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Cronkhite SE, Daher M, Balmaceno-Criss M, Knebel A, Nassar JE, Singh M, Mcdonald CL, Basques BA, Diebo BG, Daniels AH. Impact of Gender on Peri-Operative Characteristics and Outcomes of Lumbar Spine Surgery: A Current Concepts Review. World Neurosurg 2024; 190:46-52. [PMID: 38977128 DOI: 10.1016/j.wneu.2024.07.019] [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: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
The success of spine surgery is variable among patients. Finding reliable predictors of successful outcomes will not only maximize patient benefit, but also increase the cost effectiveness of surgery. Recent research has demonstrated the importance of patient specific factors in predicting patient outcomes, including gender. While many studies show that female patients present with worse pain and function preoperatively, there is conflicting data on whether male and female patients reap the same benefits from lumbar spine surgery. In this manuscript we review the current research on gender and sex differences in preoperative characteristics and post-operative outcomes and comment on the need for more studies to better elucidate the mechanism driving the conflicting evidence.
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Affiliation(s)
- Shelby E Cronkhite
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ashley Knebel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph E Nassar
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Manjot Singh
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher L Mcdonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Iliopoulou S, Tzika M, Foroglou N. Neurosurgical Patient's Quality of Life: A Questionnaire-Based Study. Cureus 2024; 16:e64553. [PMID: 39144874 PMCID: PMC11322904 DOI: 10.7759/cureus.64553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION The burden of disease, as well as social and epidemiological factors, have a clear impact on a patient's quality of life. Especially in neurosurgery, patients commonly experience a decline in their quality of life. This study aims to assess the quality of life of neurosurgical patients and evaluate the impact of epidemiologic and disease-related factors. METHODS AND MATERIAL Adult, non-trauma neurosurgical patients were included in the study, which took place in the Neurosurgical Department at AHEPA University Hospital. Self-administered questionnaires including the 36-Item Short Form Survey Instrument (SF-36) and the EQ-5D-5L were used to assess the overall patient's quality of life. Additionally, all patients were asked to provide data on the perceived severity of the disease and the extent of information regarding their health condition. Epidemiologic factors including gender, age, education level, and rural or urban living environment were also taken into account. Statistical analysis was performed to assess the impact of the aforementioned parameters on the patient's quality of life. RESULTS In total, 74 patients were included in the study (56.9% male, mean age: 51 years). In general, better mean scores were observed in general health perception, vitality, social role functioning, and mental health, whereas the lowest values were detected in the reported physical and emotional role functioning. No statistically significant differences were observed among genders. Age was found to impact the general health perception and EQ-VAS (visual analog scale) score, while physical functioning presented significant differences depending on the patient's living environment and education level, with better scores for rural residents and secondary education graduates. The perceived severity of the health condition presented a significant negative effect on the EQ-VAS score, while it affected significantly physical functioning, with better outcomes reported by patients dealing with more serious diseases. Finally, in most of the evaluated categories, the level of information seemed to increase the reported quality of life, even though statistical significance was not confirmed. CONCLUSION Quality of life should be taken into account when treating neurosurgical patients, and utilizing measuring tools assists in objectively evaluating their well-being. Most parameters that influence the patient's quality of life are fixed. Therefore, based on our study results, healthcare professionals should prioritize providing comprehensive information regarding the patient's disease and treatment, as the level of information seems to improve the overall patient's quality of life.
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Affiliation(s)
- Sofia Iliopoulou
- Neutropenic Care Unit, AHEPA University Hospital, Thessaloniki, GRC
| | - Maria Tzika
- Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
| | - Nikolaos Foroglou
- Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
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Pericot-Mozo X, Suñer-Soler R, Reig-Garcia G, Patiño-Masó J, Sitjar-Suñer M, Masià-Plana A, Bertran-Noguer C. Quality of Life in Patients with Chronic Low Back Pain and Differences by Sex: A Longitudinal Study. J Pers Med 2024; 14:496. [PMID: 38793078 PMCID: PMC11121820 DOI: 10.3390/jpm14050496] [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: 03/30/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The experience of chronic low back pain has a significant impact on the quality of life of affected people, resulting in difficulties in performing basic activities of daily living. AIM To study the perceived quality of life of people affected by chronic low back pain and the associated factors by sex. METHODS A prospective, longitudinal and observational design was used. RESULTS A total of 129 people (58.1% women) with chronic low back pain were studied. The mean pain intensity scores were of moderate severity (6.42 points), with a modest improvement at follow-up (6.17 points). Epidural nerve blocks were the most effective therapeutic intervention in reducing the intensity of pain. Participants described a negative perception of their health with regard to quality of life, with low scores for the two constructs both at baseline (health index, 0.444; perception of health, 38.76 points) and at follow-up (health index, 0.447; perception of health, 40.43 points). Participants had severe functional limitation scores (50.79 points). The results were significantly better among men. There was an inverse relationship between the average pain intensity (β = -0.304; p < 0.001), functional limitation (β = -0.466; p < 0.001) and mental health (β = -0.565; p < 0.001) and quality of life. CONCLUSIONS The chronification of low back pain complicates people's biopsychosocial adaptation to life. There is a longitudinal inverse association between pain and functional limitation and health-related quality of life.
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Affiliation(s)
- Xavier Pericot-Mozo
- Pain Unit, Institut Català de la Salut, 17007 Girona, Spain;
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Rosa Suñer-Soler
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Glòria Reig-Garcia
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Josefina Patiño-Masó
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Miquel Sitjar-Suñer
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Afra Masià-Plana
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
| | - Carme Bertran-Noguer
- Department of Nursing, Faculty of Nursing, University of Girona, 17004 Girona, Spain; (G.R.-G.); (J.P.-M.); (M.S.-S.); (A.M.-P.); (C.B.-N.)
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Patel MR, Jacob KC, Parsons AW, Vanjani NN, Prabhu MC, Pawlowski H, Singh K. Impact of Gender on Postsurgical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2022; 16:991-1000. [PMID: 36418177 PMCID: PMC9807048 DOI: 10.14444/8366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prior studies associate male gender with higher complication rates following anterior cervical discectomy and fusion (ACDF), but none has investigated gender influence on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) following single-level ACDF. METHODS Patients undergoing primary, single-level ACDF were divided into female and male groups. Visual analog scale (VAS) neck/arm, Neck Disability Index (NDI), 12-item short form (SF-12) physical composite score (PCS), PROM information system physical function (PROMIS-PF), and veterans RAND 12-item (VR-12) health survey PCS were collected preoperatively and postoperatively. Simple linear regression analysis evaluated the predictive capability of gender on PROMs. Multiple regression analysis was performed to determine the effects of gender on mean PROMs while accounting for insurance type. Established MCID values determined achievement rates across PROMs. χ 2 analysis compared MCID achievement by gender. RESULTS A total of 179 women and 134 men were included. Cohorts differed in insurance type, length of stay, and discharge day (P ≤ 0.017, all). Women improved in PROMs at all timepoints (P ≤ 0.049, all) except SF-12 PCS 6 weeks and PROMIS-PF 6 weeks. Men improved in PROMs at all timepoints (P ≤ 0.042) except VAS arm 2 years, SF-12 PCS 6 weeks and 2 years, PROMIS-PF 6 weeks, and VR-12 PCS 6 weeks. Women demonstrated higher SF-12 PCS (P = 0.043) and VR-12 PCS (P = 0.035) 2 years. Multiple regression determined that VAS neck and arm from 6 weeks to 6 months, NDI from preoperative to 6 months, SF-12 PCS and VR-12 PCS from preoperative to 12 weeks, and PROMIS-PF preoperative, 6 weeks, and 6 months were significantly affected by gender and insurance status (P ≤ 0.031, all). MCID achievement rate did not differ for any PROM between genders. CONCLUSION Women reported significantly higher long-term physical function health (SF-12 PCS and VR-12 PCS) compared with men, while disability and pain did not differ. Nevertheless, no significant differences in MCID achievement were observed for any PROM studied. Gender does not appear to play a significant role in clinically meaningful recovery following single-level ACDF. CLINICAL RELEVANCE Gender has little value in prognostication for determining clinically meaningful recovery after single-level ACDF. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander W. Parsons
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N. Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C. Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Dr. Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA;
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Salamanna F, Contartese D, Tschon M, Borsari V, Griffoni C, Gasbarrini A, Fini M. Sex and gender determinants following spinal fusion surgery: A systematic review of clinical data. Front Surg 2022; 9:983931. [PMID: 36325040 PMCID: PMC9618873 DOI: 10.3389/fsurg.2022.983931] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
In the last decade, numerous studies analyzed and described the surgical outcomes in male and female patients submitted to orthopedic surgery. Although this, the impact of sex/gender on spinal fusion surgery clinical outcomes is still poorly defined. This review systematically maps and synthesizes the scientific literature on sex/gender differences in postoperative outcomes for patients undergoing spinal fusion surgery. The search was performed in PubMed, Scopus, and Web of Science in the last 22 years. Clinical studies evaluating potential sex/gender differences in postoperative outcomes and/or complications, as primary or secondary aim, were included and analyzed. Out of the 1,885 records screened, 47 studies were included. These studies comprised a total of 1,158,555 patients (51.31% female; 48.69% male). About 77% of the analyzed studies reported sex/gender-related differences in postoperative outcomes. Most studies treated patients for lumbar degenerative diseases and more than 55% of them reported a worse postoperative outcome in female patients in terms of pain, disability, health-related quality of life questionnaires, and complications. Differently, a significant heterogeneity across studies on patients treated for cervical and sacral degenerative diseases as well as for spinal deformity and traumatic spinal fracture prevented the understanding of specific sex/gender differences after spinal fusion surgery. Despite this, the present review highlighted those female patients treated for lumbar degenerative spine diseases could require more clinical awareness during postoperative care. The understanding of how sex/gender differences can really affect clinical outcomes after spinal fusion surgeries is mandatory for all spinal pathological conditions to drive clinical research toward oriented and personalized protocols.
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Affiliation(s)
- Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Deyanira Contartese
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Correspondence: Deyanira Contartese
| | - Matilde Tschon
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Borsari
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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DEMİREL C, TÜRKÖZ D, YİLMAZ T. Experimental Comparison of Autograft and DBM Flex (Grafton) for Spinal Lumbar Fusion in Rabbits. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2021. [DOI: 10.25000/acem.963125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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Influence of Osteoporosis Following Spine Surgery on Reoperation, Readmission, and Economic Costs: An 8-Year Nationwide Population-Based Study in Korea. World Neurosurg 2021; 149:e360-e368. [PMID: 33601076 DOI: 10.1016/j.wneu.2021.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relationship between prevalence of osteoporosis and risk factors, medical costs, reoperation, and readmission in patients after spine surgery. METHODS Patients >50 years old with thoracic or lumbar spine diseases who underwent spine surgery between 2005 and 2008 were selected from the Korean National Health Insurance Service databases for analysis. There were 147,676 patients selected, who were divided into 2 groups (osteoporosis and non-osteoporosis) and followed for 8 years. Multiple logistic regressions were performed to examine the effect of osteoporosis following spine surgery. RESULTS Patients with osteoporosis showed significant increases in readmission rates (odds ratio = 1.26, P < 0.001). Osteoporosis was found to be significantly associated with longer hospital stays and increased medical costs regardless of the cause of spine disease. For readmission, there was a 62-day difference in hospitalization time and U.S. dollars $2040 difference in medical costs between the osteoporosis group and non-osteoporosis group. Total medical costs of the osteoporosis group were about U.S. dollars $310 million more than total medical costs of the non-osteoporosis group. Osteoporosis increased the risk of reoperation in fusion surgery, particularly in the first 3 months postoperatively (odds ratio = 1.34, P < 0.001). CONCLUSIONS Osteoporosis was significantly associated with higher readmission rates, longer hospitalization, and greater medical costs during the 8-year follow-up. It also increased the risk of reoperation in fusion surgery. Proper management of osteoporosis is essential before spine surgery, particularly fusion surgery, to help reduce patients' socioeconomic burden and produce more satisfactory surgical outcomes.
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MacLean MA, Touchette CJ, Han JH, Christie SD, Pickett GE. Gender differences in the surgical management of lumbar degenerative disease: a scoping review. J Neurosurg Spine 2020; 32:799-816. [PMID: 32005013 DOI: 10.3171/2019.11.spine19896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis). METHODS A systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected. RESULTS Thirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females. CONCLUSIONS Female patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.
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Affiliation(s)
- Mark A MacLean
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Charles J Touchette
- 2Division of Neurosurgery, Universitaire de Sherbrooke, Centre de recherche du Centre Hospitalier, Sherbrooke, Quebec, Canada
| | - Jae H Han
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Sean D Christie
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Gwynedd E Pickett
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
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Han S, Park B, Lim JW, Youm JY, Choi SW, Kim DH, Ahn DK. Comparison of Fusion Rate between Demineralized Bone Matrix versus Autograft in Lumbar Fusion : Meta-Analysis. J Korean Neurosurg Soc 2020; 63:673-680. [PMID: 32455520 PMCID: PMC7671781 DOI: 10.3340/jkns.2019.0185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90–1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91–1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.
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Affiliation(s)
- Sanghyun Han
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Bumsoo Park
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong-Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seoung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dae Hwan Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Ahn
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Abstract
PURPOSE OF REVIEW This review aims to identify perioperative patient-related factors that are associated with the development of persistent postoperative pain (PPP) in patients undergoing spine surgery. RECENT FINDINGS Twenty-one studies published between 2000 and 2019 were included in this literature review. The following five patient-related factors were identified to be associated with the development of PPP after spine surgery: anxiety, depression, pain catastrophizing, pain sensitivity, and preoperative opioid consumption. The existing literature suggests that the risk factors for developing chronic pain after spine surgery appear to be similar to those for other types of surgery. Psychological factors and preoperative opioid consumption are associated with developing chronic pain after spinal surgery. Other factors such as gender, age, preoperative pain intensity, and immediate postoperative pain may also be involved but the evidence on this is limited.
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An Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery. Curr Pain Headache Rep 2020; 24:11. [DOI: 10.1007/s11916-020-0842-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rezasoltani Z, Azizi S, Najafi S, Sedighi S, Movahed ME, Dadarkhah A. Transcranial direct current stimulation for nonspecific low back pain: double-blind randomized sham-controlled trial. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Low back pain is recognized as a major cause of morbidity worldwide. Between 70 and 80% of adults experience at least one occasion of low back pain with duration of 3 months or longer in their lifetime. Aside from the classic treatment methods, there are other new techniques yet to be clinically investigated. Transcranial direct current stimulation (tDCS) has been reported to alleviate pain by affecting the central nervous system. To date only a small number of studies have been published on the effects of tDCS on chronic low back pain. Some of these were pilot studies and others were low-powered in terms of their inference. Therefore the clinical application of tDCS requires further careful evaluation. Objective: To assess the efficacy of transcranial direct current stimulation for treatment of chronic nonspecific low back pain. Materials and methods: We carried out a double-blind randomized sham-controlled trial in a University Hospital. In total 70 people (15 women) with low back pain were randomized to either active or sham stimulation. The primary outcome was intensity of low back pain on the Visual Analog Scale. We also used the Oswestry Disability Questionnaire to evaluate the effects of back pain on daily activities. For the active stimulation group we administered 2 mA tDCS, 20 minutes for each session, once daily, 5 days per week for 2 weeks, totaling 10 sessions. For the sham stimulation group a similar program was followed with no stimulation. Both groups used analgesic medication. Results: Within-group analysis showed that an initial decrease in pain intensity was significant in both groups (both p < 0.001). However, pain reduction became stable only in the active treatment group. There was a significant difference in the pattern of change in mean pain scores in favor of tDCS (p < 0.001). Active treatment also significantly reduced disability scores (all p values < 0.001), whereas participants in the sham treatment group did not experience functional recovery. Mixed ANOVA indicated that the pattern of change in mean scores of disability differed between the two groups throughout the study course, in favor of active stimulation (p < 0.001). Conclusion: Transcranial direct current stimulation is an effective and safe initial treatment for chronic nonspecific low back pain, and the benefits remain for at least several months.
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Affiliation(s)
- Zahra Rezasoltani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sirous Azizi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Sharif Najafi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Samaneh Sedighi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Maysam Elahi Movahed
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dadarkhah
- Department of Physical Medicine and Rehabilitation, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Pelegrini ACA, Gasoto E, Bussolaro JM, Segatti G, de Albuquerque CE, Bertolini GRF. The analgesic action of Aussie current in women with non-specific chronic lumbar pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aimsDespite electrostimulation being a common adjuvant therapy for non-specific low back pain, the use of Aussie current for muscle contraction is still underreported in the literature. The present study aimed to assess the use of Aussie current in the treatment of chronic, non-specific lumbar pain.MethodsTwenty-four young women with chronic non-specific low back pain were randomly assigned to the Aussie current group or control group. Pain (visual analogue scale and McGill Pain Questionnaire), function (Oswestry Disability Index), trunk muscle resistance (the time the participant remained in a predefined static position) and multifidus muscle thickness (ultrasound images) were analysed bilaterally before, at the end of and 30 days after completing the treatment protocol. The treatment group received 12 sessions of Aussie current over a period of 4 weeks. The electrodes were arranged laterally and bilaterally to the spinous processes of the first and fifth lumbar vertebrae.ResultsThere was a reduction in the pain profile for the Aussie group, as measured by a visual analogue scale and the McGill Pain Questionnaire. There was an increase in trunk muscle resistance and in muscle thickness in the Aussie group when compared to the control group. There were no changes in the Oswestry Disability Index in either group.ConclusionsAussie current resulted in significant improvements in pain, endurance and muscle thickness in women with chronic, non-specific low back pain.
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Affiliation(s)
| | - Eduardo Gasoto
- Physiotherapy student, Western Paraná State University, Cascavel, Brazil
| | | | - Gabriel Segatti
- Physiotherapy student, Western Paraná State University, Cascavel, Brazil
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Patient’s Preference on Neurosurgeon’s Attire and Appearance: A Single Center Study in Korea Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3893049. [PMID: 31093498 PMCID: PMC6481109 DOI: 10.1155/2019/3893049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
Objective This study was performed to assess neurosurgery patients' preference for surgeon's attire and appearance in the hospital. Methods A total of 100 patients were investigated using a questionnaire comprising 13 questions. We first asked patients about neurosurgeon's appearance including accessories, hair color, mustache, and beard. Then, based on their preferences, they were asked to rank a series of photographs which illustrated a variety of neurosurgeon attires worn by a doctor. Results Professional attire with white coat was the most ideal for patients compared to any other attire (preference scale 5.28 ± 1.24), and there was a significant preference gap between wearing a white coat and not wearing a white coat (p <0.01). Patients expressed a preference for neurosurgeon's shoes (30%) but the majority of the respondents answered that it does not matter which shoes their neurosurgeon wears (43%). Furthermore, the patients did not have any preferences regarding accessories, dyeing, and mustache or beard (58%, 67%, and 51%, respectively), and they did not have negative view towards doctor wearing accessories (71.7%) and growing mustache or beard (71.6%). Conclusion The patients in this study preferred professional attire along with a white coat compared to any other form of outfit. This result is similar to those of many other studies conducted in other departments or other countries. However, patients did not have a strong negative view on accessories, dyeing, and facial hair. With regard to medical training, patients did not show a preference for their neurosurgeon's educational background.
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