Outcome Of Lumbar Spine Surgery Research Articles

Do Modic changes have an impact on clinical outcome in lumbar spine surgery? A systematic literature review.

To provide a systematic literature review of the impact of preoperative Modic changes (MCs) on the clinical outcome following lumbar spine surgery for degenerative lumbar spine disease. A PubMed search until 31 October 2015 was performed to identify publications correlating preoperative MC with clinical outcome in patients undergoing spine surgery. Inclusion criteria were met by 14 articles (7 prospective and 7 retrospective studies) representing a total of 1652 surgical patients, of which at least 804 (>49%) showed MC. Of the 14 publications, 6 concerned discectomy (n=607), 1 fusion versus discectomy (n=91), 3 fusion surgery (n=454), and 4 total disc replacement (TDR, n=500). A trend toward less improvement in low back pain or Oswestry Disability Index score was found in the discectomy studies, and a trend toward increased improvement was demonstrated in the TDR studies when MC was present preoperatively. The fusion studies were of low evidence, and showed conflicting results. Preoperative MC showed a trend toward a negative correlation with clinical improvement in patients undergoing discectomy for LDH and a positive correlation with clinical improvement in patients undergoing TDR for degenerative disc disease. However, it is questionable whether the differences surpass the minimal clinically important difference (MCID). In patients undergoing fusion surgery, there was insufficient evidence to draw any conclusions. Future studies should include a larger patient material, focus on MCID, and include known confounding factors of the clinical outcome of spine surgery in the analysis.

The Relationship between Preoperative Expectations and the Short-Term Postoperative Satisfaction and Functional Outcome in Lumbar Spine Surgery: A Systematic Review.

Study Design Systematic review. Objective To examine the relationship between the patient's preoperative expectations and short-term postoperative satisfaction and functional outcome in lumbar spine surgery. Methods The Medline, Embase, and Cochrane databases were queried using a predefined search algorithm to identify all lumbar spine studies analyzing the influence of preoperative expectations on postoperative satisfaction and functional outcome. Two independent reviewers and a third independent mediator reviewed the literature and performed study screening, selection, methodological assessment, and data extraction using an objective protocol. Results Of 444 studies identified, 13 met the inclusion criteria. Methodological quality scores ranged from 59 to 100% with the greatest variability in defining patient characteristics and the methods of assessing patient expectations. Patient expectations were assessed in 22 areas, most frequently back and leg pain expectations and general expectations. Functional outcome was assessed by 13 tools; the most common were the visual analog scale, Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Positive expectations for symptomatology, activity, general health, and recovery correlated with satisfaction. General expectations correlated with higher SF-36 Physical Subcomponent scores, better global function, and lower ODI outcome. Conclusions on the influence of the expectations for pain were limited due to the study heterogeneity, but the evidence suggests a positive correlation between the expectation and outcome for back and leg pain. Conclusions Positive expectations correlated significantly with short-term postoperative satisfaction and functional outcome, including higher SF-36 scores, earlier return to work, and decreased ODI scores. Future expectation-based investigations will benefit from implementation of the standardized methods of expectation, satisfaction, and outcome analysis discussed herein.

Pre-operative high body mass index has no effect in clinical outcome of lumbar spine surgery

Pre-operative high body mass index has no effect in clinical outcome of lumbar spine surgery

Registry Data May Prove Useful in Benchmarking Lumbar Spine Surgery Outcomes

Registry Data May Prove Useful in Benchmarking Lumbar Spine Surgery Outcomes

Benchmarking the Outcome of Lumbar Spine Surgery Using a Spine Register Database

Benchmarking the Outcome of Lumbar Spine Surgery Using a Spine Register Database

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

The purpose is to study rates, trends, geographic variations and outcome of lumbar spine surgery in the Belgian population during the last decade. This is a retrospective cohort study using administrative data of the largest Belgian sickness fund from January 1, 2000 through December 31, 2009. Cases included lumbar laminectomy, combined discectomy and fusion, posterior interarticular fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and standard discectomy. The main outcome measures were age- and sex-adjusted rates of lumbar spine surgery, 1-year mortality, 1-year iterative surgery, no return to work (RTW) rate 1 year after surgery and length of hospital stay. Multivariate logistic regression analysis was used to determine the association between age, sex, geographic region, type of surgery, year of intervention and duration of pre-operative sick leave on outcome. Spine surgery rates rose 44 % from 2001 through 2009 and data for 2009 showed twofold variations in spine surgery rates among 10 Belgian provinces. Reported 1-year mortality varied from 0.6 to 2.5 % among surgical procedures performed in 2008. The overall 5-year reoperation rate was 12 %. RTW rates 1 year after standard discectomy, ALIF, PLIF and combined discectomy and fusion for the follow-up sample of 2008 were 14.4, 22.7, 26.1 and 30.6 %, respectively. The median length of hospital stay significantly decreased throughout the decade. Type of surgery and geographic region were significantly related to patient outcomes. Regional variations highlight professional uncertainty and controversy. The study results point to the need for peer comparisons and surgeon feedback.

JOABPEQ心理的障害の手術成績への影響

腰椎手術例における心理的障害と手術成績の関連を調べるために，JOABPEQでの術前心理的障害の程度と他項目，VASの改善度との相関性，および術後心理的障害改善度と他項目，VAS改善度との相関性を調べた．術後，疼痛関連障害や歩行機能障害は70％以上改善していたが，社会生活障害や心理的障害の改善は50％以下と低かった．術前心理的障害の程度と術後各項目の改善度とは正の相関性はみられなかった．術後心理的障害改善度と腰椎機能障害，歩行機能障害，社会生活障害，腰痛VAS，下肢痛VASそれぞれの改善度とに正の相関性がみられた．自験例でのJOABPEQ，VAS評価の統計学的検討において術前心理的障害と手術成績との関連はなく，腰椎機能や歩行能力の向上，腰下肢痛の軽減が術後心理的障害改善に強く影響したと示唆された．

Obesity Is Associated With Inferior Results After Surgery for Lumbar Spinal Stenosis

A cohort study based on the Swedish Spine Register. To determine the association between body mass index (BMI) and outcome of lumbar spine surgery for spinal stenosis. Several small studies have sought to evaluate the importance of obesity in relation to results after surgery for lumbar spinal stenosis (LSS), but the findings are inconsistent and relatively weak. All patients who underwent surgery for LSS from January 1, 2006, to June 30, 2008, with a completed 2-year follow-up in the Swedish Spine Register were included. Logistic regression was used to assess the association between BMI and different outcomes. Of the 2633 patients enrolled, 819 (31%) had normal weight, 1208 (46%) were overweight, and 606 (23%) were obese. On average, all 3 BMI groups achieved significant improvements after surgery. A higher BMI, however, was associated with greater odds of dissatisfaction after surgery and inferior results at the 2-year follow-up. After adjusting for differences in baseline characteristics, the obese group demonstrated inferior function and quality of life as measured by the Oswestry Disability Index (ODI) and the EuroQol Group Index (EQ-5D), respectively. At the 2-year follow-up, obese patients had a mean ODI of 33 (95% confidence interval [CI], 31-34) and mean EQ-5D of 0.56 (95% CI, 0.54-0.59) compared with a mean ODI of 25 (95% CI, 24-26) and mean EQ-5D of 0.64 (95% CI, 0.62-0.66) in the normal weight group. When compared with the normal weight patients, the adjusted odds ratio for dissatisfaction was 1.73 in the obese group (95% CI, 1.36-2.19). Differences between the normal weight and overweight groups were modest and therefore could not be considered clinically relevant. Obese patients achieved significant pain reduction, better walking ability, and improved quality of life after surgical treatment of LSS. Nevertheless, obesity was associated with a higher degree of dissatisfaction and poorer outcomes after surgery for LSS.

Defining Substantial Clinical Benefit Following Lumbar Spine Arthrodesis

Validated health-related quality-of-life measures have become important standards in the evaluation of the outcomes of lumbar spine surgery. However, there are few well-defined criteria for clinical success based on these measures. The minimum clinically important difference is an important demarcation, but it could be considered a floor value rather than a goal in defining clinical success. Therefore, we sought to define thresholds of substantial clinical benefit for commonly used health-related quality-of-life measures following lumbar spine arthrodesis. Prospectively collected preoperative and one-year postoperative health-related quality-of-life measures from 357 patients who were managed with lumbar spine arthrodesis for the treatment of degenerative conditions were identified. Candidate substantial clinical benefit thresholds for the Short Form-36 physical component score, Oswestry Disability Index, and back and leg pain numeric rating scales were identified with use of receiver operating characteristic curve analysis. Receiver operating characteristic curves were used to discriminate between patients who reported being "much better" or "about the same" with use of the validated Short Form-36 health transition item and between those who reported being "mostly satisfied" or "unsure" with use of a nonvalidated but more surgery-specific satisfaction-with-results survey. For each health-related quality-of-life measure, three response parameters were used: net change, percent change, and raw score at the time of the one-year follow-up. Substantial clinical benefit thresholds for the Short Form-36 physical component score were a 6.2-point net improvement, a 19.4% improvement, or a final raw score of > or = 35.1 points. Substantial clinical benefit thresholds for the Oswestry Disability Index were an 18.8-point net improvement, a 36.8% improvement, or a final raw score of < 31.3 points. Substantial clinical benefit thresholds for the back pain and leg pain numeric rating scales were a 2.5-point net improvement or a final raw score of < 3.5 points. Substantial clinical benefit thresholds for percent change were 41.4% for the back pain numeric rating scale and 38.8% for the leg pain numeric rating scale. We believe that thresholds of substantial clinical benefit for commonly used health-related quality-of-life measures following lumbar spine arthrodesis are important as they describe a magnitude of change that the patient recognizes as a major improvement.

Complications and Outcomes of Lumbar Spine Surgery in Elderly People: A Review of the Literature

As the number of elderly persons in the United States continues to increase, there will be an associated increase in age-related diseases, such as degenerative conditions of the lumbar spine. Elderly patients frequently present to their geriatrician or primary care provider with low back and leg pain. Spine surgery is one of several options the geriatric patient may consider for symptomatic relief, but the literature describing the safety and efficacy of spine surgery in older patients is inconclusive and at times confusing. The purpose of this article is to describe common degenerative conditions of the lumbar spine and to review the complications and outcomes of spine surgery in elderly patients, with particular attention to how they compare with those of younger patients. A better understanding of the risks and prognosis associated with these types of surgeries will enable more-informed decision-making by patients and physicians.

Evaluation of a Dallas Pain Questionnaire classification in relation to outcome in lumbar spinal fusion

Several studies have suggested that psychosocial distress is an important predictor of negative outcome in lumbar spine surgery. Ozguler et al. [Spine 27:1783-1789, 2002, 18] described a classification tool for low back pain patients using the Dallas Pain Questionnaire (DPQ) which included a measure of distress. We wanted to evaluate the ability of this classification tool to predict the outcome in spinal fusion patients. Five hundred and sixty-six patients (239 men, 327 women; mean age 46, range 18-81) operated between 1992 and 2002, with a complete DPQ preoperatively and after a minimum of 1-year follow-up, were included. They were classified preoperatively and at follow-up into four groups: group 1 (slight disability), group 2 (intermediate disability), group 3 (major disability) and group 4 (major disability and emotional distress). Using logistic regression, seven predictor variables were investigated: age (-39 years/40-59 years/60+ years), Gender (male/female), Indication (spondylolisthesis/primary degeneration/secondary degeneration), Work status (working/without work or on sick leave/retired or pensioned), Duration of pain (less than 1 year/1-2 years/more than 2 years), Presence of radiating pain (yes/no) and disability/distress [intermediate disability (group 1-2)/major disability (group 3)/major disability and distress (group 4)]. The outcome variable was disability at follow-up (low = group1 + 2/high = group 3 + 4). Preoperative classification was group 1, 1%; group 2, 14%; group 3, 37%; group 4, 48%. Variables found to predict high disability at follow-up were secondary degeneration Odds Ratio (OR) 1.61 (P=0.020), being retired/pensioned OR 3.48 (P<0.0005), age between 40-59 years OR 1.68 (P=0.011), belonging to group 3 OR 2.69 (P=0.003) or belonging to group 4 OR 5.53 (P<0.0005). The classification based on the DPQ were able to identify lumbar spinal fusion patients with a considerable amount of psychological distress in their symptomatology. Furthermore, the presence of distress, as determined by this classification, was a highly significant risk factor for inferior outcome.

Surgery of the Lumbar Spine for Spinal Stenosis in 118 Patients 70 Years of Age or Older

A consecutive case retrospective chart review and an outcome satisfaction questionnaire were used in this study. To provide a surgical reference for surgeons and elderly patients who may have concerns regarding the safety and outcome of lumbar spine surgery in their age population. Elderly patients scheduled for spine surgery have a major concern about the safety and outcome of the procedure in light of their advanced age. A review of the literature demonstrated conflicting results regarding the outcome of lumbar spine surgery for spinal stenosis in the elderly. A retrospective review evaluated 118 consecutive patients ages 70 to 101 years who were managed surgically for lumbar spinal stenosis. This patient population was analyzed for the operative procedure, postoperative morbidity and mortality, and long-term clinical outcome and satisfaction. All 118 patients had at least a 2-year follow-up evaluation, and 21 of these patients were older than 80 years. Clinical parameters were compiled and analyzed on the basis of chart review. Overall morbidity occurred in 24 patients (20%). During the study period, the average length of hospitalization declined an average of 2 days. Of the 118 patients, 109 expressed satisfaction with the operation and resumed daily activities, whereas 9 had fair or poor results. Advanced age did not increase the morbidity associated with this operation because the results reported in this study are comparable with those from other studies of a younger population, nor did advanced age decrease patient satisfaction or return to activities.

Lumbar Spine Surgery in the Obese Patient

A prospective study was performed in obese and nonobese patients undergoing lumbar spine surgery to report perioperative data and surgical outcomes. One hundred fifty-nine consecutive patients who underwent lumbar spine surgery by a single surgeon entered the study. Among 159 consecutive patients, 55 met the criteria for obesity (> 20% ideal body weight). The average weight was 226 lb in the obese group. There were 28 men and 27 women with ages ranging from 25 to 81 years, with a mean of 47.9 years. The diagnoses and procedures included 31% herniated nucleus pulposus with laminotomy and discectomy, 14% spinal stenosis with laminectomy, and 55% lumbar fusion procedures for other disorders. Twenty-nine percent had previous lumbar surgery that had failed. Results indicated that there were no significant differences between the obese and control groups in terms of duration of surgery (3.8 versus 3.2 h), blood loss (723 versus 605 ml), and duration of hospital stay (5.6 versus 5.8 days). The clinical results were 24% excellent, 40% good, 27% fair, and 9% poor in the obese group; and 27% excellent, 37% good, 19% fair, and 17% poor in the control group. This study found no significant differences between obese and control patients relative to blood loss, operative time, hospital stay, rate of complications, and functional outcome in lumbar spine surgery. Patient selection continues to be the most important factor in terms of operative success. We believe that lumbar spine surgery, including fusion, should not be withheld from obese patients who present with proper indications for surgery and fail an appropriate course of conservative treatment.

Predictors of Bad and Good Outcome of Lumbar Spine Surgery

Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. The prognostic value of a screening checklist developed in a previous study was evaluated in a 2-year follow-up. Outcome studies of lumbar disc surgery document a success rate between 49-90%. It has been shown that a number of medical history data and sociodemographic and psychodiagnostic findings are of prognostic value for the outcome of lumbar spine surgery. In addition to clinical and neuroradiologic examinations, 164 patients took part in a standardized interview. Eighty-two percent participated in a follow-up performed 2 years after the operation. Preoperative findings, outcome, and prediction of three diagnostic subgroups were compared. Eighty-three (51%) patients had disc herniation only, 29 (18%) had disc herniation and other relevant back diagnoses, and 51 (31%) had no disc herniation but had other relevant back diagnoses. In patients with disc herniation only, good results were observed in 53%, moderate in 19%, and bad in 28%. The accuracy of prediction of the postoperative result was 75% for the patients with good outcome and 86% for those with bad outcome. In the group of patients with diagnoses other than disc herniation, the success rate of the operation was 38% good, 28% moderate, and 41% bad, but the predictor score was not as useful as for the other groups. Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.

Point of View: Predictors of Bad and Good Outcome of Lumbar Spine Surgery: A Prospective clinical Study with 2 Years' Follow-up

Point of View: Predictors of Bad and Good Outcome of Lumbar Spine Surgery: A Prospective clinical Study with 2 Years' Follow-up

Psychological vulnerability as a predictor for short-term outcome in lumbar spine surgery

A prospective survey of the outcome following lumbar spine surgery was carried out during a period of six months. Of a consecutive series of 144 patients 130 cases (90%) could be evaluated. Postoperative follow-up was for six months. A test of psychological vulnerability was included with the preoperative data. Outcome was determined as unsatisfactory in case of re-operation (9%) before follow-up or if pain persisted unchanged or became worse (30%). Psychological vulnerability was significantly associated with poor outcome irrespective of age, sex, pre-operative somatic health, and surgical findings. The relative risk ratio of persisting pain attributable to psychological vulnerability was 1.8. The finding support the contention that psychogenic factors independently and significantly contribute to the multiple factor interaction that determines short-term outcome. The social consequences were strongly associated with psychological vulnerability. Among patients pre-operatively on sick-leave the relative risk ratio of unemployment attributable to psychological vulnerability was 6.0.

Short-term outcome in lumbar spine surgery. A prospective study (Part I).

A prospective survey of the outcome of lumbar surgery was carried out under conditions where all intervention was according to routine procedures. Of a consecutive series of patients 132 cases (92%) could be evaluated. The aim was to investigate possible predictive factors among self-reported data and clinical data readily available under routine circumstances. Follow-up was for six months post-operatively. Surgical findings were: herniated disc (62%), osteochondrosis (21%), other pathology (7%), and negative findings (10%). Unsatisfactory outcome was either relapse, operation before follow-up (9%) or persisting pain (30%). The surgical finding of a disc herniation predicted a significantly better outcome than any other finding. Cases previously operated upon (20%) fared equal with those operated upon for the first time irrespective of surgical findings. Self-reported weighting of preoperative pain and its location showed that predominant sciatica was significantly associated with the finding of a disc herniation, but also with satisfactory outcome irrespective of the operative finding. Factors without predictive value included sex, age, number of prior back surgeries, duration and impact of symptoms, and clinical findings. The social consequences were associated with the duration of low back disease.