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Anwar FN, Roca AM, Loya AC, Medakkar SS, Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Sayari AJ, Lopez GD, Singh K. The influence of preoperative Veterans RAND-12 physical composite score in patients undergoing anterior lumbar interbody fusion [Retrospective Review]. J Clin Neurosci 2024; 123:36-40. [PMID: 38522109 DOI: 10.1016/j.jocn.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
No study has evaluated the preoperative impact of Veterans RAND-12 Physical Composite Score (VR-12 PCS) on anterior lumbar interbody fusion (ALIF) patients. This study examines its influence on physical function, mental health, pain, and disability outcomes. Two cohorts of ALIF patients with preoperative VR-12 PCS scores were formed using a single-surgeon registry: VR-12 PCS < 30 and VR-12 PCS ≥ 30. Demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected. PROMs of VR-12 PCS/Mental Composite Score (MCS), Short Form-12 (SF-12) PCS/MCS, Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale-Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected pre/postoperatively up to 2-years. Demographics, perioperative characteristics, and preoperative PROMs were compared. Intercohort postoperative 6-week/final PROMs and improvements were compared. Of 80 patients, there were 41 in the VR-12 PCS < 30 cohort. Besides VR-12 PCS, VR-12 PCS < 30 patients reported inferior preoperative VR-12 MCS/SF-12 PCS/PROMIS-PF/PHQ-9/ODI scores (p ≤ 0.003, all). At 6-weeks postoperatively, VR-12 PCS < 30 reported inferior VR-12 PCS/SF-12 PCS/PROMIS-PF/PHQ-9 (p ≤ 0.030, all). There was greater improvement up to 6-weeks postoperatively in VR-12 PCS < 30 for VR-12 PCS/MCS and SF-12 PCS (p ≤ 0.020, all). VR-12 PCS < 30 reported superior improvement by final follow-up in VR-12 PCS/SF-12 PCS/PHQ-9 (p ≤ 0.006, all). MCID achievement rates were higher in VR-12 PCS < 30 for PHQ-9 and ODI (p ≤ 0.013, both). VR-12 PCS < 30 patients reported inferior postoperative physical function, mental health, and disability, yet superior magnitude of improvement in physical function and mental health. Rates of clinically meaningful improvement for VR-12 PCS < 30 were greater in mental health and disability.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Revollo YDLB, Atassi H, Fandino J, Kienzler JC. Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register. J Neurol Surg A Cent Eur Neurosurg 2023; 84:123-127. [PMID: 34897621 DOI: 10.1055/s-0041-1739233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD. METHODS This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery. RESULTS Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score. CONCLUSION LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.
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Affiliation(s)
- Yessika De Leon Benito Revollo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Neuro Research Office, Kantonsspital Aarau, Aarau, Switzerland
| | - Hermien Atassi
- Neuro Research Office, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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El-Qadi M, Thabit MA, Eissa E, Aziz AAFA, Kamel R. Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients.
AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents.
PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period.
RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved.
CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.
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Xue J, Song Y, Liu H, Liu L, Li T, Gong Q. Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis. J Back Musculoskelet Rehabil 2022; 35:505-516. [PMID: 34602458 PMCID: PMC9198744 DOI: 10.3233/bmr-210004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Numerous studies on the comparison of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) have been published, but there is no clear conclusion. OBJECTIVE The aim of this study was to evaluate the efficacy of MIS-TLIF compared with O-TLIF in the treatment of LDH in the Chinese population by meta-analysis. METHODS Studies on the treatment of LDH by MIS-TLIF versus O-TLIF were searched in Pubmed, Web of Science, Medline, Embase, CNKI, VIP and China Wanfang databases from the establishment of the databases to January 2020. The meta-analysis was used to analyze the pooled operation time, intraoperative blood loss, postoperative drainage, postoperative ground movement time, Waist and leg Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and Japanese orthopaedic association (JOA) score. Mean difference (MD) and standard mean difference (SMD) were used as the effect size. RESULTS Eleven studies with 1132 patients were included. The results showed that MIS-TLIF compared with O-TLIF, MD =-133.82 (95% CI: -167.10 ∼-100.53, P< 0.05) in intraoperative blood loss, MD =-114.43 (95% CI: -141.12 ∼-87.84, P< 0.05) in postoperative drainage, MD =-3.30 (95% CI: -4.31 ∼-2.28, P< 0.05) in postoperative ground movement time, SMD =-1.44 (95% CI: -2.63 ∼-0.34, P< 0.05) in postoperative low back pain VAS score, SMD = 0.41 (95% CI: 0.15 ∼ 0.66, P< 0.05) in postoperative JOA score, MD = 4.12 (95% CI: -11.64 ∼ 19.87, P> 0.05) in the average operation time, SMD =-0.00 (95% CI: -0.36 ∼ 0.36, P> 0.05) in leg pain VAS score, and SMD =-0.59 (95% CI: -1.22 ∼ 0.03, P> 0.05) in ODI score. CONCLUSION MIS-TLIF was superior to O-TLIF in the treatment of LDH, especially in the intraoperative blood loss, postoperative drainage, postoperative ground movement time and low back pain in the Chinese population.
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Affiliation(s)
| | - Yueming Song
- Corresponding author: Yueming Song, Department of Orthopaedics, West China Hospital, Sichuan University, No 37 in Road Guoxue, Chengdu, Sichuan 610041, China. Tel.: +86 18980601382; E-mail:
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Song J, Pan F, Kong C, Sun X, Wang Y, Wang W, Lu S. Does the sagittal spinal profile differ between the elderly Chinese populations with and without lumbar disc herniation? Asian J Surg 2022; 45:2719-2724. [DOI: 10.1016/j.asjsur.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
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Sencan S, Erdem D, Gunduz OH, Bilim S, Duruoz MT. Reliability and validity of the Istanbul Low Back Pain Disability Index in lumbosacral radiculopathy. J Back Musculoskelet Rehabil 2021; 34:813-820. [PMID: 33935066 DOI: 10.3233/bmr-200339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbosacral radiculopathy is associated with a broad range of complaints; therefore, specific disability measurements should be validated for this condition. OBJECTIVES The aim of this study was to investigate the validity and reliability of the Istanbul Low Back Pain Disability Index (ILBPDI) in lumbosacral radiculopathy. METHODS Patients diagnosed with radiculopathy caused by a disc herniation were included. Disability and quality of life were evaluated with the Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. The severity of low back pain and leg pain were evaluated using a Numeric Rating Scale (NRS). The reliability of the ILBPDI was assessed using the Cronbach's alpha coefficient. The relation of ILBPDI with SF-36, ODI, NRS-back and NRS-leg scores were analyzed for convergent validity. The relation of the ILBPDI with age, body mass index (BMI), and disease duration was analyzed for divergent validity. Factor analysis was used to establish the internal construct validity. RESULTS One hundred patients (55% female) were included in this study. The Cronbach's alpha coefficient was 0.92. The ILBPDI was found to be correlated with the ODI (rho: 0.619, p< 0.005) and NRS-leg score (rho: 0.597, p< 0.005), but not with NRS-back score (rho: 0.164, p> 0.05). The ILBPDI was significantly correlated with physical functioning (rho: -0.638, p< 0.005), bodily pain (rho: -0.488, p< 0.005), general health (rho: -0.264, p= 0.008) and social function (rho: -0.372, p< 0.005) subscales of SF-36 (convergent validity). The ILBPDI was not correlated with age, BMI, or disease duration (divergent validity). Factor analysis showed that the scale had three-factors which were correlated to bending forward, standing, and sitting activities. CONCLUSION The ILBPDI is a valid and reliable instrument in patients with lumbosacral radiculopathy.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Didem Erdem
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Serhad Bilim
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Mehmet Tuncay Duruoz
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Rheumatology, Istanbul, Turkey
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Beck J, Brisby H, Baranto A, Westin O. Low lordosis is a common finding in young lumbar disc herniation patients. J Exp Orthop 2020; 7:38. [PMID: 32476065 PMCID: PMC7261711 DOI: 10.1186/s40634-020-00253-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The sagittal alignment of the lumbar spine and pelvis can be classified into several subtypes. It has been suggested that the risk of developing certain pathologies, such as a lumbar disc herniation (LDH) is affected by spinal sagittal profiles. The main aim of this study was to investigate the sagittal profile in young patients surgically treated for a lumbar disc herniation and if a discectomy would alter the sagittal parameters. Methods Sixteen active young patients (mean age 18.3 ± 3.2 SD) with a lumbar disc herniation having a discectomy were included. A classification according to Roussouly of the sagittal parameters was made by two senior spinal surgeons, both pre-operatively and post-operatively on radiographs. The distribution of sagittal parameters and spinopelvic profiles were analysed and compared to a previous established healthy normal population. Results This series of active young patients with LDH exhibited a low lumbar lordosis dominance, with Roussouly sagittal profiles type 1 and type 2 accounting for more than 75% of the examined patients. An analysis of the erect radiographs revealed no significant changes in the post-operative sagittal profile. Conclusions This study showed that sagittal spinal alignment according to Roussouly in a young population with LDH is skewed compared with a normal population cohort. Furthermore, the lack of post-operative correction is suggestive of a non-ephemeral response to a LDH. Roussouly type 2 spinal sagittal profile may be a risk factor in young individuals suffering a disc herniation.
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Affiliation(s)
- Joel Beck
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden.
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
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Parrish JM, Jenkins NW, Hrynewycz NM, Brundage TS, Singh K. The influence of gender on postoperative PROMIS physical function outcomes following minimally invasive transforaminal lumbar interbody fusion. J Clin Orthop Trauma 2020; 11:910-915. [PMID: 32879580 PMCID: PMC7452261 DOI: 10.1016/j.jcot.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Our aim is to examine the gender performance of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) scores among patients undergoing minimally invasive transforaminal lumbar fusion (MIS TLIF). METHODS A prospectively collected surgical dataset was retrospectively assessed for eligible patients from March 2015-June 2019. We included patients if they underwent primary MIS TLIF procedures on one or two vertebral levels. We collected baseline demographics, perioperative characteristics, and PROMIS-PF scores for each subject at pre and postoperative timepoints (e.g., 6-weeks, 3-months, 6-months, and 1-year). Chi-squared analyses were utilized to assess categorical variables and a Student's t-tests analyzed continuous variables. A linear regression was used to analyze PROMIS-PF scores from baseline through all postoperative time points. Finally, we evaluated the PROMIS PF achievement of minimal clinically important difference (MCID) among gender. RESULTS 192 patients were included: 77 were females and 115 were males. No significant differences were observed among gender subgroups for PROMIS-PF scores at pre- or postoperative evaluations. Compared to males, females experienced significantly greater postoperative improvement with PROMIS-PF scores at the 3-month assessments, though no significant gender differences were observed during later follow-up evaluations at 6-months or one year. Females were observed to have significant PROMIS-PF score improvement from their preoperative evaluation to each postoperative score. Males were assessed to have statistically significant postoperative (e.g., at 3-months, 6-months, and 1-year) PROMIS-PF score improvement from their preoperative PROMIS-PF scores. There were no significant differences among gender in achieving MCID at any postoperative time interval. CONCLUSION Among gender, we observed no statistically significant difference in PROMIS-PF scores during the pre- or postoperative evaluations. Additionally, with no difference in the rate of achieving PROMIS-PF MCID postoperatively, this study established that both genders should experience similar functional outcomes following MIS TLIF.
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Hareni N, Strömqvist F, Strömqvist B, Rosengren BE, Karlsson MK. Predictors of satisfaction after lumbar disc herniation surgery in elderly. BMC Musculoskelet Disord 2019; 20:594. [PMID: 31818279 PMCID: PMC6902341 DOI: 10.1186/s12891-019-2975-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to evaluate satisfaction and factors associated with satisfaction in elderly undergoing lumbar disc herniation surgery. Methods In the national Swedish register for spinal surgery (SweSpine) we identified 2095 patients aged > 65 years (WHO definition of elderly) whom during 2000–2016 had undergone LDH surgery and had pre- and one-year postoperative data (age, gender, preoperative duration and degree of back- and leg pain, quality of life (SF-36) and one-year satisfaction (dissatisfied, uncertain, satisfied). We utilized a logistic regression model to examine preoperative factors that were independently associated with low and high satisfaction and after LDH surgery. Results One year after surgery, 71% of the patients were satisfied, 18% uncertain and 11% dissatisfied. Patients who were satisfied were in comparison to others, younger, had shorter preoperative duration of leg pain, higher SF-36 mental component summary and more leg than back pain (all p < 0.01). Patients who were dissatisfied were compared to others older, had longer preoperative duration of leg pain and lower SF-36 scores (all p < 0.01). 81% of patients with leg pain up to 3 months were satisfied in comparison with 57% of patients with leg pain > 2 years (p < 0.001). Conclusion Only one out of ten elderly, is dissatisfied with the outcome of LDH surgery. Age, preoperative duration of leg pain, preoperative SF 36 score, and for satisfaction also dominance of back over leg pain, are in elderly factors associated to good and poor subjective outcome after LDH surgery.
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Affiliation(s)
- Niyaz Hareni
- Departments of Orthopaedics, Varberg Hospital, Träslövsvägen 68, 432 37, Varberg, Sweden. .,Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Strömqvist
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn Strömqvist
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Sex Differences on Postoperative Pain and Disability Following Minimally Invasive Lumbar Discectomy. Clin Spine Surg 2019; 32:E444-E448. [PMID: 31162188 DOI: 10.1097/bsd.0000000000000848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To determine if sex is associated with differences in postoperative pain scores, narcotic consumption, and long-term improvements in pain and disability following minimally invasive lumbar discectomy (MIS LD). SUMMARY OF BACKGROUND DATA There exists a question as to what extent sex influences surgical and clinical outcomes following MIS LD. METHODS Patients undergoing primary, single-level MIS LD were retrospectively reviewed and stratified on the basis of sex. Immediate postoperative Visual Analog Scale (VAS) pain scores and narcotic consumption were collected. Patient-reported outcomes, including Oswestry Disability Index (ODI), 12-Item Short-Form- (SF-12) Physical Component Score, and VAS back and leg pain, were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Sex differences were tested for an association between immediate postoperative pain, narcotics utilization, and long-term improvements in patient-reported outcomes using linear regression. RESULTS A total of 188 patients were included and 62.8% were male individuals. At the time of surgery, female individuals were older than male individuals (P=0.045). There were no observed differences in other demographic or perioperative characteristics between cohorts. Female individuals had similar inpatient VAS pain scores and narcotic consumption compared with male individuals. Female individuals had a higher ODI score than male individuals preoperatively, however, both cohorts had similar improvements in ODI at all postoperative time points. Both sexes had similar VAS back and leg pain and SF-12 PCS scores preoperatively and at all postoperative time points. CONCLUSIONS Our study demonstrated that sex does not affect immediate postoperative pain, narcotic consumption, and long-term recovery following MIS LD. Female individuals demonstrated similar preoperative back and pain scores compared with male individuals but reported greater disability before surgery. However, both sexes experienced similar improvements in pain and disability at all follow-up time points through 12 months. The results of this study may enable providers to better counsel patients regarding the expected improvement in pain and disability.
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Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019; 185:105486. [DOI: 10.1016/j.clineuro.2019.105486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
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Gender differences in degenerative spine surgery: Do female patients really fare worse? 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 2018; 27:2427-2435. [PMID: 30132176 DOI: 10.1007/s00586-018-5737-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Prior data has set the precedent that female patients fare somewhat worse than men after spine surgery. We aimed to evaluate the effect of gender on patient-reported outcomes after lumbar spine surgery for degenerative pathologies. METHODS We identified a consecutive cohort of patients from a prospective registry. Absolute values, as well as change scores for back and leg pain severity (numeric rating scale [NRS]), functional disability (Oswestry disability index [ODI]), and health-related quality of life (HRQOL) as assessed by EQ-5D were compared among male and female patients. RESULTS Of the 3279 included patients, 1543 (47%) were female. At baseline, women reported higher NRS for back and leg pain, higher ODI, but equal HRQOL (all p < 0.05). Otherwise, both groups had comparable baseline data. The absolute differences in patient-reported outcomes persisted at the 6-week, 12- and 24-months follow-up, with women now additionally reporting worse HRQOL as assessed by EQ-5D (all p < 0.05). For all outcome measures, change scores were equal among male and female patients, as were the incidences of complications and reoperations (all p > 0.05). Clinical success was achieved in 82% of men and 79% of women (p = 0.34). CONCLUSIONS Female patients are generally scheduled for surgery with a more advanced disease state. While women seem to report more severe symptoms at long-term follow-up, the degree of improvement is equal among men and women. Female patients may thus fare worse in terms of absolute scores, but enjoy the same benefit from surgery in relative terms. These slides can be retrieved under Electronic Supplementary Material.
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Big data analysis reveals the truth of lumbar fusion: gender differences. Spine J 2017; 17:754-755. [PMID: 28431681 DOI: 10.1016/j.spinee.2016.12.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/15/2016] [Indexed: 02/03/2023]
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Zhang J, Lan PH, Wang HQ. Letter to the Editor: Defining the overall hallmarks of young patients undergoing lumbar discectomy. J Neurosurg Spine 2016; 26:135-136. [PMID: 27588915 DOI: 10.3171/2016.6.spine16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jun Zhang
- Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Baoji Municipal Central Hospital, Baoji, Shaanxi Province, China
| | - Ping-Heng Lan
- Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hai-Qiang Wang
- Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Pieber K, Salomon N, Inschlag S, Amtmann G, Resch KL, Ebenbichler G. Predictors of an unfavorable outcome 1.5 and 12 years after a first, uncomplicated lumbar disc 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 2016; 25:3520-3527. [PMID: 27421281 DOI: 10.1007/s00586-016-4700-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify predictors of both intermediate and long-term unfavorable outcomes after first time, uncomplicated lumbar disc surgery. METHODS Patients (n = 120) who had undergone lumbar disc surgery were followed up 1.5 and 12 years thereafter. Baseline assessments were carried out 5-8 days after surgery. Clinical outcome was assessed in both follow-ups using the Low Back Pain Rating Scale. Statistical analysis included binary logistic and linear regression. RESULTS Unfavorable outcomes were found in 50.5 % (1.5 years) and 52.6 % (12 years) of patients available for follow-up examination. Low pre-operative physical activity and severe pain in the first week after surgery were predictive of an unfavorable post-operative outcome at both follow-ups. CONCLUSIONS Identified predictors suggest that particular emphasis should put on comprehensive post-operative care at large and encouragement to adapt a physically active lifestyle in particular in rehabilitation concepts after first time uncomplicated lumbar disc surgery.
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Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Nora Salomon
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Silke Inschlag
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabriele Amtmann
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Gerold Ebenbichler
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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