The palm beach spine index: Afunctional measure of postlaminectomy patients

Abstract

The functional importance of spinal surgery has recently been investigated using a battery of tests, resembling activities of daily living, referred to as the Palm Beach Spine Index (PBSI). Forty-two patients (23 men and 19 women, aged 74.2 ± 5.7 years), with a primary diagnosis of moderate to severe degenerative spinal stenosis, underwent a series of functional tests before and after surgical intervention. The functional tests included a timed progressive treadmill walk (TW) at 1.0 mph with a 0.4 increase in speed every 2 minutes for a maximum time of 10 minutes; a chair stand test (CS), which required the patient to rise from a straight-back chair to a standing position as quickly as possible without the use of the arms; and a timed weight-carrying task (WC) that involved having the patient walk a distance of 20 meters as quickly as possible while carrying dumbbells representing 10% of their body weight. Significant ( P < 0.05) improvements were observed from preoperative to 30 days and 6 months postoperatively for all tests: TW time improved from 351.40 seconds preoperatively to 449.19 seconds at 30 days (27.8%) and to 600.00 seconds at 6 months (33.5%), whereas the CS time improved from 0.82 milliseconds to 0.62 at 30 days (32.2%) and 0.35 at 6 months (77.1%), with WC time improving from 12.12 seconds to 9.34 seconds at 30 days (29.7%) and 6.55 at 6 months (42.6%). The functional improvements as surgical outcomes were successfully measured using the PBSI. Moreover, the results associated with the PBSI are easily understood by the patient and serve to facilitate self-monitoring and adherence to postoperative treatment. Self-reports of pain and a loss of mobility in conjunction with radiographic analysis are not enough to maintain the support of managed care for both surgical and postsurgical care. In contrast, the PBSI serves as an alternative to subjective assessments (eg, pain) with a quantitative approach to recognizing the benefits of surgical intervention.