, Hamade A, Yang AI, Wathen C, Ghenbot Y, Mannam S, Subtirelu R, Bashti M, Wang MY, Basil G, Yoon JW. Determining Differences in Perioperative Functional Mobility Patterns in Lumbar Decompression Versus Fusion Patients Using Smartphone Activity Data. Neurosurgery 2024:00006123-990000000-01010. [PMID: 38169310 DOI: 10.1227/neu.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences. METHODS Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch. RESULTS Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated. CONCLUSION Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Hamade
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sai Mannam
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Subtirelu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Malek Bashti
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Michael Y Wang
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Gregory Basil
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kaiser R, Kantorová L, Langaufová A, Slezáková S, Tučková D, Klugar M, Klézl Z, Barsa P, Cienciala J, Hajdúk R, Hrabálek L, Kučera R, Netuka D, Prýmek M, Repko M, Smrčka M, Štulík J. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 2023; 94:657-666. [PMID: 36849239 PMCID: PMC10359551 DOI: 10.1136/jnnp-2022-330158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). RESULTS We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). CONCLUSIONS Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO REGISTRATION NUMBER CRD42022308267.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Lucia Kantorová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Simona Slezáková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Dagmar Tučková
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Czech Health Research Council, Prague, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University Faculty of Medicine, Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Zdeněk Klézl
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Pavel Barsa
- Department of Neurosurgery, Regional Hospital Liberec, Liberec, Czech Republic
| | - Jan Cienciala
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Richard Hajdúk
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Lumír Hrabálek
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Kučera
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Military University Hospital Prague, Prague, Czech Republic
| | - Martin Prýmek
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Repko
- Department of Orthopaedic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
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Huang P, Liu Z, Liu H, Yu Y, Huang L, Lu M, Jin X. Decompression versus decompression plus fusion for treating degenerative lumbar spinal stenosis: A systematic review and meta-analysis. Pain Pract 2022; 23:390-398. [PMID: 36504445 DOI: 10.1111/papr.13193] [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: 04/08/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (DLSS) is a complex clinical syndrome that leads to spinal compression. Decompression with fusion has been the most commonly used surgical procedure for treating DLSS symptoms for many years. However, the exact role of fusion and its effectiveness in DLSS therapy has recently been debated. OBJECTIVE The main purpose of this study was to compare the efficacy and safety of decompression alone and decompression plus fusion in the treatment of DLSS with or without spondylolisthesis. STUDY DESIGN A systematic review and meta-analysis of the therapeutic effects of decompression for DLSS with or without the combination of fusion. METHODS A literature search in five relevant databases, including Web of Science, PubMed, Embase, Medline, and Cochrane Library was performed from the inception of the database to March 2022. Only randomized controlled trials (RCTs) assessing the comparison between decompression and decompression plus fusion for DLSS were included. RESULTS A total of seven studies, 894 patients were analyzed in this meta-analysis. Among these, 443 patients were included in the decompression plus fusion group while 451 patients were included in the decompression alone group. Pooled analysis showed that the combination of decompression with fusion had no superior benefits to decompression alone in terms of Oswestry Disability Index (ODI) score in the first 2 years and long-term follow-up after surgery, also no significant difference in the improvement of back and leg pain was found between two groups. Adding fusion to decompression was associated with a longer operation time, higher complication rate, more blood loss, and extended hospital stay. Furthermore, there was no difference in reoperation rates and patients' satisfaction between the two groups at the last follow-up. CONCLUSION Decompression plus fusion may not be associated with a better clinical outcome in ODI scores and back or leg pain improvement but with a longer duration of operation time, extended hospital stay, and more blood loss.
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Affiliation(s)
- Peng Huang
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenxiu Liu
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Liu
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yaqiong Yu
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liqun Huang
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Lu
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaohong Jin
- Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review. Int J Spine Surg 2022; 16:361-372. [PMID: 35444044 PMCID: PMC9930662 DOI: 10.14444/8218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lateral recess stenosis (LRS) represents a major etiology of pain and disability in recent years. The aim of the present study was to compare the clinical outcomes of full-endoscopic ventral facetectomy (FEVF) vs conventional open laminectomy (OL) for surgical treatment of lumbar LRS. METHODS Ninety individuals with diagnosed LRS according to clinical and radiological criteria were included in this study. Patients were appropriately classified into 2 distinct groups according to received treatment. Group A was constituted from 48 patients subjected to FEVF. Contrariwise, the 42 patients of Group B underwent OL. All patients were consecutively evaluated with particular clinical scores preoperatively and at 6 weeks, 3, months, 6 months, 12 months, and 2 years postoperatively. Clinical assessment was conducted with the visual analog scale for leg pain (VAS-LP) and back pain (VAS-BP) and with the Short-Form 36 (SF-36) medical questionnaire. RESULTS Values of all studied indices in both groups featured a major clinical improvement in 6 weeks with subsequent quantitatively minor albeit still statistically significant amelioration until the end of follow-up at 2 years. Comparative evaluation of recorded parameters between the 2 groups disclosed that VAS-BP, bodily pain, and role emotional indices of SF-36 were quantitatively and statistically differentiated in favor of Group A in 6 weeks, featuring an amelioration that persisted until the end of follow-up. Registered values of the other parameters were not found to demonstrate a quantitatively and clinically noteworthy differentiation between the 2 groups. CONCLUSIONS FEVF represents a feasible, safe, and beneficial alternative for surgical therapy of patients with LRS, featuring comparable outcomes with conventional OL. CLINICAL RELEVANCE Lumbar LRS represents a frequent entity with remarkable clinical sequelae. FEVF represents a novel, groundbreaking and minimally invasive technique that should be considered as a safe and efficacious alternative over conventional open surgery in specific patients with LRS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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