Which functional outcome parameters correlate better with elderly patients' satisfaction after non-fusion lumbar spine surgery?

Preoperative risk factors for nonsatisfaction after lumbar interbody fusion

Introduction

Low back pain (LBP) is a common cause of impaired quality of life and disability and studies regarding surgical management of patients with LBP show a high variation in patient-reported success rate.

Research question

To find valuable preoperative clinical risk factors and variables associated with a non-satisfactory patient-reported outcome following surgery.

Materials and methods

The Danish surgical spine database (DaneSpine) was used to collect eight years of pre- and postoperative data on patients undergoing single-level fusions with either posterior- (PLIF) or transforaminal lumbar interbody fusions (TLIF). The primary outcome was patient nonsatisfaction. We collected data on European Quality of Life-5 Dimensions (EQ-5D), visual analogue scale (VAS), Oswestry Disability Index (ODI) score, pain intensity, duration of back pain, previous discectomy, and expectations regarding return to work after surgery at 2-year follow-up.

Results

The cohort included 453 patients of which 19% reported treatment nonsatisfaction. The nonsatisfaction group demonstrated higher preoperative VAS scores for back pain (75 ± 19 vs. 68 ± 21, p = 0.006) and leg pain (65 ± 25 vs. 58 ± 28, p = 0.004). The preoperative EQ-5D score was significantly lower in the nonsatisfaction group (0.203 + 0.262 vs. 0.291 ± 0.312, p = 0.016). There was no statistical significance between patient nonsatisfaction and preoperative ODI score, age, body mass index, duration of back pain or expectations regarding return to work after surgery.

Discussion and conclusion

Low preoperative EQ-5D scores and high VAS leg and back pain scores were statistically significant with patient nonsatisfaction following surgery and may prove to be valuable tools in the preoperative screening and alignment of patient expectations.

Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease

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.

Digital Phenotyping in Patients with Spine Disease: A Novel Approach to Quantifying Mobility and Quality of Life

OBJECTIVE

To identify trends in mobility and daily pain levels among a cohort of patients with clinically diagnosed spine disease.

METHODS

Participants with spine disease were enrolled from a general neurosurgical clinic and installed a smartphone application (Beiwe) designed for digital phenotyping to their personal smartphone. This application collected passive meta-data on a minute-to-minute basis, including global positioning system (GPS), WiFi, accelerometer, text and telephone logs, and screen on and off time. The application also administered daily visual analog scale pain surveys. A linear mixed model framework was used to test for associations between self-reported pain and mobility and sociability from the passively collected data.

RESULTS

A total of 105 patients were enrolled, with a median follow-up time of 94.5 days; 55 patients underwent a surgical intervention during the follow-up period. The weekly pain survey response rate was 73.2%. By the end of follow-up, the mean change in pain for all patients was -1.3 points (4.96 at the start of follow-up to 3.66 by the end of follow-up). Increased pain was significantly associated with reduced patient mobility as measured using 3 daily GPS summary statistics (i.e., average flight length, maximum diameter travelled, total distance travelled).

CONCLUSIONS

Patients with spine disease who reported greater pain had reduced mobility, as measured by the passively collected smartphone GPS data. Smartphone-based digital phenotyping appears to be a promising and scalable approach to assess mobility and quality of life of patients with spine disease.