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Gao M, Zeng Z, Jiang X, Ge J, Song J. Long-term quality of life and influencing factors in elderly patients after vertebroplasty based on the EQ-5D-3L Chinese utility scoring system: a retrospective study. BMC Geriatr 2024; 24:686. [PMID: 39143487 PMCID: PMC11323696 DOI: 10.1186/s12877-024-05249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/25/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The quality of life of elderly patients after vertebroplasty is influenced by various factors. Although the EuroQol 5-Dimension 3-Level (EQ-5D-3L) scale has been widely used to assess quality of life, the factors affecting the long-term postoperative quality of life of elderly vertebroplasty patients in China have not been thoroughly studied. METHODS This retrospective study included 519 patients aged 65 years and older who underwent elective vertebroplasty. We collected baseline data from these patients and conducted telephone follow-ups 12 months postoperation to evaluate their EQ-5D-3L health utility scores and EuroQol Visual Analogue Scale (EQ-VAS) scores. Univariate and multivariate linear regression models were used to analyse the factors affecting quality of life. RESULTS Of the 519 patients, the majority were female (78.0%), aged 65 to 95 years, with an average age of 75.2 years. Twelve months postoperation, pain/discomfort was the most commonly reported issue for 68.4% of patients. The median EQ-5D-3L health utility score was 0.783, with a range between 0.450 and 0.887; the median EQ-VAS score was 75, ranging from 60 to 85. Multivariate linear regression analysis indicated that older age, hormone use, higher American Society of Anesthesiologists (ASA) grades, nondrinking habits, and low albumin levels were found to be independent risk factors affecting long-term quality of life in elderly patients after vertebroplasty. Additionally, a history of tumours, the number of vertebral compression fractures, and bone mineral density were also crucial influencing factors. CONCLUSIONS Based on the use of the EQ-5D-3L Chinese utility scoring system, we evaluated the quality of life of patients aged 65 and above 12 months after vertebroplasty. This study identified several factors related to postoperative quality of life in elderly vertebroplasty patients, providing crucial evidence for further clinical decisions and patient education.
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Affiliation(s)
- Min Gao
- Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, China
- Department of Anesthesiology, The First People's Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Zhen Zeng
- Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, China
| | - Xiuli Jiang
- Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, China
| | - Jianyun Ge
- Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, China.
| | - Jie Song
- Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu Province, China.
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Issa TZ, Haider AA, Lambrechts MJ, Sherman MB, Canseco JA, Vaccaro AR, Schroeder GD, Kepler CK, Hilibrand AS. Preoperative Oswestry Disability Index Should not be Utilized to Determine Surgical Eligibility for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease. Spine (Phila Pa 1976) 2024; 49:965-972. [PMID: 38420655 DOI: 10.1097/brs.0000000000004972] [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: 12/26/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion. SUMMARY OF BACKGROUND DATA As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient-reported outcomes (PROMs) in reimbursement approvals for orthopedic procedures. The feasibility of this has not been investigated in spine surgery. MATERIALS/METHODS We included all adult patients undergoing one to three-level primary lumbar fusion at a single urban tertiary academic center from 2014 to 2020. ODI was collected preoperatively and one year postoperatively. We implemented theoretical threshold cutoffs at increments of 10. MCID was set at 14.3. The percent of patients meeting MCID were determined among patients "approved" or "denied" at each threshold. At each threshold, the positive predictive value (PPV) for MCID attainment was calculated. RESULTS A total 1368 patients were included and 62.4% (N=364) achieved MCID. As the ODI thresholds increased, a greater percent of patients in each group reached the MCID. At the lowest ODI threshold, 6.58% (N=90) of patients would be denied, rising to 20.2%, 39.5%, 58.4%, 79.9%, and 91.4% at ODI thresholds of 30, 40, 50, 60, and 70, respectively. The PPV increased from 0.072 among patients with ODI>20 to 0.919 at ODI>70. The number of patients denied a clinical improvement in the denied category per patient achieving the MCID increased at each threshold (ODI>20: 1.96; ODI>30: 2.40; ODI>40: 2.75; ODI>50: 3.03; ODI>60: 3.54; ODI>70: 3.75). CONCLUSION Patients with poorer preoperative ODI are significantly more likely to achieve MCID following lumbar spine fusion at all ODI thresholds. Setting a preoperative ODI threshold for surgical eligibility will restrict access to patients who may benefit from spine fusion despite ODI>20 demonstrating the lowest predictive value for MCID achievement. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Ameer A Haider
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Matthew B Sherman
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA
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Anwar FN, Roca AM, Loya AC, Medakkar SS, Kaul A, Wolf JC, Federico VP, Sayari AJ, Lopez GD, Singh K. Worse Preoperative 12-Item Veterans Rand Physical Component Scores Prognosticate Inferior Outcomes Following Outpatient Lumbar Decompression. Clin Spine Surg 2024:01933606-990000000-00329. [PMID: 38940436 DOI: 10.1097/bsd.0000000000001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/22/2024] [Indexed: 06/29/2024]
Abstract
STUDY DESIGN Retrospective Review. OBJECTIVE Evaluate the influence of the 12-Item veterans Rand (VR-12) physical component score (PCS) on patient-reported outcome measures (PROMs) in an outpatient lumbar decompression (LD) cohort. SUMMARY OF BACKGROUND DATA The influence of baseline VR-12 PCS on postoperative clinical outcomes has not been evaluated in patients undergoing outpatient LD. METHODS Patients undergoing primary, elective, 1/2-level outpatient LD with baseline VR-12 PCS scores were retrospectively identified from a prospectively maintained single-surgeon database. Cohorts were preoperative VR-12 PCS<30 and VR-12 PCS≥30. Patient/perioperative characteristics and preoperative/postoperative 6-week/final follow-up (FF) PROMs were collected. Physical health PROMs included the VR-12 PCS, 12-Item Short Form (SF-12) PCS, patient-reported outcome measure information system-physical function (PROMIS-PF), visual analog scale (VAS)-back/leg, and Oswestry disability index (ODI). Mental health PROMs included the VR-12/SF-12 mental component score (MCS) and the patient-health questionnaire-9 (PHQ-9). Average FF was 13.8±8.9 months postoperatively. PROM improvements at 6 weeks/FF and minimal clinically important difference (MCID) achievement rates were determined. χ2 analysis and the Student's t tests compared demographics, perioperative data, and preoperative PROMs. Multivariate linear/logistic regression compared postoperative PROMs, PROM improvements, and MCID achievement rates. RESULTS Six weeks postoperatively, VR-12 PCS<30 reported worse baseline PROMs (P≤0.042, all) and worse scores except VR-12/SF-12 MCS (P≤0.043, all). Compared with VR-12 PCS≥30, VR-12 PCS<30 had worse FF VR-12 PCS, SF-12 PCS/MCS, PROMIS-PF, PHQ-9, and VAS-Back (P≤0.033, all). VR-12 PCS<30 experienced greater 6-week improvements in VR-12/SF-12 PCS, PHQ-9, VAS-Back, and ODI (P≤0.039, all). VR-12 PCS<30 had greater FF improvements in VR-12/SF-12 PCS, PHQ-9, and ODI (P≤0.001, all) and greater overall MCID achievement in VR-12 PCS/MCS, SF-12 PCS, PHQ-9, and ODI (P≤0.033, all). CONCLUSIONS VR-12 PCS<30 patients-reported worse baseline/postoperative mental/physical health scores. However, they reported greater improvements in physical function, depressive burden, back pain, and disability by 6 weeks and FF and experienced greater MCID achievement for physical functioning, mental health, and disability scores.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Aayush Kaul
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jacob C Wolf
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago
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Anwar FN, Roca AM, Hartman TJ, Nie JW, Medakkar SS, Loya AC, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Sayari AJ, Lopez GD, Singh K. Worse Pain and Disability at Presentation Predicts Greater Improvement in Pain, Disability, and Mental Health in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis. Clin Spine Surg 2024:01933606-990000000-00330. [PMID: 38940454 DOI: 10.1097/bsd.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
STUDY DESIGN Retrospective Review. OBJECTIVE To assess the impact of preoperative pain and disability on patient-reported outcome measures (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA Varying preoperative symptom severity in lumbar fusion patients alters perceptions of surgical success. METHODS Degenerative spondylolisthesis patients undergoing elective, primary, single-level MI-TLIF were stratified by preoperative symptom severity: Mild (VAS-B<7/ODI<50), Moderate (VAS-B≥7/ODI<50 or VAS-B<7/ODI≥50), and Severe (VAS-B≥7/ODI≥50). PROMs, Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), ODI, VAS-B, VAS-Leg (VAS-L), and 9-item Patient Health Questionnaire (PHQ-9) were compared at baseline, 6 weeks, and final follow-up (μ=16.3±8.8 mo). Postoperative PROMs, magnitudes of improvement, and minimal clinically important difference (MCID) achievement rates were compared between cohorts through multivariable regression. RESULTS A total of 177 patients were included. Acute postoperative pain and narcotic consumption were highest in the severe cohort (P≤0.003). All preoperative PROMs worsened from mild to severe cohorts (P<0.001). All PROMs continued to be significantly different between cohorts at 6 weeks and final follow-up, with the worst scores in the Severe cohort (P≤0.003). At 6 weeks, all cohorts improved in ODI, VAS-B, VAS-L, and PHQ-9 (P≤0.003), with the Moderate cohort also improving in PROMIS-PF (P=0.017). All Cohorts improved across PROMs at the final follow-up (P≤0.044). Magnitudes of improvement in ODI, VAS-B, and PHQ-9 increased with worsening preoperative symptom severity (P≤0.042). The Moderate and Severe cohorts demonstrated higher MCID achievement in ODI, VAS-B, and PHQ-9 rates than the Mild cohort. CONCLUSIONS Despite preoperative pain and disability severity, patients undergoing MI-TLIF for degenerative spondylolisthesis report significant improvement in physical function, pain, disability, and mental health postoperatively. Patients with increasing symptom severity continued to report worse severity postoperatively compared with those with milder symptoms preoperatively but were more likely to report larger improvements and achieve clinically meaningful improvement in disability, pain, and mental health.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Issa TZ, Tarawneh OH, Ezeonu T, Haider AA, Narayanan R, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The attainment of a patient acceptable symptom state in patients undergoing revision spine fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08358-8. [PMID: 38913182 DOI: 10.1007/s00586-024-08358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision. METHODS We retrospectively identified all 1-3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22. RESULTS We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47). CONCLUSIONS The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations.
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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Feinberg School of Medicine, Northwestern University, 420 E Superior St Chicago Il, Chicago, IL, 60611, USA.
| | - Omar H Tarawneh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ameer A Haider
- Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Asthana S, Walker J, Staub J, Bajaj P, Reyes S, Shlobin NA, Beestrum M, Hsu WK, Patel AA, Divi SN. Preference Sensitive Care and Shared Decision-Making in Lumbar Spinal Stenosis: A Scoping Review. Spine (Phila Pa 1976) 2024; 49:788-797. [PMID: 38369716 DOI: 10.1097/brs.0000000000004952] [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: 10/20/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
STUDY DESIGN Scoping review. OBJECTIVE The objective of this study was to conduct a scoping review exploring the extent to which preference sensitivity has been studied in treatment decisions for lumbar spinal stenosis (LSS), utilizing shared decision-making (SDM) as a proxy. BACKGROUND Preference-sensitive care involves situations where multiple treatment options exist with significant tradeoffs in cost, outcome, recovery time, and quality of life. LSS has gained research focus as a preference-sensitive care scenario. MATERIALS AND METHODS A scoping review protocol in accordance with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews" regulations was registered with the Open Science Framework (ID: 9ewup) and conducted across multiple databases from January 2000 to October 2022. Study selection and characterization were performed by 3 independent reviewers and an unbiased moderator. RESULTS The search resulted in the inclusion of 16 studies varying in design and sample size, with most published between 2016 and 2021. The studies examined variables related to SDM, patient preferences, surgeon preferences, and decision aids (DAs). The outcomes assessed included treatment choice, patient satisfaction, and patient understanding. Several studies reported that SDM influenced treatment choice and patient satisfaction, while the impact on patient understanding was less clear. DAs were used in some studies to facilitate SDM. CONCLUSION The scoping review identified a gap in comprehensive studies analyzing the preference sensitivity of treatment for LSS and the role of DAs. Further research is needed to better understand the impact of patient preferences on treatment decisions and the effectiveness of DAs in LSS care. This review provides a foundation for future research in preference-sensitive care and SDM in the context of lumbar stenosis treatment.
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Affiliation(s)
- Shravan Asthana
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James Walker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob Staub
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pranav Bajaj
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Samuel Reyes
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nathan A Shlobin
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Molly Beestrum
- Department of Research and Information Services, Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Chicago, IL
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Carreon LY, Glassman SD, Mummaneni P, Bydon M, Chan AK, Asher A. Assessment of the External Validity of Dialogue Support for Predicting Lumbar Spine Surgery Outcomes in a US Cohort. Spine (Phila Pa 1976) 2024; 49:E107-E113. [PMID: 37235812 DOI: 10.1097/brs.0000000000004728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN External validation using prospectively collected data. OBJECTIVES To determine the model performance of "Dialogue Support" (DS) in predicting outcomes after lumbar spine surgery. SUMMARY OF BACKGROUND DATA To help clinicians discuss risk versus benefit with patients considering lumbar fusion surgery, DS has been made available online. As DS was created using a Swedish sample, there is a need to study how well DS performs in alternative populations. PATIENTS AND METHODS Preoperative data from patients enrolled in the Quality Outcomes Database were entered into DS. The probability for each patient to report satisfaction, achieve success (leg pain improvement ≥3), or have no leg pain 12 months after surgery was extracted and compared with their actual 12-month postoperative data. The ability of DS to identify patients in the Quality Outcomes Database who report satisfaction, achieve success, or have no leg pain 12 months after surgery was determined using Receiver operating characteristic curve analysis, goodness-of-fit tests, and calibration plots. RESULTS There was a significant improvement in all outcomes in 23,928 cases included in the analysis from baseline to 12 months postoperative. Most (84%) reported satisfaction, 67% achieved success, and 44% were pain-free 12 months postoperative. Receiver operating characteristic analysis showed that DS had a low ability to predict satisfaction [area under the curve (AUC) = 0.606], success (AUC = 0.546), and being pain-free (AUC = 0.578) at 12 months postoperative; poor fit for satisfaction (<0.001) and being pain-free ( P = 0.004), but acceptable fit for success ( P = 0.052). Calibration plots showed underestimation for satisfaction and success, but acceptable estimates for being pain-free. CONCLUSION DS is not directly transferable to predict satisfaction and success after lumbar surgery in a US population. This may be due to differences in patient characteristics, weights of the variables included, or the exclusion of unknown variables associated with outcomes. Future studies to better understand and improve the transferability of these models are needed.
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Affiliation(s)
| | | | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester; Rochester, MN
| | - Andrew K Chan
- The Neurological Institute of New York, New York, NY
| | - Anthony Asher
- Carolina Neurosurgery and Spine Associates, Charlotte, NC
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Adjei J, Tang M, Lipa S, Oyekan A, Woods B, Mesfin A, Hogan MV. Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States. J Bone Joint Surg Am 2024; 106:631-638. [PMID: 38386767 DOI: 10.2106/jbjs.22.01155] [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] [Indexed: 02/24/2024]
Abstract
➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.
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Affiliation(s)
- Joshua Adjei
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaina Lipa
- Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barrett Woods
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Van Bogaert W, Coppieters I, Nijs J, Buyl R, Ickmans K, Moens M, Goudman L, Putman K, Huysmans E. Influence of Preoperative Pain, Cognitions, and Quantitative Sensory Testing Measures on the Effects of Perioperative Pain Neuroscience Education for People Receiving Surgery for Lumbar Radiculopathy: Secondary Analysis of a Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:279-288. [PMID: 38189683 DOI: 10.2519/jospt.2024.12051] [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] [Indexed: 01/09/2024]
Abstract
OBJECTIVE: To explore whether preoperative pain intensity, pain cognitions, and quantitative sensory measures influence the established effectiveness of perioperative pain neuroscience education (PPNE) on health-related quality of life at 1 year after surgery for lumbar radiculopathy. DESIGN: Secondary analysis of a triple-blinded randomized controlled trial. METHODS: Participants (n = 90) were Dutch-speaking adults (18-65 years) who were scheduled for surgery for lumbar radiculopathy in 3 Belgian hospitals. They were randomized (1:1) to receive PPNE (n = 41) or perioperative biomedical education (n = 49). Linear mixed models were built for health-related quality of life (ie, SF-6D utility values, Physical and Mental Component of the 36-item Short Form Health Survey) using the following independent variables: therapy, time, and preoperative scores for back and leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and quantitative sensory measures. RESULTS: The impact of PPNE on SF-6D utility values over time was influenced by kinesiophobia (F = 3.30, P = .02) and leg pain intensity (F = 3.48, P = .02). Regardless of the intervention, back pain intensity negatively influenced SF-6D values over time (F = 3.99, P = .009). The Physical Component scores were negatively impacted by back pain intensity (F = 9.08, P = .003) and were influenced over time by leg pain intensity (F = 2.87, P = .04). The Mental Component scores were negatively impacted by back pain intensity (F = 6.64, P = .01) and pain catastrophizing (F = 5.42, P = .02), as well as hypervigilance (F = 3.16, P = .03) and leg pain intensity (F = 3.12, P = .03) over time. CONCLUSION: PPNE may be more effective than perioperative biomedical education in improving postoperative health utility values in patients who reported higher kinesiophobia and leg pain intensity before surgery for lumbar radiculopathy. J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 8 January 2024. doi:10.2519/jospt.2024.12051.
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Carreon LY, Nian H, Archer KR, Andersen MØ, Hansen KH, Glassman SD. Performance of the streamlined quality outcomes database web-based calculator: internal and external validation. Spine J 2024; 24:662-669. [PMID: 38081465 DOI: 10.1016/j.spinee.2023.11.024] [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: 06/14/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND CONTEXT With an increasing number of web-based calculators designed to provide the probabilities of an individual achieving improvement after lumbar spine surgery, there is a need to determine the accuracy of these models. PURPOSE To perform an internal and external validation study of the reduced Quality Outcomes Database web-based Calculator (QOD-Calc). STUDY DESIGN Observational longitudinal cohort. PATIENT SAMPLE Patients enrolled study-wide in Quality Outcomes Database (QOD) and patients enrolled in DaneSpine at a single institution who had elective lumbar spine surgery with baseline data to complete QOD-Calc and 12-month postoperative data. OUTCOME MEASURES Oswestry Disability Index (ODI), Numeric Rating Scales (NRS) for back and leg pain, EuroQOL-5D (EQ-5D). METHODS Baseline data elements were entered into QOD-Calc to determine the probability for each patient having Any Improvement and 30% Improvement in NRS leg pain, back pain, EQ-5D and ODI. These probabilities were compared with the actual 12-month postop data for each of the QOD and DaneSpine cases. Receiver-operating characteristics analyses were performed and calibration plots created to assess model performance. RESULTS 24,755 QOD cases and 8,105 DaneSpine lumbar cases were included in the analysis. QOD-Calc had acceptable to outstanding ability (AUC: 0.694-0.874) to predict Any Improvement in the QOD cohort and moderate to acceptable ability (AUC: 0.658-0.747) to predict 30% Improvement. QOD-Calc had acceptable to exceptional ability (AUC: 0.669-0.734) to predict Any improvement and moderate to exceptional ability (AUC: 0.619-0.862) to predict 30% Improvement in the DaneSpine cohort. AUCs for the DaneSpine cohort was consistently lower that the AUCs for the QOD validation cohort. CONCLUSION QOD-Calc performs well in predicting outcomes in a patient population that is similar to the patients that was used to develop it. Although still acceptable, model performance was slightly worse in a distinct population, despite the fact that the sample was more homogenous. Model performance may also be attributed to the low discrimination threshold, with close to 90% of cases reporting Any Improvement in outcome. Prediction models may need to be developed that are highly specific to the characteristics of the population.
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Affiliation(s)
- Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY, USA; Center for Spine Surgery and Research, Region of Southern Denmark, Østre Hougvej 55, DK-5500, Middelfart, Denmark; Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, DK-5000, Odense, Denmark.
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Kristin R Archer
- Center for Musculoskeletal Research, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, TN, 37232 USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN, 37212, USA
| | - Mikkel Ø Andersen
- Center for Spine Surgery and Research, Region of Southern Denmark, Østre Hougvej 55, DK-5500, Middelfart, Denmark; Institute of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 3, DK-5000, Odense, Denmark
| | - Karen Højmark Hansen
- Center for Spine Surgery and Research, Region of Southern Denmark, Østre Hougvej 55, DK-5500, Middelfart, Denmark
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY, USA
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11
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Khosla I, Anwar FN, Roca AM, Medakkar SS, Loya AC, Kaul A, Wolf JC, Federico VP, Sayari AJ, Lopez GD, Singh K. Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis. Neurospine 2024; 21:253-260. [PMID: 38317557 PMCID: PMC10992647 DOI: 10.14245/ns.2347080.540] [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: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To evaluate preoperative disability's influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS). METHODS DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests. RESULTS Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all). CONCLUSION Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.
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Affiliation(s)
- Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Fatima N. Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrea M. Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Srinath S. Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexandra C. Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aayush Kaul
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Jacob C. Wolf
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Arash J. Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory D. Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Kweh BTS, Lee HQ, Tan T, Liew S, Hunn M, Wee Tee J. Posterior Instrumented Spinal Surgery Outcomes in the Elderly: A Comparison of the 5-Item and 11-Item Modified Frailty Indices. Global Spine J 2024; 14:593-602. [PMID: 35969642 PMCID: PMC10802518 DOI: 10.1177/21925682221117139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES To validate the most concise risk stratification system to date, the 5-item modified frailty index (mFI-5), and compare its effectiveness with the established 11-item modified frailty index (mFI-11) in the elderly population undergoing posterior instrumented spine surgery. METHODS A single centre retrospective review of posterior instrumented spine surgeries in patients aged 65 years and older was conducted. The primary outcome was rate of post-operative major complications (Clavien-Dindo Classification ≥ 4). Secondary outcome measures included rate of all complications, 6-month mortality and surgical site infection. Multi-variate analysis was performed and adjusted receiver operating characteristic curves were generated and compared by DeLong's test. The indices were correlated with Spearman's rho. RESULTS 272 cases were identified. The risk of major complications was independently associated with both the mFI-5 (OR 1.89, 95% CI 1.01-3.55, P = .047) and mFI-11 (OR 3.73, 95% CI 1.90-7.30, P = .000). Both the mFI-5 and mFI-11 were statistically significant predictors of risk of all complications (P = .007 and P = .003), surgical site infection (P = .011 and P = .003) and 6-month mortality (P = .031 and P = .000). Adjusted ROC curves determined statistically similar c-statistics for major complications (.68 vs .68, P = .64), all complications (.66 vs .64, P = .10), surgical site infection (.75 vs .75, P = .76) and 6-month mortality (.83 vs .81, P = .21). The 2 indices correlated very well with a Spearman's rho of .944. CONCLUSIONS The mFI-5 and mFI-11 are equally effective predictors of postoperative morbidity and mortality in this population. The brevity of the mFI-5 is advantageous in facilitating its daily clinical use.
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Affiliation(s)
- Barry T. S. Kweh
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Terence Tan
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Susan Liew
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Orthopaedics, The Alfred Hospital, Melbourne, VIC, Australia
| | - Martin Hunn
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, The Alfred Hospital, Melbourne, VIC, Australia
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13
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Berg B, Gorosito MA, Fjeld O, Haugerud H, Storheim K, Solberg TK, Grotle M. Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery. JAMA Netw Open 2024; 7:e2355024. [PMID: 38324310 PMCID: PMC10851101 DOI: 10.1001/jamanetworkopen.2023.55024] [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: 08/08/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
Importance Lumber disc herniation surgery can reduce pain and disability. However, a sizable minority of individuals experience minimal benefit, necessitating the development of accurate prediction models. Objective To develop and validate prediction models for disability and pain 12 months after lumbar disc herniation surgery. Design, Setting, and Participants A prospective, multicenter, registry-based prognostic study was conducted on a cohort of individuals undergoing lumbar disc herniation surgery from January 1, 2007, to May 31, 2021. Patients in the Norwegian Registry for Spine Surgery from all public and private hospitals in Norway performing spine surgery were included. Data analysis was performed from January to June 2023. Exposures Microdiscectomy or open discectomy. Main Outcomes and Measures Treatment success at 12 months, defined as improvement in Oswestry Disability Index (ODI) of 22 points or more; Numeric Rating Scale (NRS) back pain improvement of 2 or more points, and NRS leg pain improvement of 4 or more points. Machine learning models were trained for model development and internal-external cross-validation applied over geographic regions to validate the models. Model performance was assessed through discrimination (C statistic) and calibration (slope and intercept). Results Analysis included 22 707 surgical cases (21 161 patients) (ODI model) (mean [SD] age, 47.0 [14.0] years; 12 952 [57.0%] males). Treatment nonsuccess was experienced by 33% (ODI), 27% (NRS back pain), and 31% (NRS leg pain) of the patients. In internal-external cross-validation, the selected machine learning models showed consistent discrimination and calibration across all 5 regions. The C statistic ranged from 0.81 to 0.84 (pooled random-effects meta-analysis estimate, 0.82; 95% CI, 0.81-0.84) for the ODI model. Calibration slopes (point estimates, 0.94-1.03; pooled estimate, 0.99; 95% CI, 0.93-1.06) and calibration intercepts (point estimates, -0.05 to 0.11; pooled estimate, 0.01; 95% CI, -0.07 to 0.10) were also consistent across regions. For NRS back pain, the C statistic ranged from 0.75 to 0.80 (pooled estimate, 0.77; 95% CI, 0.75-0.79); for NRS leg pain, the C statistic ranged from 0.74 to 0.77 (pooled estimate, 0.75; 95% CI, 0.74-0.76). Only minor heterogeneity was found in calibration slopes and intercepts. Conclusion The findings of this study suggest that the models developed can inform patients and clinicians about individual prognosis and aid in surgical decision-making.
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Affiliation(s)
- Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Martin A. Gorosito
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Olaf Fjeld
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hårek Haugerud
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Tore K. Solberg
- Institute of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
- The Norwegian Registry for Spine Surgery, The University Hospital of North Norway, Tromsø, Norway
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
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14
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Zaina F, Mutter U, Donzelli S, Lusini M, Kleinstueck FS, Mannion AF. How well can the clinician appraise the patient's perception of the severity and impact of their back problem? 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 2024; 33:39-46. [PMID: 37980278 DOI: 10.1007/s00586-023-08023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE A main concern of patients with back problems is pain and its impact on function and quality of life. These are subjective phenomena, and should be probed during the clinical consultation so that the physician can ascertain the extent of the problem. This study evaluated the agreement between clinicians' and patients' independent ratings of patient status on the Core Outcome Measures Index (COMI). METHODS This was an analysis of the data from 5 spine specialists and 108 patients, in two centres. Prior to the consultation, the patient completed the COMI. After the consultation, the clinician (blind to the patient's version) also completed a COMI. Concordance was assessed by % agreement, Kappa values, Bland-Altman plots, Spearman rank, Intraclass Correlation Coefficients and comparisons of mean values, as appropriate. RESULTS Agreement regarding the "main problem" (back pain, leg/buttock pain, sensory disturbances, other) was 83%, Kappa = 0.70 (95%CI 0.58-0.81). Moderate/strong correlations were found between the doctors' and patients' COMI-item ratings (0.48-0.74; p < 0.0001), although compared with the patients' ratings the doctors systematically underestimated absolute values for leg pain (p = 0.002) and dissatisfaction with symptom state (p = 0.002), and overestimated how much the patient's function was impaired (p = 0.029). CONCLUSION The doctors were able to ascertain the location of the main problem and the multidimensional outcome score with good accuracy, but some individual domains were systematically underestimated (pain, symptom-specific well-being) or overestimated (impairment of function). More detailed/direct questioning on these domains during the consultation might deliver a better appreciation of the impact of the back problem on the patient's daily life.
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Affiliation(s)
- F Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - U Mutter
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - S Donzelli
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - M Lusini
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - F S Kleinstueck
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - A F Mannion
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland.
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15
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Ashida Y, Miki T, Kondo Y, Takebayashi T. Influence of radiological factors, psychosocial factors, and central sensitization-related symptoms on clinical symptoms in patients with lumbar spinal canal stenosis. J Back Musculoskelet Rehabil 2024; 37:369-377. [PMID: 37955077 DOI: 10.3233/bmr-230093] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND No study to date has concurrently evaluated the impact of radiological factors, psychosocial factors, and central sensitization (CS) related symptoms in a single lumbar spinal canal stenosis (LSS) patient cohort. OBJECTIVE To investigate the associations between these factors and clinical symptoms in LSS patients. METHODS We recruited 154 patients with LSS scheduled for surgery. Patient-reported outcome measures and imaging evaluation including clinical symptoms, psychosocial factors, CS-related symptoms, and radiological classifications. Spearman's rank correlation coefficient and multiple regression analyses were employed. RESULTS Spearman's correlation revealed CS-related symptoms positively correlated with low back pain (r= 0.25, p< 0.01), leg pain (r= 0.26, p< 0.01), and disability (r= 0.32, p< 0.01). Pain catastrophizing positively correlated with leg pain (r= 0.23, p< 0.01) and disability (r= 0.36, p< 0.01). Regression analysis showed that pain catastrophizing was associated with disability (β= 0.24, 95%CI = 0.03-0.18), and CS-related symptoms with low back pain (β= 0.28, 95%CI = 0.01-0.09). Radiological classifications were not associated with clinical symptoms. CONCLUSION Our findings suggest that psychosocial factors and CS-related symptoms, rather than radiological factors, seem to contribute to clinical symptoms in patients with LSS.
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Affiliation(s)
- Yuzo Ashida
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Takahiro Miki
- PREVENT Inc., Nagoya, Japan
- Graduate School, Hokkaido University, Sapporo, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
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16
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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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Jakobsson M, Hagströmer M, Lotzke H, von Rosen P, Lundberg M. Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder. BMC Musculoskelet Disord 2023; 24:874. [PMID: 37950235 PMCID: PMC10636920 DOI: 10.1186/s12891-023-06980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery. METHODS Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders. RESULTS Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points. CONCLUSIONS Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.
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Affiliation(s)
- Max Jakobsson
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- The Back in Motion Research group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, Stockholm, SE, 11486, Sweden
| | - Hanna Lotzke
- Department of Rehabilitation, Ängelholm Hospital, Ängelholm, Sweden
| | - Philip von Rosen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mari Lundberg
- The Back in Motion Research group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, Stockholm, SE, 11486, Sweden.
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
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18
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Lee Y, Issa TZ, Vaccaro AR. State-of-the-art Applications of Patient-Reported Outcome Measures in Spinal Care. J Am Acad Orthop Surg 2023; 31:e890-e897. [PMID: 36727887 DOI: 10.5435/jaaos-d-22-01009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Patient-reported outcome measures (PROMs) assign objective measures to patient's subjective experiences of health, pain, disability, function, and quality of life. PROMs can be useful for providers in shared decision making, outcome assessment, and indicating patients for surgery. In this article, we provide an overview of the legacy PROMs used in spinal care, recent advancements in patient-reported outcomes, and future directions in PROMs. Recent advances in patient-reported outcome assessments have included standardization of measurement tools, integration of data collection into workflow, and applications of outcome measures in predictive models and decision-making tools. Continual appraisal of instruments and incorporation into artificial intelligence and machine learning analytics will continue to augment the delivery of high-value spinal care.
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Affiliation(s)
- Yunsoo Lee
- From the Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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Segelcke D, Rosenberger DC, Pogatzki-Zahn EM. Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges. Curr Opin Anaesthesiol 2023; 36:580-588. [PMID: 37552002 DOI: 10.1097/aco.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW Prognostic models for chronic postsurgical pain (CPSP) aim to predict the likelihood for development and severity of CPSP in individual patients undergoing surgical procedures. Such models might provide valuable information for healthcare providers, allowing them to identify patients at higher risk and implement targeted interventions to prevent or manage CPSP effectively. This review discusses the latest developments of prognostic models for CPSP, their challenges, limitations, and future directions. RECENT FINDINGS Numerous studies have been conducted aiming to develop prognostic models for CPSP using various perioperative factors. These include patient-related factors like demographic variables, preexisting pain conditions, psychosocial aspects, procedure-specific characteristics, perioperative analgesic strategies, postoperative complications and, as indicated most recently, biomarkers. Model generation, however, varies and performance and accuracy differ between prognostic models for several reasons and validation of models is rather scarce. SUMMARY Precise methodology of prognostic model development needs advancements in the field of CPSP. Development of more accurate, validated and refined models in large-scale cohorts is needed to improve reliability and applicability in clinical practice and validation studies are necessary to further refine and improve the performance of prognostic models for CPSP.
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Affiliation(s)
- Daniel Segelcke
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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20
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Hartman TJ, Nie JW, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Neck Disability Index as a Prognostic Factor for Outcomes Following Cervical Disc Replacement. Clin Spine Surg 2023; 36:310-316. [PMID: 37053118 DOI: 10.1097/bsd.0000000000001459] [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: 07/13/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE We aim to elucidate the potential relationship between neck disability index (NDI) and outcomes following cervical disk replacement (CDR). SUMMARY OF BACKGROUND DATA The use of preoperative disability scores as predictors of outcomes following spine surgery has previously been studied, yet no literature has been published regarding its use in CDR. METHODS A retrospective database of a single orthopedic spine surgeon was searched for single-level CDR patients with preoperative NDI scores, excluding those with trauma, infection, or malignancy. Patients were separated into 2 cohorts by NDI score: Mild-Moderately Disabled (MD) (NDI<50) and Severely Disabled (NDI≥50). Patient-reported outcome measures were collected and compared within and between groups up to 1 year postoperatively and included Patient-reported Outcome Measurement Information System Physical Function, 12-Item Short Form (SF-12) Physical Component Score and Mental Component Score, visual analog scale (VAS) neck and arm pain, and NDI. MCID achievement rates were compared between the groups. RESULTS All PROM scores significantly improved for both cohorts at one or more postoperative time points compared with preoperative baseline ( P ≤0.049, all), with the exception of SF-12 Mental Component Score, which only significantly improved in the MD cohort at 2 postoperative points ( P ≤0.007, both). Between groups, the MD cohort reported significantly superior scores at one or more time points for all studied patient-reported outcome measures ( P ≤0.047, all). MCID achievement rate did not significantly vary for any outcome at any time between cohorts. CONCLUSION Regardless of preoperative disability, both groups reported improvement in physical function, pain, and disability scores following CDR. While not finding significance, patients with severe disability preoperatively consistently demonstrated higher minimal clinically important difference achievement in NDI. These data do not promote the use of NDI as a prognostic factor for outcomes following CDR. Further study with larger patient populations may be useful to clarify this potential relationship.
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Affiliation(s)
- Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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21
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Lentz TA, Stephens BF, Abtahi AM, Schwarz J, Schoenfeld AJ, Rhoten BA, Block S, O'Brien A, Archer KR. Leveraging web-based prediction calculators to set patient expectations for elective spine surgery: a qualitative study to inform implementation. BMC Med Inform Decis Mak 2023; 23:149. [PMID: 37537577 PMCID: PMC10399016 DOI: 10.1186/s12911-023-02234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Prediction calculators can help set outcomes expectations following orthopaedic surgery, however effective implementation strategies for these tools are unknown. This study evaluated provider and patient perspectives on clinical implementation of web-based prediction calculators developed using national prospective spine surgery registry data from the Quality Outcomes Database. METHODS We conducted semi-structured interviews in two health systems, Vanderbilt University Medical Center (VUMC) and Duke University Health System (DUHS) of orthopedic and neurosurgery health care providers (VUMC: n = 19; DUHS: n = 6), health care administrators (VUMC: n = 9; DUHS: n = 9), and patients undergoing elective spine surgery (VUMC: n = 16). Qualitative template analysis was used to analyze interview data, with a focus on end-user perspectives regarding clinical implementation of web-based prediction tools. RESULTS Health care providers, administrators and patients overwhelmingly supported the use of the calculators to help set realistic expectations for surgical outcomes. Some clinicians had questions about the validity and applicability of the calculators in their patient population. A consensus was that the calculators needed seamless integration into clinical workflows, but there was little agreement on best methods for selecting which patients to complete the calculators, timing, and mode of completion. Many interviewees expressed concerns that calculator results could influence payers, or expose risk of liability. Few patients expressed concerns over additional survey burden if they understood that the information would directly inform their care. CONCLUSIONS Interviewees had a largely positive opinion of the calculators, believing they could aid in discussions about expectations for pain and functional recovery after spine surgery. No single implementation strategy is likely to be successful, and strategies vary, even within the same healthcare system. Patients should be well-informed of how responses will be used to deliver better care, and concerns over how the calculators could impact payment and liability should be addressed prior to use. Future research is necessary to determine whether use of calculators improves management and outcomes for people seeking a surgical consult for spine pain.
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Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob Schwarz
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Shannon Block
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex O'Brien
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Brintz CE, Coronado RA, Schlundt DG, Jenkins CH, Bird ML, Bley JA, Pennings JS, Wegener ST, Archer KR. A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients' Expectations, Experiences, and Satisfaction. Spine (Phila Pa 1976) 2023; 48:E235-E244. [PMID: 36580586 PMCID: PMC10949898 DOI: 10.1097/brs.0000000000004520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/18/2022] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Qualitative interview study. OBJECTIVE The aim was to develop a conceptual model for Spine Surgery Recovery in order to better understand why patients undergo lumbar spine surgery and what factors influence patient satisfaction. SUMMARY OF BACKGROUND DATA Quantitative studies have assessed patients' expectations for lumbar spine surgery outcomes, with greater expectation fulfillment leading to higher satisfaction. However, there is limited literature using qualitative methods to understand the patient perspective from the decision to undergo lumbar spine surgery through long-term recovery. MATERIALS AND METHODS Semistructured phone interviews were conducted with 20 participants (nine females, mean age ±SD=61.2±11.1 yr) and three focus groups with 12 participants (nine females, mean age ±SD=62.0±10.9 yr). Sessions were audio recorded and transcribed. Two independent researchers coded the transcripts using a hierarchical coding system. Major themes were identified and a conceptual model was developed. RESULTS A total of 1355 coded quotes were analyzed. The decision to have lumbar spine surgery was influenced by chronic pain impact on daily function, pain coping, and patient expectations. Results demonstrated that fulfilled expectations and setting realistic expectations are key factors for patient satisfaction after surgery, while less known constructs of accepting limitations, adjusting expectations, and optimism were found by many patients to be essential for a successful recovery. Emotional factors of fear, anxiety, and depression were important aspects of presurgical and postsurgical experiences. CONCLUSION Our Spine Surgery Recovery conceptual model provides guidance for future research and clinical practice to optimize treatment and improve overall patient satisfaction. Recommendations based on this model include the assessment of patient expectations and mental well-being throughout postoperative recovery as well as preoperatively to help set realistic expectations and improve satisfaction. Educational, acceptance-based or positive psychological interventions may be potentially beneficial for addressing key factors identified in this model.
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Affiliation(s)
- Carrie E. Brintz
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rogelio A. Coronado
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Mackenzie L. Bird
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jordan A. Bley
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S. Pennings
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen T. Wegener
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristin R. Archer
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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23
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Agarwal N, White MD, Roy S, Ozpinar A, Alan N, Lavadi RS, Okonkwo DO, Hamilton DK, Kanter AS. Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion. Neurosurgery 2023; 93:60-65. [PMID: 36757328 DOI: 10.1227/neu.0000000000002371] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The long-term durability of stand-alone lateral lumbar interbody fusion (LLIF) remains unknown. OBJECTIVE To evaluate whether early patient-reported outcome measures after stand-alone LLIF are sustained on long-term follow-up. METHODS One hundred and twenty-six patients who underwent stand-alone LLIF between 2009 and 2017 were included in this study. Patient-reported outcome measures included the Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), and visual analog score (VAS) scores. Durable outcomes were defined as scores showing a significant improvement between preoperative and 6-week scores without demonstrating any significant decline at future time points. A repeated measures analysis was conducted using generalized estimating equations (model) to assess the outcome across different postoperative time points, including 6 weeks, 1 year, 2 years, and 5 years. RESULTS ODI scores showed durable improvement at 5-year follow-up, with scores improving from 46.9 to 38.5 ( P = .001). Improvements in EQ-5D showed similar durability up to 5 years, improving from 0.48 to 0.65 ( P = .03). VAS scores also demonstrated significant improvements postoperatively that were durable at 2-year follow-up, improving from 7.0 to 4.6 ( P < .0001). CONCLUSION Patients undergoing stand-alone LLIF were found to have significant improvements in ODI and EQ-5D at 6-week follow-up that remained durable up to 5 years postoperatively. VAS scores were found to be significantly improved at 6 weeks and up to 2 years postoperatively but failed to reach significance at 5 years. These findings demonstrate that patients undergoing stand-alone LLIF show significant improvement in overall disability after surgery that remains durable at long-term follow-up.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael D White
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hoag Specialty Clinic, Hoag Neurosciences Institute, Newport Beach, California, USA
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24
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Touponse G, Li G, Rangwalla T, Beach I, Zygourakis C. Socioeconomic Effects on Lumbar Fusion Outcomes. Neurosurgery 2023; 92:905-914. [PMID: 36606803 PMCID: PMC10158874 DOI: 10.1227/neu.0000000000002322] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recent studies suggest that socioeconomic status (SES) influences outcomes after spinal fusion. The influence of SES on postoperative outcomes is increasingly relevant as rates of lumbar fusion rise. OBJECTIVE To determine the influence of SES variables including race, education, net worth, and homeownership on postoperative outcomes. METHODS Optum's deidentified Clinformatics Data Mart Database was used to conduct a retrospective review of SES variables for patients undergoing first-time, inpatient lumbar fusion from 2003 to 2021. Primary outcomes included hospital length of stay (LOS) and 30-day reoperation, readmission, and postoperative complication rates. Secondary outcomes included postoperative emergency room visits, discharge status, and total hospital charges. RESULTS In total, 217 204 patients were identified. On multivariate analysis, Asian, Black, and Hispanic races were associated with increased LOS (Coeff. [coefficient] 0.92, 95% CI 0.68-1.15; Coeff. 0.61, 95% CI 0.51-0.71; Coeff. 0.43, 95% CI 0.32-0.55). Less than 12th grade education (vs greater than a bachelor's degree) was associated with increased odds of reoperation (OR [odds ratio] 1.88, 95% CI 1.03-3.42). Decreased net worth was associated with increased odds of readmission (OR 1.32, 95% CI 1.25-1.40) and complication (OR 1.14, 95% CI 1.10-1.20). Renting a home (vs homeownership) was associated with increased LOS, readmissions, and total charges (Coeff. 0.30, 95% CI 0.17-0.43; OR 1.19, 95% CI 1.11-1.30; Coeff. 13 200, 95% CI 9000-17 000). CONCLUSION Black race, less than 12th grade education, <$25K net worth, and lack of homeownership were associated with poorer postoperative outcomes and increased costs. Increasing perioperative support for patients with these sociodemographic risk factors may improve postoperative outcomes.
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Affiliation(s)
- Gavin Touponse
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Guan Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Taiyeb Rangwalla
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Isidora Beach
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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25
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Halicka M, Wilby M, Duarte R, Brown C. Predicting patient-reported outcomes following lumbar spine surgery: development and external validation of multivariable prediction models. BMC Musculoskelet Disord 2023; 24:333. [PMID: 37106435 PMCID: PMC10134672 DOI: 10.1186/s12891-023-06446-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND This study aimed to develop and externally validate prediction models of spinal surgery outcomes based on a retrospective review of a prospective clinical database, uniquely comparing multivariate regression and random forest (machine learning) approaches, and identifying the most important predictors. METHODS Outcomes were change in back and leg pain intensity and Core Outcome Measures Index (COMI) from baseline to the last available postoperative follow-up (3-24 months), defined as minimal clinically important change (MCID) and continuous change score. Eligible patients underwent lumbar spine surgery for degenerative pathology between 2011 and 2021. Data were split by surgery date into development (N = 2691) and validation (N = 1616) sets for temporal external validation. Multivariate logistic and linear regression, and random forest classification and regression models, were fit to the development data and validated on the external data. RESULTS All models demonstrated good calibration in the validation data. Discrimination ability (area under the curve) for MCID ranged from 0.63 (COMI) to 0.72 (back pain) in regression, and from 0.62 (COMI) to 0.68 (back pain) in random forests. The explained variation in continuous change scores spanned 16%-28% in linear, and 15%-25% in random forests regression. The most important predictors included age, baseline scores on the respective outcome measures, type of degenerative pathology, previous spinal surgeries, smoking status, morbidity, and duration of hospital stay. CONCLUSIONS The developed models appear robust and generalisable across different outcomes and modelling approaches but produced only borderline acceptable discrimination ability, suggesting the need to assess further prognostic factors. External validation showed no advantage of the random forest approach.
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Affiliation(s)
- Monika Halicka
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rui Duarte
- Liverpool Reviews & Implementation Group (LRiG), University of Liverpool, Liverpool, UK
- Saluda Medical Pty Ltd., NSW, Artarmon, Australia
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26
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Quigley M, Apos E, Truong TA, Ahern S, Johnson MA. Comorbidity data collection across different spine registries: an evidence map. 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 2023; 32:753-777. [PMID: 36658363 DOI: 10.1007/s00586-023-07529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Comorbidities are significant patient factors that contribute to outcomes after surgery. There is highly variable collection of this information across the literature. To help guide the systematic collection of best practice data, the Australian Spine Registry conducted an evidence map to investigate (i) what comorbidities are collected by spine registries, (ii) how they are collected and (iii) the compliance and completeness in collecting comorbidity data. METHOD A literature search was performed to identify published studies of adult spine registry data reporting comorbidities. In addition, targeted questionnaires were sent to existing global spine registries to identify the maximum number of relevant results to build the evidence map. RESULTS Thirty-six full-text studies met the inclusion criteria. There was substantial variation in the reporting of comorbidity data; 55% of studies reported comorbidity collection, but only 25% reported the data collection method and 20% reported use of a comorbidity index. The variation in the literature was confirmed with responses from 50% of the invited registries (7/14). Of seven, three use a recognised comorbidity index and the extent and methods of comorbidity collection varied by registry. CONCLUSION This evidence map identified variations in the methodology, data points and reporting of comorbidity collection in studies using spine registry data, with no consistent approach. A standardised set of comorbidities and data collection methods would encourage collaboration and data comparisons between patient cohorts and could facilitate improved patient outcomes following spine surgery by allowing data comparisons and predictive modelling of risk factors.
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Affiliation(s)
- Matthew Quigley
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Esther Apos
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. .,Spine Society of Australia, 3-5 West Street, North Sydney, NSW, 2060, Australia.
| | - Trieu-Anh Truong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Michael A Johnson
- Spine Society of Australia, 3-5 West Street, North Sydney, NSW, 2060, Australia
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27
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Teo BJX, Howe TS, Chan C, Koh JSB, Yeo W, Ng YH. Preoperative Oswestry Disability Index Cannot Reliably Predict Patient Satisfaction After Single and Double Level Lumbar Transforaminal Interbody Fusion Surgery. Geriatr Orthop Surg Rehabil 2023; 14:21514593231152172. [PMID: 36687777 PMCID: PMC9846293 DOI: 10.1177/21514593231152172] [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: 07/10/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery. Aims To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction. Methods 1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score. Results At 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 (P < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups. Conclusions Overall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients' satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.
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Affiliation(s)
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - Cheri Chan
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - Joyce SB. Koh
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General
Hospital, Singapore
| | - Yeong Huei Ng
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore,Yeong Huei Ng, FRCS, Department of
Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore
169856, Singapore.
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28
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Lawless MH, Tong D, Claus CF, Hanson C, Li C, Park P, Chang VW, Abdulhak MM, Houseman CM, Bono PL, Carr DA, Richards BF, Kelkar PS, Soo TM. The Effect of Preoperative Symptom Duration on Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients: Analyses From the Michigan Spine Surgery Improvement Collaborative (MSSIC). Neurosurgery 2022; 92:955-962. [PMID: 36524819 DOI: 10.1227/neu.0000000000002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The effect of preoperative symptom duration (PSD) on patient-reported outcomes (PROs) in anterior cervical discectomy and fusion (ACDF) for radiculopathy is unclear. OBJECTIVE To determine whether PSD is a predictor for PRO after ACDF for radiculopathy. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried between March, 2014, and July, 2019, for patients who underwent ACDF without myelopathy and PROs (baseline, 90 days, 1 year, 2 years). PROs were measured by numerical rating scales for neck/arm pain, Patient-Reported Outcomes Measurement Information System Short Form-Physical Function (PROMIS-PF), EuroQol-5D (EQ5D), and North American Spine Society satisfaction. Univariate analyses were used to evaluate the proportion of patients reaching minimal clinically important differences (MCID). PSD was <3 months, 3 month-1 year, or >1 years. Multiple logistic regression models were used to estimate the association between PSD and PRO reaching MCID. The discriminative ability of the model was evaluated by receiver operating characteristic curve. RESULTS We included 2233 patients who underwent ACDF with PSD <3 months (278, 12.4%), 3 month-1 year (669, 30%), and >1 years (1286, 57.6%). Univariate analyses demonstrated a greater proportion of patients achieving MCID in <3-month cohort for arm numerical rating scales, PROMIS-PF, EQ5D, and North American Spine Society Satisfaction. Multivariable analyses demonstrated using <3 months PSD as a reference, PSD >1 years was associated with decreased odds of achieving MCID for EQ5D (odds ratio 0.5, CI 0.32-0.80, P = .004). Private insurance and increased baseline PRO were associated with significantly higher odds for achieving PROMIS-PF MCID and EQ5D-MCID. CONCLUSION Preoperative symptom duration greater than 1 year in patients who underwent ACDF for radiculopathy was associated with worse odds of achieving MCID for multiple PROs.
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Affiliation(s)
- Michael H Lawless
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Doris Tong
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Chad F Claus
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Connor Hanson
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victor W Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Clifford M Houseman
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Peter L Bono
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Daniel A Carr
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Boyd F Richards
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Prashant S Kelkar
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Teck M Soo
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
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29
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Arcidiacono UA, Armocida D, Pesce A, Maiotti M, Proietti L, D’Andrea G, Santoro A, Frati A. Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review. J Clin Med 2022; 11:jcm11247409. [PMID: 36556025 PMCID: PMC9781971 DOI: 10.3390/jcm11247409] [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] [Received: 11/07/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon's inappropriate decision to resort to a second surgical treatment. METHODS We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. RESULTS We retrieve 20 articles. Most of the papers are clinical cases showing the disorder's rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. CONCLUSION CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.
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Affiliation(s)
| | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
- IRCCS “Neuromed”, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-393-287-4496
| | - Alessandro Pesce
- Neurosurgery Unit, Santa Maria Goretti Hospital, Via Guido Reni 1, 04100 Latina, Italy
| | - Marco Maiotti
- Villa Stuart Hospital, Orthopedic Clinic, 00135 Roma, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Institute of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
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Jacob KC, Patel MR, Collins AP, Parsons AW, Prabhu MC, Vanjani NN, Pawlowski H, Singh K. The Effect of the Severity of Preoperative Leg Pain on Patient-Reported Outcomes, Minimum Clinically Important Difference Achievement, and Patient Satisfaction After Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2022; 167:e1196-e1207. [PMID: 36075356 DOI: 10.1016/j.wneu.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients stratified by preoperative leg pain. METHODS Patients undergoing MIS-TLIF were collected through retrospective review of a prospectively maintained single-surgeon database. PROMs administered preoperatively/postoperatively included Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back/leg pain, Oswestry Disability Index (ODI), and 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS). Patients were grouped based on preoperative VAS leg scores: VAS leg ≤7 or VAS leg >7. Inferential statistics were used to compare PROMs, MCID achievement rates, and postoperative satisfaction between groups. RESULTS A total of 562 patients were eligible (168 VAS leg score ≤7; 394 VAS leg score >7). Significant differences between cohorts in postoperative mean PROMs were noted for PROMIS-PF at 6 weeks/2 years, SF-12 PCS at 6 weeks/2 years, SF-12 MCS at 6 weeks/12 weeks/6 months/1 year, VAS back score at 6 weeks/12 weeks/6 months, VAS leg score at 6 weeks/12 weeks/6 months/2 years and ODI at all postoperative time points (P < 0.045, all). In the VAS leg score >7 cohort, a greater proportion achieving MCID for VAS leg score at all postoperative time points and ODI at 12 weeks (P < 0.010, all). Postoperative satisfaction was greater in VAS back score ≤7 cohort for VAS leg score at 6 weeks/12 weeks/6 months/2 years, VAS back score at 12 weeks/2 years, and ODI at 6 weeks/12 weeks/6 months/2 years (P < 0.046, all). CONCLUSIONS Patients with severe preoperative leg pain showed worse postoperative PROM scores and patient satisfaction for disability and back/leg pain. MCID achievement rates across cohorts were similar. Patients with severe leg pain may have expectations for surgical benefits incongruent with their postoperative outcomes, and physicians may seek to manage the preoperative expectations of their patients to reflect likely outcomes after MIS-TLIF.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew P Collins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander W Parsons
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Steinle AM, Nian H, Pennings JS, Bydon M, Asher A, Archer KR, Gardocki RJ, Zuckerman SL, Stephens BF, Abtahi AM. Complications, readmissions, reoperations and patient-reported outcomes in patients with multiple sclerosis undergoing elective spine surgery - a propensity matched analysis. Spine J 2022; 22:1820-1829. [PMID: 35779839 DOI: 10.1016/j.spinee.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease that can lead to significant functional disability. Improving treatment regimens have extended life expectancy and led to an increase in the number of elective spine surgeries for degenerative conditions in the MS population. Recent literature has reported mixed results regarding the efficacy of elective spine surgery for patients with MS. There is also a paucity of literature comparing postoperative patient reported outcomes (PROs) and reoperation rates between patients with and without MS. PURPOSE To determine if patients with MS have worse PROs and higher complication, readmission and reoperation rates after elective spine surgery compared with patients without neurodegenerative conditions when adjusting for baseline covariates through propensity matching. STUDY DESIGN/SETTING Retrospective review of prospectively collected data from the Quality Outcomes Database (QOD), a national, longitudinal, multicenter spine outcomes registry. PATIENT SAMPLE For the lumbar cohort, 312 patients with MS and 46,738 patients without MS were included. The cervical myelopathy cohort included 91 patients with MS and 6,426 patients without MS. The cervical radiculopathy cohort consisted of 103 patients with MS and 13,751 patients without MS. OUTCOME MEASURES 1) complication rates, 2) readmission rates, 3) reoperation rates, and 4) PROs at 3- and 12-months including ODI/NDI, NRS back/neck/arm/leg pain, mJOA scores and patient satisfaction ratings. METHODS Data from the QOD was queried for patients with surgeries occurring between 04/2013-01/2019. Three surgical groups were included: 1) Elective lumbar surgery, 2) Elective cervical surgery for myelopathy, 3) Elective cervical surgery for radiculopathy. Patients with any neurodegenerative condition other than MS were excluded. Patients without MS were propensity matched against patients with MS in a 5 to 1 ratio without replacement based on ASA grade, arthrodesis, surgical approach, number of operated levels, age, and baseline ODI/NDI, NRS leg/arm pain, NRS back/neck pain, and EQ-5D. Multivariable regressions with cluster-robust standard errors were used to estimate average effect of how the outcome would change if the MS patient didn't have the disease. The mean difference was used for continuous outcomes and the risk difference was used for binary outcomes. RESULTS For the lumbar cohort, no differences were found between the 2 groups at 3 or 12 months in any of the outcome measures. For the myelopathy cohort, patients with MS patients had a lower rate of reoperation at 12 months (risk difference=-0.036, p=.007) and worse 3-month mJOA scores (mean difference=-1.044, p=.004) compared with patients without MS. For the radiculopathy cohort, patients with MS had a lower rate of reoperation at 3 months (risk difference=-0.019, p=.018) and 12 months (risk difference=-0.029, p=.007) compared with those without MS. CONCLUSIONS Patients with MS had similar PROs compared with patients without MS when adjusting for baseline covariates through propensity matching, except for 3-month mJOA scores in the myelopathy cohort. Reoperation rates were found to be lower in patients with MS undergoing elective cervical surgery for both myelopathy and radiculopathy. These results suggest that when analyzed independently, a diagnosis of MS does not significantly impact complication, readmission and reoperation rates or PROs, and therefore should not represent a major contraindication to elective spine surgery. Surgical decisions in this patient population should be made based on careful consideration of patient factors including other comorbidities as well as baseline patient functional status.
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Affiliation(s)
- Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA
| | - Hui Nian
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, 200 First St SW Floor 8. Rochester, MN 55905, USA
| | - Anthony Asher
- Neuroscience Institute, Atrium Health and Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, 1021 Morehead Medical Dr, Charlotte, NC 28204, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN 37203, USA
| | - Raymond J Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S #3200, Nashville, TN 37232, USA; Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN 37212, USA.
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Nie JW, Hartman TJ, Pawlowski H, Prabhu MC, Vanjani NN, Oyetayo OO, Singh K. Impact of Ambulatory Setting for Workers' Compensation Patients Undergoing One-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion and Review of the Literature. World Neurosurg 2022; 167:e251-e267. [PMID: 35948231 DOI: 10.1016/j.wneu.2022.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To compare perioperative characteristics and patient-reported outcome measures (PROMs) in workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in either the inpatient/outpatient setting. METHODS Patients with WC undergoing 1-level MIS-TLIF were included. Patients were separated into inpatient/outpatient groups and demographically propensity score matched. PROMs included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI)/12-item Short Form Physical Composite Score (SF-12 PCS)/Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) preoperatively and 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results were compared preoperatively and postoperatively and between cohorts. Minimum clinically important difference (MCID) achievement was determined through comparison with values established in the literature. RESULTS A total of 216 patients were included (184 inpatient). The inpatient cohort (IC) showed worse perioperative outcomes in multiple measures (P < 0.034; all). The IC improved in all PROMs (P < 0.038; all), besides ODI at 6 weeks, SF-12 PCS at 6 weeks/6 months/1 year, and PROMIS-PF at 6 weeks. The outpatient cohort (OC) improved in VAS back at all time points and VAS leg at 6 months (P < 0.033; all). Between cohorts, the OC showed better scores with VAS leg/ODI/SF-12 PCS/PROMIS-PF at multiple time points (P < 0.031; all). Most of the IC achieved MCID, aside from ODI, whereas the OC achieved MCID in SF-12 PCS. MCID achievement between cohorts was higher in the IC at PROMIS-PF at 1 year and VAS back overall (P < 0.034; all). CONCLUSIONS Despite more comorbidities and worse perioperative measures, the IC showed improved PROMs from preoperative to ≥1 follow-up visit, whereas the OC had improvement with only VAS back and leg. The IC showed multiple MCID achievements, whereas the OC showed MCID in only SF-12 PCS. These findings may help guide a surgeon's decision making between inpatient/outpatient lumbar surgery in the WC population.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis. Spine (Phila Pa 1976) 2022; 47:1452-1462. [PMID: 35796661 DOI: 10.1097/brs.0000000000004401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis on prospectively collected data. OBJECTIVE To determine the effectiveness of elective spine surgery in patients with Parkinson disease (PD). BACKGROUND CONTEXT PD has become increasingly prevalent in an aging population. While surgical treatment for degenerative spine pathology is often required in this population, previous literature has provided mixed results regarding its effectiveness. METHODS Data from the Quality Outcomes Database (QOD) was queried between April 2013 and January 2019. Three surgical groups were identified: (1) elective lumbar surgery, (2) elective cervical surgery for myelopathy, (3) elective cervical surgery for radiculopathy. Patients without PD were propensity matched against patients with PD in a 5:1 ratio without replacement based on American Society of Anesthesiology grade, arthrodesis, surgical approach, number of operated levels, age, and baseline Oswestry Disability Index, Numerical Rating Scale (NRS) extremity pain, NRS back pain, and EuroQol 5-Dimensions (EQ-5D). The mean difference was calculated for continuous outcomes (Oswestry Disability Index, NRS leg pain, NRS back pain, and EQ-5D at 3 and 12 mo after surgery) and the risk difference was calculated for binary outcomes (patient satisfaction, complications, readmission, reoperation, and mortality). RESULTS For the lumbar analysis, PD patients had a higher rate of reoperation at 12 months (risk difference=0.057, P =0.015) and lower mean EQ-5D score at 12 months (mean difference=-0.053, P =0.005) when compared with patients without PD. For the cervical myelopathy cohort, PD patients had lower NRS neck pain scores at 3 months (mean difference=-0.829, P =0.005) and lower patient satisfaction at 3 months (risk difference=-0.262, P =0.041) compared with patients without PD. For the cervical radiculopathy cohort, PD patients demonstrated a lower readmission rate at 3 months (risk difference=-0.045, P =0.014) compared with patients without PD. CONCLUSION For the matched analysis, in general, patients with and without PD had similar patient-reported outcomes and complication, readmission, and reoperation rates. These results demonstrate that a diagnosis of PD alone should not represent a major contraindication to elective spine surgery.
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Outcomes Following Direct Versus Indirect Decompression Techniques for Lumbar Spondylolisthesis: A Propensity-Matched Analysis. Spine (Phila Pa 1976) 2022; 47:1443-1451. [PMID: 35867585 DOI: 10.1097/brs.0000000000004396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim was to compare outcomes at 3 and 12 months for patients with lumbar spondylolisthesis treated with direct decompression (DD) versus indirect decompression (ID) techniques. SUMMARY OF BACKGROUND DATA Debate persists regarding the optimal surgical strategy to treat lumbar spondylolisthesis. Novel techniques relying on ID have shown superior radiographic outcomes compared to DD, however, doubt remains regarding their effectiveness in achieving adequate decompression. Currently, there is a paucity of data comparing the clinical efficacy of DD to ID. METHODS The Quality Outcomes Database (QOD), a national, multicenter prospective spine registry, was queried for patients who underwent DD and ID between April 2013 and January 2019. Propensity scores for each treatment were estimated using logistic regression dependent on baseline covariates potentially associated with outcomes. The propensity scores were used to exclude nonsimilar patients. Multivariable regression analysis was performed with the treatment and covariate as independent variables and outcomes as dependent variables. RESULTS A total of 4163 patients were included in the DD group and 86 in the ID group. The ID group had significantly lower odds of having a longer hospital stay and for achieving 30% improvement in back and leg pain at 3 months. These trends were not statistically significant at 12 months. There were no differences in ED5D scores or Oswestry disability index 30% improvement scores at 3 or 12 months. ID patient had a significantly higher rate of undergoing a repeat operation at 3 months (4.9% vs. 1.5%, P =0.015). CONCLUSION Our study suggests that both DD and ID for the treatment of lumbar spondylolisthesis result in similar clinical outcomes, with the exception that those treated with ID experienced a lower reduction in back and leg pain at 3 months and a higher 3-month reoperation rate. This data can provide surgeons with additional information when counseling patients on the pros and cons of ID versus DD surgery.
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Frailty and Sarcopenia: Impact on Outcomes Following Elective Degenerative Lumbar Spine Surgery. Spine (Phila Pa 1976) 2022; 47:1410-1417. [PMID: 35867606 DOI: 10.1097/brs.0000000000004384] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective review of prospectively collected data. OBJECTIVE The aim was to evaluate the impact of frailty and sarcopenia on outcomes after lumbar spine surgery. SUMMARY OF BACKGROUND DATA Elderly patients are commonly diagnosed with degenerative spine disease requiring surgical intervention. Frailty and sarcopenia result from age-related decline in physiological reserve and can be associated with complications after elective spine surgery. Little is known about the impact of these factors on patient-reported outcomes (PROs). METHODS Patients older than 70 years of age undergoing elective lumbar spine surgery were included. The modified 5-item frailty index (mFI-5) was calculated. Sarcopenia was defined using total psoas index, which is obtained by dividing the mid L3 total psoas area by VB area (L3-TPA/VB). PROs included Oswestry disability index (ODI), EuroQual-5D (EQ-5D), numeric rating scale (NRS)-back pain, NRS leg pain (LP), and North American Spine Society (NASS) at postoperative 12 months. Clinical outcomes included length of stay (LOS), 90-day readmission and complications. Univariate and multivariable regression analyses were performed. RESULTS Total 448 patients were included. The mean mFI-5 index was 1.6±1.0 and mean total psoas index was 1.7±0.5. There was a significant improvement in all PROs from baseline to 12 months ( P <0.0001). After adjusting for age, body mass index, smoking status, levels fused, and baseline PROs, higher mFI-5 index was associated with higher 12-month ODI ( P <0.001), lower 12-month EQ-5D ( P =0.001), higher NRS-L P ( P =0.039), and longer LOS ( P =0.007). Sarcopenia was not associated with 12-month PROs or LOS. Neither sarcopenia or mFI-5 were associated with 90-day complication and readmission. CONCLUSIONS Elderly patients demonstrate significant improvement in PROs after elective lumbar spine surgery. Frailty was associated with worse 12 months postoperative ODI, EQ-5D, NRS-LP scores, and longer hospital stay. While patients with sarcopenia can expect similar outcomes compared with those without, the mFI-5 should be considered preoperatively in counseling patients regarding expectations for disability, health-related quality of life, and leg pain outcomes after elective lumbar spine surgery. LEVEL OF EVIDENCE 3.
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Streamlining the QOD Web-based Calculator for Clinical Integration: Development and Validation of a Reduced Prediction Model for Lumbar Spine Surgery. Spine (Phila Pa 1976) 2022; 47:E587-E590. [PMID: 35905327 DOI: 10.1097/brs.0000000000004358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023]
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Wang SK, Mu H, Wang P, Li XY, Kong C, Cheng JB, Lu SB, Zhao GG. The Charlson Comorbidity Index and depression are associated with satisfaction after short-segment lumbar fusion in patients 75 years and older. Front Surg 2022; 9:991271. [PMID: 36171818 PMCID: PMC9512134 DOI: 10.3389/fsurg.2022.991271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe rate and volume of lumbar spinal fusion (LSF) surgery performed for patients aged 75 years and older increased in recent years. The purposes of our study were to identify factors associated with postoperative dissatisfaction and evaluate the predictive value of comprehensive geriatric assessment (CGA) for dissatisfaction at 2 years after elective short-segment (one- or two- level) LSF in patients aged 75 and older.MethodsThis was a retrospective study using a prospectively collected database of consecutive patients (aged 75 and older) who underwent elective short-segment transforaminal lumbar interbody fusion surgery for degenerative diseases from June 2018 to May 2020. Preoperative CGA consisting six domains was performed for each patient 1 day before the operative day. Univariate and multivariate analyses were performed to identify factors that predict for dissatisfaction with surgical treatment. The primary outcome was patient satisfaction with LSF surgery, as measured by the North American Spine Society (NASS) satisfaction scale. Secondary outcomes included postoperative complications, the length of stay, visual analog scale (VAS), and Oswestry Disability Index.ResultsA total of 211 patients were available for a follow-up at 2 years and included in our final study cohort with a mean age of 80.0 years. A total of 175 patients (82.9%) were included in the satisfied group, and 36 patients (17.1%) were included in the not dissatisfied group. In the dissatisfied group, there was a higher incidence of postoperative complications (30.6% vs. 14.3%, p = 0.024) and greater VAS scores for lower back (4.3 ± 1.9 vs. 1.3 ± 1.4, p = 0.001) and leg (3.9 ± 2.1 vs. 0.9 ± 1.3, p = 0.001). Multivariate regression analysis revealed that patients with greater CCI score [odd ratio (OR) 2.56, 95% CI, 1.12–5.76; p = 0.030 for CCI 1 or 2 and OR 6.20, 95% CI, 1.20–28.69; p = 0.024], and depression (OR 3.34, 95% CI, 1.26–9.20; p = 0.016) were more likely to be dissatisfied compared with patients with the CCI score of 0 and without depression.ConclusionsSatisfaction after LSF in older patients (aged 75 and older) was similar to that of previously reported younger patients. Preoperative depression and higher CCI scores were independent risk factors for postoperative dissatisfaction two years after LSF surgery. These results help inform decision-making when considering LSF surgery for patients aged 75 and older.
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Affiliation(s)
- Shuai-Kang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Mu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing-bo Cheng
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Correspondence: Shi-Bao Lu
| | - Guo-Guang Zhao
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
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Garcia AN, Simon CB, Yang ZL, Niedzwiecki D, Cook CE, Gottfried O. Classification of older adults who underwent lumbar-related surgery using pre-operative biopsychosocial predictors and relationships with surgical recovery: An observational study conducted in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1570-e1584. [PMID: 34587349 DOI: 10.1111/hsc.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/29/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Lumbar surgery is a commonly prescribed intervention for low back pain but poses higher risks and worse outcomes for older adults. Identifying clinical phenotypes based on biopsychosocial factors may help identify older adults who are at greatest risk for poor postoperative recovery. This study aimed to (a) classify older adults who underwent lumbar surgery based on preoperative biopsychosocial factors, and (b) quantify the association between preoperative biopsychosocial classifications and 3 and 12 months postoperative improvement outcomes. Latent class analysis was used to identify biopsychosocial classifications in 10,283 individuals aged ≥60 from the Quality Outcomes Database (the United States, 2021-2018). Logistic regression models measured the association between biopsychosocial classifications and 3 and 12 months postoperative outcomes (back/leg pain intensity, disability and quality of life), adjusting for covariates. Three classes were identified based on 19 a priori biopsychosocial factors and were characterised as 'high-risk' (15%), 'physical-/social health-risk' (44%) and 'low-risk' (41%). The high-risk class demonstrated increased odds of failing to recover post-operatively compared to the other classes. Similarly, the physical-/social-risk class demonstrated increased odds of failing to recover in all outcomes and time points compared to the low-risk class. Biopsychosocial factors with higher prevalence in the high versus low-risk class were depression (92.5% vs. 10.6%), multiple morbidities (55.3% vs. 25.7%) and obesity (59.5% vs. 37.2%). This study introduces novel non-recovery phenotypes for older adults undergoing lumbar surgery and may lead to the development of tailored interventions to improve clinical care and outcomes for this population.
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Affiliation(s)
- Alessandra N Garcia
- Doctor of Physical Therapy Program, College of Pharmacy & Health Sciences, Campbell University, Lillington, North Carolina, USA
| | - Corey B Simon
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Zidanyue Lexie Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Chad E Cook
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Oren Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Xie N, Wilson PJ, Reddy R. Use of machine learning to model surgical decision-making in lumbar spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2000-2006. [PMID: 35088119 DOI: 10.1007/s00586-021-07104-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE The majority of lumbar spine surgery referrals do not proceed to surgery. Early identification of surgical candidates in the referral process could expedite their care, whilst allowing timelier implementation of non-operative strategies for those who are unlikely to require surgery. By identifying clinical and imaging features associated with progression to surgery in the literature, we aimed to develop a machine learning model able to mirror surgical decision-making and calculate the chance of surgery based on the identified features. MATERIAL AND METHODS In total, 55 factors were identified to predict surgical progression. All patients presenting with a lumbar spine complaint between 2013 and 2019 at a single Australian Tertiary Hospital (n = 483) had their medical records reviewed and relevant data collected. An Artificial Neural Network (ANN) was constructed to predict surgical candidacy. The model was evaluated on its accuracy, discrimination, and calibration. RESULTS Eight clinical and imaging predictive variables were included in the final model. The ANN was able to predict surgical progression with 92.1% accuracy. It also exhibited excellent discriminative ability (AUC = 0.90), with good fit of data (Calibration slope 0.938, Calibration intercept - 0.379, HLT > 0.05). CONCLUSION Through use of machine learning techniques, we were able to model surgical decision-making with a high degree of accuracy. By demonstrating that the operating patterns of single centres can be modelled successfully, the potential for more targeted and tailored referrals becomes possible, reducing outpatient wait-list duration and increasing surgical conversion rates.
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Affiliation(s)
- Nathan Xie
- School of Medical Sciences, University of New South Wales, Prince of Wales Private Hospital, High Street, Kensington, Sydney, 2052, Australia.
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
| | - Peter J Wilson
- School of Medical Sciences, University of New South Wales, Prince of Wales Private Hospital, High Street, Kensington, Sydney, 2052, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Rajesh Reddy
- School of Medical Sciences, University of New South Wales, Prince of Wales Private Hospital, High Street, Kensington, Sydney, 2052, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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Korhonen T, Pesälä J, Järvinen J, Haapea M, Niinimäki J. Correlation between the degree of pain relief following discoblock and short-term surgical disability outcome among patients with suspected discogenic low back pain. Scand J Pain 2022; 22:526-532. [PMID: 35355491 DOI: 10.1515/sjpain-2021-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/07/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate how well the degree of pain relief after discoblock predicts the disability outcome of subsequent fusion or total disc replacement (TDR) surgery, based on short-term Oswestry Disability Index (ODI) scores. METHODS We retrospectively analyzed a set of patients who had undergone discoblock and subsequent fusion or TDR surgery of the same lumbar intervertebral disc due to suspected discogenic chronic LBP between 2011 and 2018. We calculated the degree of pain relief following discoblock (ΔNRS) and the changes in both absolute and percentual ODI scores (ΔODI and ΔODI%, respectively) following fusion or TDR surgery. We analyzed the statistical significance of ΔNRS and ΔODI and the correlation (Spearman's rho) between ΔNRS and ΔODI%. The fusion and TDR group were analyzed both in combination and separately. RESULTS Fifteen patients were eligible for the current study (fusion n=9, TDR n=6). ΔNRS was statistically significant in all groups, and ΔODI was statistically significant in the combined group and in the fusion group alone. The parameters of both decreased. We found a Spearman's rho of 0.57 (p=0.026) between ΔNRS and ΔODI% for the combined group. The individual Spearman's rho values were 0.85 (p=0.004) for the fusion group and 0.62 (p=0.191) for the TDR group. CONCLUSIONS We suggest that discoblock is a useful predictive criterion for disability outcome prior to surgery for discogenic LBP, especially when stabilizing spine surgery is under consideration. ETHICAL COMMITTEE NUMBER 174/2019 (Oulu University Hospital Ethics Committee).
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Affiliation(s)
- Tero Korhonen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Orthopaedic and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Juha Pesälä
- Department of Orthopaedic and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jyri Järvinen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Orthopaedic and Traumatology, Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Orthopaedic and Traumatology, Oulu University Hospital, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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André A, Peyrou B, Carpentier A, Vignaux JJ. Feasibility and Assessment of a Machine Learning-Based Predictive Model of Outcome After Lumbar Decompression Surgery. Global Spine J 2022; 12:894-908. [PMID: 33207969 PMCID: PMC9344503 DOI: 10.1177/2192568220969373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study at a unique center. OBJECTIVE The aim of this study is twofold, to develop a virtual patients model for lumbar decompression surgery and to evaluate the precision of an artificial neural network (ANN) model designed to accurately predict the clinical outcomes of lumbar decompression surgery. METHODS We performed a retrospective study of complete Electronic Health Records (EHR) to identify potential unfavorable criteria for spine surgery (predictors). A cohort of synthetics EHR was created to classify patients by surgical success (green zone) or partial failure (orange zone) using an Artificial Neural Network which screens all the available predictors. RESULTS In the actual cohort, we included 60 patients, with complete EHR allowing efficient analysis, 26 patients were in the orange zone (43.4%) and 34 were in the green zone (56.6%). The average positive criteria amount for actual patients was 8.62 for the green zone (SD+/- 3.09) and 10.92 for the orange zone (SD 3.38). The classifier (a neural network) was trained using 10,000 virtual patients and 2000 virtual patients were used for test purposes. The 12,000 virtual patients were generated from the 60 EHR, of which half were in the green zone and half in the orange zone. The model showed an accuracy of 72% and a ROC score of 0.78. The sensitivity was 0.885 and the specificity 0.59. CONCLUSION Our method can be used to predict a favorable patient to have lumbar decompression surgery. However, there is still a need to further develop its ability to analyze patients in the "failure of treatment" zone to offer precise management of patient health before spinal surgery.
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Affiliation(s)
- Arthur André
- Ramsay santé, Clinique Geoffroy
Saint-Hilaire, Paris, France,Neurosurgery Department,
Pitié-Salpêtrière University Hospital, Paris, France,Cortexx Medical Intelligence, Paris,
France,Arthur André, Cortexx Medical Intelligence,
156 Boulevard, Haussmann 75008, Paris.
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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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Butala NM, Tamez H, Secemsky EA, Grantham JA, Spertus JA, Cohen DJ, Jones P, Salisbury AC, Arnold SV, Harrell F, Lombardi W, Karmpaliotis D, Moses J, Sapontis J, Yeh RW. Predicting Residual Angina After Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the OPEN-CTO Registry. J Am Heart Assoc 2022; 11:e024056. [PMID: 35574949 PMCID: PMC9238547 DOI: 10.1161/jaha.121.024056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022]
Abstract
Background Given that percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) is indicated primarily for symptom relief, identifying patients most likely to benefit is critically important for patient selection and shared decision-making. Therefore, we identified factors associated with residual angina frequency after CTO PCI and developed a model to predict postprocedure anginal burden. Methods and Results Among patients in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated the association between patient characteristics and residual angina frequency at 6 months, as assessed by the Seattle Angina Questionnaire Angina Frequency Scale. We then constructed a prediction model for angina status after CTO PCI using ordinal regression. Among 901 patients undergoing CTO PCI, 28% had no angina, 31% had monthly angina, 30% had weekly angina, and 12% had daily angina at baseline. Six months later, 53% of patients had a ≥20-point increase in Seattle Angina Questionnaire Angina Frequency Scale score. The final model to predict residual angina after CTO PCI included baseline angina frequency, baseline nitroglycerin use frequency, dyspnea symptoms, depressive symptoms, number of antianginal medications, PCI indication, and presence of multiple CTO lesions and had a C index of 0.78. Baseline angina frequency and nitroglycerin use frequency explained 71% of the predictive power of the model, and the relationship between model components and angina improvement at 6 months varied by baseline angina status. Conclusions A 7-component OPEN-AP (OPEN-CTO Angina Prediction) score can predict angina improvement and residual angina after CTO PCI using variables commonly available before intervention. These findings have implications for appropriate patient selection and counseling for CTO PCI.
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Affiliation(s)
- Neel M. Butala
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyDivision of CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Division of CardiologyMassachusetts General HospitalBostonMA
| | - Hector Tamez
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyDivision of CardiologyBeth Israel Deaconess Medical CenterBostonMA
| | - Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyDivision of CardiologyBeth Israel Deaconess Medical CenterBostonMA
| | | | | | | | - Philip Jones
- Saint Luke’s Mid America Heart Institute/UMKCKansas CityMO
| | | | | | - Frank Harrell
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTN
| | | | | | | | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyDivision of CardiologyBeth Israel Deaconess Medical CenterBostonMA
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Woodard TK, Cortese BD, Gupta S, Mohanty S, Casper DS, Saifi C. Racial Differences in Patients Undergoing Anterior Cervical Discectomy and Fusion: A Multi-Site Study. Clin Spine Surg 2022; 35:176-180. [PMID: 35344526 DOI: 10.1097/bsd.0000000000001312] [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: 01/24/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective chart review. OBJECTIVE The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS). SUMMARY OF BACKGROUND DATA There are previously described racial disparities in spinal surgery outcomes and quality metrics. METHODS A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient's LOS was related to their self-identified race, demographics, and perioperative clinical data. RESULTS Of the 278 patients who received an ACDF, 71.6% (199) self-identified as White and 28.4% (79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P=0.001). AA patients had longer LOS by an average of half a day (P=0.001) and experienced a larger percentage of extended stays (P=0.002). AA patients experienced longer overall operation times on average (P=0.001) across all different levels of fusion. AA race was not an independent driver of LOS (β=0.186; P=0.246). CONCLUSIONS As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study's results. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Sachin Gupta
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - David S Casper
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Comron Saifi
- Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX
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One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050606. [PMID: 35630022 PMCID: PMC9144472 DOI: 10.3390/medicina58050606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal-invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre-op), 3-weeks postoperative (post-op), 1-year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c-reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1−4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10-L2 (12/68) and TH11-L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post-op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3-week and 1-year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal-invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow-up. PROMs were not significantly associated with clinicopathological characteristics, technique-related variables, or the number of targeted levels.
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Goh GS, Yue WM, Guo CM, Tan SB, Chen JLT. Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis? Clin Spine Surg 2022; 35:E143-E149. [PMID: 34008509 DOI: 10.1097/bsd.0000000000001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The objective of this study was to determine how different combinations of preoperative back pain (BP) and leg pain (LP) may influence functional outcomes, patient satisfaction and return to work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA Surgical decision-making is often based on the traditional assumption that the predominance of lower extremity symptoms is a stronger indication for lumbar spine surgery. Surprisingly, there is a paucity of literature supporting this notion and the isolated impact of the preoperative pattern of pain on outcome remains unclear. METHODS Prospectively collected data for patients who underwent primary MIS-TLIF for degenerative spondylolisthesis were reviewed. Patients were categorized into 3 groups depending on predominant pain location: LP predominant (LP>BP), back pain predominant [(BPP); BP>LP] and equal pain predominance (BP=LP). Patients were prospectively followed for at least 2 years. RESULTS In total, 781 patients were included: 33.4% LP predominant, 28.7% BPP and 37.9% equal pain predominance cases. The BPP group was significantly younger (P=0.005) and showed a trend towards poorer baseline Short-Form-36 Mental Component Summary (P=0.069). After adjusting for baseline differences, there was no significant difference in BP, LP, Oswestry Disability Index (ODI), SF-36 Physical Component Summary, and SF-36 Mental Component Summary between the 3 groups at all time points (P>0.05) except for poorer 1-month ODI in the BPP group (P=0.010). The rate of minimal clinically important difference attainment for ODI and SF-36 Physical Component Summary, satisfaction, expectation fulfilment and RTW were also similar (P>0.05). CONCLUSIONS The functional outcomes, quality of life and satisfaction after MIS-TLIF were similar, regardless of the predominant pain location. Equal proportions of patients achieved the minimal clinically important difference and RTW. In the context of proper indications, these results suggest that MIS-TLIF can be equally effective for patients with varying combinations of BP or LP. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital
| | | | - Chang Ming Guo
- Department of Orthopedic Surgery, Singapore General Hospital
| | - Seang-Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore
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Jacob KC, Patel MR, Collins AP, Ribot MA, Pawlowski H, Prabhu MC, Vanjani NN, Singh K. The Effect of the Severity of Preoperative Disability on Patient-Reported Outcomes and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 159:e334-e346. [PMID: 34942388 DOI: 10.1016/j.wneu.2021.12.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/14/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare patient-reported outcomes (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion stratified by preoperative disability. METHODS Minimally invasive transforaminal lumbar interbody fusions were grouped by preoperative Oswestry Disability Index (ODI) score: ODI <41 or ODI ≥41. PROMs administered pre/postoperatively included Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), visual analog scale (VAS) back/leg, ODI, and 12-Item Short-Form Physical Composite Score (SF-12 PCS)/12-Item Short-Form Mental Composite Score (SF-12 MCS). Satisfaction scores were collected for VAS back/leg and ODI. Coarsened exact match controlled for differences between cohorts. T tests compared mean PROMs and postoperative improvement/satisfaction between cohorts. Simple logistic regression compared MCID achievement. RESULTS After coarsened exact matching, there were 118 patients in the ODI ≤41 and 377 patients in the ODI >41 cohort. The ODI >41 cohort saw greater postoperative inpatient VAS pain score and narcotic consumption on days 0/1 (P < 0.018, all). PROMs differed between cohorts: PROMIS-PF, SF-12 PCS, ODI, VAS back/leg at all postoperative time points and SF-12 MCS at 6 weeks/12 weeks/6 months/1 year (P < 0.045, all). Patients in the ODI >41 cohort demonstrated greater proportion achieving MCID for ODI at all postoperative time points and for SF-12 MCS 6-week/12-week/6-month/1-year (P < 0.040, all). The ODI ≤41 cohort demonstrated greater MCID achievement for overall PROMIS-PF and SF-12 PCS 6 months (P < 0.047, all). Postoperative satisfaction was greater in the ODI ≤41 cohort for VAS leg 6 weeks/12 weeks, VAS back 6 weeks/12 weeks, and ODI all postoperative time points (P < 0.048, all). CONCLUSIONS Preoperative disability associated with worse postoperative PROMs and patient satisfaction for disability, back/leg pain at multiple time points. MCID achievement rates across cohorts were similar for most PROMs at most postoperative time points. Patients with severe disability may have unrealistic expectations for surgical benefits, influencing corresponding postoperative satisfaction.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew P Collins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Max A Ribot
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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The Influence of Baseline Clinical Status and Surgical Strategy on Early Good to Excellent Result in Spinal Lumbar Arthrodesis: A Machine Learning Approach. J Pers Med 2021; 11:jpm11121377. [PMID: 34945849 PMCID: PMC8705358 DOI: 10.3390/jpm11121377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
The study aims to create a preoperative model from baseline demographic and health-related quality of life scores (HRQOL) to predict a good to excellent early clinical outcome using a machine learning (ML) approach. A single spine surgery center retrospective review of prospectively collected data from January 2016 to December 2020 from the institutional registry (SpineREG) was performed. The inclusion criteria were age ≥ 18 years, both sexes, lumbar arthrodesis procedure, a complete follow up assessment (Oswestry Disability Index-ODI, SF-36 and COMI back) and the capability to read and understand the Italian language. A delta of improvement of the ODI higher than 12.7/100 was considered a "good early outcome". A combined target model of ODI (Δ ≥ 12.7/100), SF-36 PCS (Δ ≥ 6/100) and COMI back (Δ ≥ 2.2/10) was considered an "excellent early outcome". The performance of the ML models was evaluated in terms of sensitivity, i.e., True Positive Rate (TPR), specificity, i.e., True Negative Rate (TNR), accuracy and area under the receiver operating characteristic curve (AUC ROC). A total of 1243 patients were included in this study. The model for predicting ODI at 6 months' follow up showed a good balance between sensitivity (74.3%) and specificity (79.4%), while providing a good accuracy (75.8%) with ROC AUC = 0.842. The combined target model showed a sensitivity of 74.2% and specificity of 71.8%, with an accuracy of 72.8%, and an ROC AUC = 0.808. The results of our study suggest that a machine learning approach showed high performance in predicting early good to excellent clinical results.
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Hamilton T, Macki M, Oh SY, Bazydlo M, Schultz L, Zakaria HM, Khalil JG, Perez-Cruet M, Aleem I, Park P, Easton R, Nerenz DR, Schwalb J, Abdulhak M, Chang V. The association of patient education level with outcomes after elective lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine 2021:1-9. [PMID: 34891131 DOI: 10.3171/2021.9.spine21421] [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: 03/22/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Socioeconomic factors have been shown to impact a host of healthcare-related outcomes. Level of education is a marker of socioeconomic status. This study aimed to investigate the relationship between patient education level and outcomes after elective lumbar surgery and to characterize any education-related disparities. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations. Primary outcomes included patient satisfaction determined by the North American Spine Society patient satisfaction index, and reaching the minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score and return to work up to 2 years after surgery. Multivariate Poisson generalized estimating equation models reported adjusted risk ratios. RESULTS A total of 26,229 lumbar spine patients had data available for inclusion in this study. On multivariate generalized estimating equation analysis all comparisons were done versus the high school (HS)/general equivalency development (GED)-level cohort. For North American Spine Society satisfaction scores after surgery the authors observed the following: at 90 days the likelihood of satisfaction significantly decreased by 11% (p < 0.001) among < HS, but increased by 1% (p = 0.52) among college-educated and 3% (p = 0.011) among postcollege-educated cohorts compared to the HS/GED cohort; at 1 year there was a decrease of 9% (p = 0.02) among < HS and increases of 3% (p = 0.02) among college-educated and 9% (p < 0.001) among postcollege-educated patients; and at 2 years, there was an increase of 5% (p = 0.001) among postcollege-educated patients compared to the < HS group. The likelihood of reaching a minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score at 90 days increased by 5% (p = 0.005) among college-educated and 9% (p < 0.001) among postcollege-educated cohorts; at 1 year, all comparison cohorts demonstrated significance, with a decrease of 12% (p = 0.007) among < HS, but an increase by 6% (p < 0.001) among college-educated patients and 14% (p < 0.001) among postcollege-educated compared to the HS/GED cohort; at 2 years, there was a significant decrease by 19% (p = 0.003) among the < HS cohort, an increase by 8% (p = 0.001) among the college-educated group, and an increase by 16% (p < 0.001) among the postcollege-educated group. For return to work, a significant increase was demonstrated at 90 days and 1 year when comparing the HS or less group with college or postcollege cohorts. CONCLUSIONS This study demonstrated negative associations on all primary outcomes with lower levels of education. This finding suggests a potential disparity linked to education in elective spine surgery.
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Affiliation(s)
| | | | - Seok Yoon Oh
- 2Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | | | - Lonni Schultz
- Departments of1Neurosurgery and.,3Public Health Sciences, and
| | | | | | | | | | - Paul Park
- 7Neurosurgery, University of Michigan Hospital, Ann Arbor
| | - Richard Easton
- 8Department of Orthopedic Surgery, William Beaumont Hospital-Troy, Michigan; and
| | - David R Nerenz
- 9Center for Health Services Research, Henry Ford Hospital, Detroit
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Brusko GD, Basil G, Wang MY. Big Data in the Clinical Neurosciences. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 134:271-276. [PMID: 34862551 DOI: 10.1007/978-3-030-85292-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The clinical neurosciences have historically been at the forefront of innovation, often incorporating the newest research methods into practice. This chapter will explore the adoption, implementation, and refinement of big data and predictive modeling using machine learning within neurosurgery. Initial development of national databases arose from surgeons aiming to improve outcome predictions for patients with traumatic brain injury in the 1960s. In the following decades, other surgical specialties began building databases that left a lasting impact on the current national neurosurgical databases, particularly in spine surgery. Significant contributions to the literature have been made as a result of the numerous registries today, leading to broad quality improvements for neurosurgical patients. Important limitations of large databases do exist, including lack of standardized reporting and challenges in data extraction from medical records. New vistas will include the use of metadata to track human function, performance, and pain in a real-time manner to augment the reliance on traditional patient-reported outcome measures (PROMs). Overall, big data has demonstrated significant utility within neurosurgical research and machine learning-powered analyses have highlighted several promising areas of interest for future exploration.
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Affiliation(s)
- G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA.
| | - Gregory Basil
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
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