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Nakajima Y, Nagai S, Michikawa T, Hachiya K, Ito K, Takeda H, Kawabata S, Yoshioka A, Ikeda D, Kaneko S, Hachiya Y, Fujita N. Predictors of Patient Dissatisfaction after Lumbar Spinal Canal Stenosis Surgery: A Multicenter Retrospective Study. Spine Surg Relat Res 2024; 8:322-329. [PMID: 38868782 PMCID: PMC11165491 DOI: 10.22603/ssrr.2023-0256] [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: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Recently, patient satisfaction has gained prominence as a crucial measure for ensuring patient-centered care. Furthermore, patient satisfaction after lumbar spinal canal stenosis (LCS) surgery is an important metric for physician's decision of surgical indication and informed consent to patient. This study aimed to elucidate how patient satisfaction changed after LCS surgery to identify factors that predict patient dissatisfaction. Methods We retrospectively reviewed time-course data of patients aged ≥40 years who underwent LCS surgery at multiple hospitals. The participants completed the Zurich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) before surgery and then 6 months and 1 year postsurgery. Patient satisfaction was categorized according to the postoperative score of the satisfaction domain of the ZCQ: satisfied, score ≤2.0; moderately satisfied, 2.0< score ≤2.5; and dissatisfied, score >2.5. Results The study enrolled 241 patients. Our data indicated a satisfaction rate of around 70% at 6 months and then again 1 year after LCS surgery. Among those who were dissatisfied 6 months after LCS surgery, 47.6% were more satisfied 1 year postsurgery. Furthermore, 86.2% of those who were satisfied 6 months after LCS surgery remained satisfied at 1 year. Multivariable analysis revealed that age (relative risk, 0.5; 95% confidence interval, 0.2-0.8) and preoperative score of psychological disorders on the JOABPEQ (relative risk, 0.2; 95% confidence interval, 0.03-0.08) were significantly associated with LCS surgery dissatisfaction. In addition, the receiver operating characteristic curve analysis revealed that the cutoff value for the preoperative score of psychological disorder of the JOABPEQ was estimated at 40 for LCS surgery dissatisfaction. Conclusions Age and psychological disorders were identified as significant predictors of dissatisfaction, with a JOABPEQ cutoff value providing potential clinical applicability.
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Affiliation(s)
- Yukio Nakajima
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Atsushi Yoshioka
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
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Seok SY, Cho JH, Lee HR, Lee DH, Park S, Lee CS, Hwang ES. Risk factors for postoperative complaints in patients following lumbar decompression and fusion: Analyses focusing on preoperative symptoms. J Orthop Sci 2024; 29:755-761. [PMID: 37211525 DOI: 10.1016/j.jos.2023.04.008] [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: 03/03/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Several patients complained of residual symptoms following lumbar decompressive surgery for lumbar degenerative disease (LDD). However, few studies analyze this dissatisfaction by focusing on preoperative patients' symptoms. This study was conduct to determine the factors that could predict the patients' postoperative complaints by focusing on their preoperative symptoms. METHODS Four hundred and seventeen consecutive patients who underwent lumbar decompression and fusion surgery for LDD were included. Postoperative complaint was defined by at least twice same complaint during the outpatient follow-up of 6,12, 18 and 24 months after surgery. A comparative analysis was performed between complaint group (group C, N = 168) and non-complaint group (group NC, N = 249). Demographic, operative, symptomatic, and clinical factors were compared between the groups by univariate and multivariate analyses. RESULTS The main preoperative chief complaints were radiating pain (318/417, 76.2%). However, most common postoperative complaint was residual radiating pain (60/168, 35.7%) followed by tingling sensation (43/168, 25.6%). The presence of psychiatric disease (adjusted odds ratio [aOR], 4.666; P = 0.017), longer pain duration (aOR, 1.021; P < 0.001), pain to below the knee (aOR, 2.326; P = 0.001), preoperative tingling sensation (aOR, 2.631; P < 0.001), preoperative sensory and motor power decrease (aOR, 2.152 and 1.678; P = 0,047 and 0.011, respectively) were significantly correlated with postoperative patients' complaints in multivariate analysis. CONCLUSIONS The postoperative patients' complaints could be predicted and explained in advance by checking the preoperative characteristics of patients' symptoms, including the duration and site carefully. This could be helpful to enhance the understanding of the surgical results preoperatively, which could control the anticipation of the patients.
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Affiliation(s)
- Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, South Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, South Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eui Seung Hwang
- Emory University, College of Arts and Sciences, United States
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Jacob KC, Patel MR, Nie JW, Hartman TJ, Vanjani NN, Pawlowski H, Prabhu MC, Singh K. Impact of American Society of Anesthesiologists' Classification on Postoperative Satisfaction and Clinical Outcomes Following Lumbar Decompression: Cohort-Matched Analysis. Clin Spine Surg 2024; 37:E89-E96. [PMID: 37941112 DOI: 10.1097/bsd.0000000000001553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim was to compare patient-reported outcomes (PROMs), minimum clinically important difference (MCID) achievement, and postoperative satisfaction following minimally invasive lumbar decompression in patients stratified by American Society of Anesthesiologists (ASA) classification. SUMMARY OF BACKGROUND DATA Some guidelines recommend against performing elective procedures for patients with an ASA score of 3 or greater; however, long-term postoperative outcomes are not well described. METHODS Primary, single-level, minimally invasive lumbar decompression procedures were identified. PROMs were administered at preoperative, 6-week, 12-week, 6-month, 1-year, 2-year timepoints and included Patient-Reported Outcomes Measurement Information System-Physical Function, visual analog scale (VAS) back/leg, Oswestry disability index (ODI), and 12-item short form physical component score. Satisfaction scores were collected postoperatively for VAS back/leg, ODI, and individual ODI subcategories. Patients were grouped (ASA<3, ASA≥3), and propensity scores were matched to control for significant differences. Demographic and perioperative characteristics were compared using χ 2 and the Student's t test. Mean PROMs and postoperative satisfaction were compared at each time point by a 2-sample t test. Postoperative PROM improvement from the preoperative baseline within each cohort was calculated with a paired t test. MCID achievement was determined by comparing ΔPROMs to established thresholds and comparing between groups using simple logistic regression. RESULTS One hundred and twenty-nine propensity-matched patients were included: 99 ASA<3 and 30 ASA≥3. No significant demographic differences were observed between groups. ASA≥3 patients experienced significantly increased length of stay and postoperative narcotic consumption on surgery day ( P <0.048, all). Mean PROMs and MCID achievement did not differ. The ASA<3 cohort significantly improved from the preoperative baseline for all PROMs at all postoperative time points. ASA<3 patients demonstrated higher levels of postoperative satisfaction at 6 weeks for VAS leg, VAS back, ODI, sleeping, lifting, walking, standing, sex, travel, and at 6 months for VAS back ( P <0.045, all). CONCLUSION ASA≥3 patients may achieve similar long-term clinical outcomes to ASA<3 patients, though they may show poorer short-term satisfaction for disability, leg pain, and back pain, which could be related to differing preoperative expectations.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Ishibashi Y, Tomita Y, Imura S, Takeuchi N. Preoperative Motor Function Associated with Short-Term Gain of Health-Related Quality of Life after Surgery for Lumbar Degenerative Disease: A Pilot Prospective Cohort Study in Japan. Healthcare (Basel) 2023; 11:3103. [PMID: 38131993 PMCID: PMC10742417 DOI: 10.3390/healthcare11243103] [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: 11/01/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to estimate the relationship between preoperative motor function and short-term recovery of health-related quality of life after lumbar surgery in patients with lumbar degenerative disease. This prospective cohort study involved 50 patients with lumbar degenerative disease at a general hospital in Japan. The primary outcome was the achievement of minimal clinically important difference (MCID) for EuroQOL 5 dimensions (EQ-5D) at discharge. Preoperative demographic, medication, surgical, and physical function data were collected. Logistic regression analysis was performed using the achievement of MCID for EQ-5D as the dependent variable and preoperative characteristics, including the Five Times Sit to Stand test (FTSTS), Oswestry Disability Index (ODI), and Self-rating Depression Scale (SDS), as the independent variables. The logistic regression analysis showed that Model 1 had a moderate predictive accuracy (Nagelkerke R2: 0.20; Hosmer-Lemeshow test: p = 0.19; predictive accuracy: 70.0%). Among the independent variables in the logistic regression model, the FTSTS was the only independent variable related to the achievement of MCID for EQ-5D at discharge (odds ratio: 0.03; 95% CI: 1.79 × 10-3, 0.18). Our results highlighted the importance of baseline motor function in the postoperative recovery of health-related quality of life in individuals with lumbar degenerative disease.
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Affiliation(s)
- Yuya Ishibashi
- Department of Physical Therapy, Graduate School of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Gunma, Japan; (Y.I.); (S.I.); (N.T.)
- Department of Rehabilitation, Harunaso Hospital, Takasaki 370-3347, Gunma, Japan
- Department of Medical Device Development, mediVR, Inc., Chuo-ku 103-0022, Tokyo, Japan
| | - Yosuke Tomita
- Department of Physical Therapy, Graduate School of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Gunma, Japan; (Y.I.); (S.I.); (N.T.)
| | - Shigeyuki Imura
- Department of Physical Therapy, Graduate School of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Gunma, Japan; (Y.I.); (S.I.); (N.T.)
| | - Nobuyuki Takeuchi
- Department of Physical Therapy, Graduate School of Health Care, Takasaki University of Health and Welfare, Takasaki 370-0033, Gunma, Japan; (Y.I.); (S.I.); (N.T.)
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Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study. Spine J 2023; 23:261-270. [PMID: 36343913 DOI: 10.1016/j.spinee.2022.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/CONTEXT Some patients do not improve after surgery for lumbar spinal stenosis (LSS), and surgical treatment implies a risk for complications and deterioration. Patient selection is of paramount importance to improve the overall clinical results and identifying predictive factors for failure is central in this work. PURPOSE We aimed to explore predictive factors for failure and worsening after surgery for LSS. STUDY DESIGN /SETTING Retrospective observational study on prospectively collected data from a national spine registry with a 12-month follow-up. PATIENT SAMPLE We analyzed 11,873 patients operated for LSS between 2007 and 2017 in Norway, included in the Norwegian registry for spine surgery (NORspine). Twelve months after surgery, 8919 (75.1%) had responded. OUTCOME MEASURES Oswestry Disability Index (ODI) 12 months after surgery. METHODS Predictors were assessed with uni- and multivariate logistic regression, using backward conditional stepwise selection and a significance level of 0.01. Failure (ODI>31) and worsening (ODI>39) were used as dependent variables. RESULTS Mean (95%CI) age was 66.6 (66.4-66.9) years, and 52.1% were females. The mean (95%CI) preoperative ODI score was 39.8 (39.4-40.1). All patients had decompression, and 1494 (12.6%) had an additional fusion procedure. Twelve months after surgery, the mean (95%CI) ODI score was 23.9 (23.5-24.2), and 2950 patients (33.2%) were classified as failures and 1921 (21.6%) as worse. The strongest predictors for failure were duration of back pain > 12 months (OR [95%CI]=2.24 [1.93-2.60]; p<.001), former spinal surgery (OR [95%CI]=2.21 [1.94-2.52]; p<.001) and age>70 years (OR (95%CI)=1.97 (1.69-2.30); p<.001). Socioeconomic variables increased the odds of failure (ORs between 1.36 and 1.62). The strongest predictors for worsening were former spinal surgery (OR [95%CI]=2.04 [1.77-2.36]; p<.001), duration of back pain >12 months (OR [95%CI]=1.83 [1.45-2.32]; p<.001) and age >70 years (OR [95%CI]=1.79 [1.49-2.14]; p<.001). Socioeconomic variables increased the odds of worsening (ORs between 1.33-1.67). CONCLUSIONS After surgery for LSS, 33% of the patients reported failure, and 22% reported worsening as assessed by ODI. Preoperative duration of back pain for longer than 12 months, former spinal surgery, and age above 70 years were the strongest predictors for increased odds of failure and worsening after surgery.
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Xu W, Ran B, Zhao J, Luo W, Gu R. Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease. BMC Musculoskelet Disord 2022; 23:1141. [PMID: 36585650 PMCID: PMC9805251 DOI: 10.1186/s12891-022-06066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the growing number of traditional posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. We aimed to investigate the incidence and risk factors for FBSS following open posterior lumbar surgery for degenerative lumbar disease (DLD). METHOD A multivariable regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed. RESULT 16.8% of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariable logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71-0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10-4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75-9.47, P = 0.001) and waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54-27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00-17.04, P < 0.001), MCs (OR: 3.41, 95%CI: 1.73-6.71, P < 0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13-6.12, P = 0.024) were risk factors for FBSS. CONCLUSION Open posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.
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Affiliation(s)
- Wenbo Xu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Bingbing Ran
- grid.478174.9Departments of Medical Cosmetology, Jilin Province People’s Hospital, No. 1183, Gongnong Road, Changchun, 130021 Jilin P.R. China
| | - Jianhui Zhao
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Wenqi Luo
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Rui Gu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
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Aaen J, Banitalebi H, Austevoll IM, Hellum C, Storheim K, Myklebust TÅ, Anvar M, Weber C, Solberg T, Grundnes O, Brisby H, Indrekvam K, Hermansen E. The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial. 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 2022; 31:2777-2785. [PMID: 35930062 DOI: 10.1007/s00586-022-07317-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/24/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). METHODS The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to ≥ 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. RESULTS The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. CONCLUSION Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
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Affiliation(s)
- Jørn Aaen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Hasan Banitalebi
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivar Magne Austevoll
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Division of Orthopedic Surgery, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | | | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway
- Dept. of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Tore Solberg
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Oliver Grundnes
- Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
| | - Helena Brisby
- Dept of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Dept. of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kari Indrekvam
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Brasil AVB, Floriani MA, Sfreddo E, do Nascimento TL, Castro AA, Pedrotti LG, Bessel M, Maccari JG, Mutlaq MP, Nasi LA. Success and failure after surgery of degenerative disease of the lumbar spine: an operational definition based on satisfaction, pain, and disability from a prospective cohort. BMC Musculoskelet Disord 2022; 23:501. [PMID: 35624507 PMCID: PMC9137061 DOI: 10.1186/s12891-022-05460-0] [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] [Received: 03/13/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background To describe success and failure (S&F) after lumbar spine surgery in terms equally understandable across the entire health ecosystem. Methods Back and leg pain and disability were prospectively recorded before and up to 12 months after the procedure. Satisfaction was recorded using a Likert scale. Initially, patients were classified as satisfied or unsatisfied. Optimal satisfaction/unsatisfaction cutoff values for disability and pain were estimated with ROC curves. Satisfied and unsatisfied groups underwent a second subdivision into four subcategories: success (satisfied AND pain and disability concordant with cutoff values), incomplete success (satisfied AND pain and disability nonconformant with cutoff values), incomplete failure (unsatisfied AND pain and disability nonconformant with cutoff values), and failure (unsatisfied AND pain and disability concordant with cutoff values). Results A total of 486 consecutive patients were recruited from 2019–2021. The mean values of preoperative PROMs were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 points (+ 2.9). Of the total, 80.7% were classified as satisfied, and 19.3% were classified as unsatisfactory. The optimal disability and pain cutoff values for satisfaction/unsatisfaction (NPRS = 6, AND ODI = 27) defined a subdivision: 59.6% were classified as success, 20.4% as incomplete success, 7.1% as incomplete failure and 12.4% as failure. The descriptions of each group were translated to the following: success—all patients were satisfied and presented no or only mild to tolerable pain and no or borderline disability; incomplete success – all patients were satisfied despite levels of pain and/or disability worse than ideal for success; incomplete failure – all patients were not satisfied despite levels of pain and/or disability better than expected for failure; failure – all patients were unsatisfied and presented moderate to severe pain and disability. Conclusion It is possible to report S&F after surgery for DDL with precise and meaningful operational definitions focused on the experience of the patient.
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Affiliation(s)
- Albert V B Brasil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil. .,Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil.
| | - Maiara Anschau Floriani
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Ericson Sfreddo
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Tobias Ludwig do Nascimento
- Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil.,Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Andriele Abreu Castro
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | | | - Marina Bessel
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juçara Gasparetto Maccari
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
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Patel MR, Jacob KC, Hartman TJ, Nie JW, Shah VP, Chavez FA, Vanjani NN, Lynch CP, Cha EDK, Prabhu MC, Pawlowski H, Singh K. Patient Satisfaction Following Lumbar Decompression: What is the Role of Mental Health? World Neurosurg 2022; 164:e540-e547. [PMID: 35568123 DOI: 10.1016/j.wneu.2022.05.017] [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: 02/23/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the association between patient-reported depressive symptoms and patient satisfaction following minimally invasive lumbar decompression (MIS LD) METHODS: Primary, single/multilevel MIS LD were identified. Patient-reported outcome measures (PROMs) collected pre-/post-operatively included VAS back/leg, ODI, PHQ-9, and SF-12 MCS. Patients rated current satisfaction level (0-10) with back/leg pain and disability. Paired Student's t-test compared each postoperative PROM score to its preoperative baseline. At each timepoint, patients were categorized by PHQ-9 and SF-12 MCS scores. One-way ANOVA compared patient satisfaction with back/leg pain and disability among PHQ-9 subgroups. Student's t-test for independent samples compared patient satisfaction between SF-12 MCS subgroups. ANCOVA assessed differences in satisfaction between depression subgroups while controlling for pre-/post-operative values in corresponding PROMs. RESULTS 193 patients were included. All PROMs demonstrated significant postoperative improvement from 6-weeks through 2-years(p<0.001,all) except PHQ-9 2-years(p=0.874). Mean satisfaction scores ranged from 6.9-7.9(back pain), 7.3-8.0(leg pain), and 7.6-8.0(disability). Satisfaction with back/leg pain and disability significantly differed among PHQ-9 subgroups at all postoperative timepoints(p<0.001,all). Accounting for baseline and current pain/disability values, ANCOVA revealed differences between PHQ-9 subgroups only in satisfaction with back pain 2-years(p<0.001), leg pain 12-weeks/1-year/2-years(p≤0.047,all), and disability 6-months/2-years(p≤0.049,both). Satisfaction differed between SF-12 MCS subgroups at all timepoints(p≤0.047), except back pain 6-months(p=0.263). Accounting for baseline and postoperative pain/disability, ANCOVA revealed differences in satisfaction between SF-12 MCS groups only for back/leg pain 2-years(p≤0.001,both). CONCLUSION Independent effect of depression at long-term follow-up was significant. This highlights the importance of understanding the interaction between physical and mental health outcomes to optimize patients' perceptions of surgical outcome.
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Affiliation(s)
- Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Vivek P Shah
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Frank A Chavez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612.
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10
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Ogura Y, Takahashi Y, Kitagawa T, Yonezawa Y, Yoshida K, Takeda K, Kobayashi Y, Takahashi Y, Alhammoud A, Yasuda A, Shinozaki Y, Ogawa J. Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis. J Clin Neurosci 2021; 93:112-115. [PMID: 34656233 DOI: 10.1016/j.jocn.2021.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction. We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, "How satisfied are you with the overall result of your back operation?". There are four possible answers consisting of "very satisfied (4-point)", "somewhat satisfied (3-point)", "somewhat dissatisfied (2-point)", or "very dissatisfied (1-point)". Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs. A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value. We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively.
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Affiliation(s)
- Yoji Ogura
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
| | - Yoshiyuki Takahashi
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Takahiro Kitagawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiro Yonezawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Kodai Yoshida
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Abduljabbar Alhammoud
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yoshio Shinozaki
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jun Ogawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
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11
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Goh GS, Soh RCC, Yue WM, Guo CM, Tan SB, Chen JLT. The patient acceptable symptom state for the Oswestry Disability Index following single-level lumbar fusion for degenerative spondylolisthesis. Spine J 2021; 21:598-609. [PMID: 33221514 DOI: 10.1016/j.spinee.2020.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/02/2020] [Accepted: 11/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The patient acceptable symptom state (PASS) is a valuable tool for interpreting patient-reported outcomes. Previous studies have attempted to define the PASS in a heterogenous cohort with various lumbar spinal disorders and surgical procedures. PURPOSE We aimed to determine the PASS threshold for the Oswestry Disability Index (ODI) specifically for patients undergoing lumbar fusion for spondylolisthesis-associated functional disability. STUDY DESIGN Retrospective review of prospectively collected registry data. PATIENT SAMPLE There were 692 patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis between 2006 and 2014. OUTCOME MEASURES The ODI was collected pre-operatively, at 6 months and 2 years postoperatively. An anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" while a validation question was taken from the same questionnaire, "Has the surgery for your back condition met your expectations so far?" METHODS Responses to the anchor question were used to determine whether a PASS was achieved. Receiver operating characteristics curve analysis was performed to assess the ability of the ODI to discriminate between an acceptable/unacceptable symptom state as well as to define PASS thresholds. Sensitivity analyses were performed for different follow-up periods (6 months, 2 years), subgroups (by age, gender, BMI, and comorbidity burden), baseline ODI tertiles, and an alternate definition of PASS. RESULTS In total, 529 of 692 (76%) patients completed 2-year follow-up, of which, 89% considered their symptom state to be acceptable. Areas under the curve (AUC) ranged from 0.81 to 0.90 for all receiver operating characteristics analyses, indicating that the ODI had an excellent discriminative ability. The PASS threshold was ≤18.09 at 6 months (AUC 0.81, sensitivity 77%, specificity 72%) and ≤15.27 at 2 years (AUC 0.86, sensitivity 79%, specificity 79%). These thresholds proved to be robust in the sensitivity analyses, showing minimal variation across different patient subgroups and baseline score tertiles. CONCLUSIONS Patients with an ODI of ≤15.27 can be considered to have achieved a PASS after lumbar fusion for degenerative spondylolisthesis. These findings will help surgeons to contextualize a patient's functional recovery after lumbar spine surgery and enable researchers to define clinically relevant benchmarks when designing trials utilizing the ODI.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore.
| | - Reuben Chee Cheong Soh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
| | - Wai-Mun Yue
- The Orthopaedic Centre, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510 Singapore
| | - Chang-Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
| | - Seang-Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510 Singapore
| | - John Li-Tat Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
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