Surgery For Lumbar Disc Herniation Research Articles

Occupational lifting predicts hospital admission due to low back pain in a cohort of airport baggage handlers

PurposeTo examine if occupational lifting assessed as cumulative years as a baggage handler is associated with first-time hospital diagnosis or treatment for low back disorders.MethodsThis study is based on the Copenhagen Airport Cohort consisting of male baggage handlers performing heavy lifting every day and a reference group of unskilled men from the greater Copenhagen area during the period 1990–2012. We followed the cohort in the National Patient Register and Civil Registration System to obtain information on diagnoses, surgery, mortality, and migration. The outcomes were first-time hospital diagnosis or surgery for (1) lumbar disc herniation or (2) low back pain (LBP).ResultsBaggage handlers (N = 3473) had a higher incidence rate of LBP, but not of lumbar disc herniation, compared to the reference group (N = 65,702). Baggage handlers with longer employment had a higher incidence of LBP compared to baggage handlers with shorter employment. The linear association of cumulative years as a baggage handler on LBP was significantly increased with an incidence rate ratio of 1.16 (95% CI 1.07–1.25) for a 5-year increase of employment as baggage handler.ConclusionsIn this large cohort study, we found an increased incidence of LBP among baggage handlers compared to the reference group with indications of a dose–response relationship between years of employment and the outcome. For baggage handlers working on the apron, the incidence was particularly increased before introduction of technical lifting equipment, suggesting that preventive measures to reduce cumulative work load may have a positive effect.

133. Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care system

BACKGROUND CONTEXT Canada has a government-fundeduniversal health care system and access to specialist care requires a referral by general practitioners. In contrast, the United States utilizes a blended public and private payer system where insured patients can directly access specialists. PURPOSE The purpose of this study is to investigate whether clinical outcomes differ between those surgically treated for lumbar disc herniation in Canada as compared to the United States. STUDY DESIGN/SETTING A retrospective analysis of the surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and the Spine Patients Outcome Research Trial (SPORT) study. PATIENT SAMPLE Consecutive surgical lumbar disc herniation patients enrolled in the CSORN registry and the SPORT trial. OUTCOME MEASURES Baseline demographics, and spine-related patient-reported outcomes (PROs), including disatisfaction, were compared at three months and one year postoperatively. METHODS A retrospective analysis of surgical lumbar disc herniation patients enrolled in the CSORN registry and the SPORT trial. RESULTS The CSORN cohort consisted of 703 patients and the SPORT cohort included 573 patients. The rate of females in each cohort was similar (47.2% vs 46.4%, p=0.78); however, patients in the CSORN cohort were older (46.2 ±13.2 vs 41.6 ±10.9, p CONCLUSIONS Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) reported higher rates of satisfaction at three months and one year postoperatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Disc inflammation and Modic changes show an interaction effect on recovery after surgery for lumbar disc herniation

PurposeTo study the interaction between Modic changes (MC) and inflammation by macrophages in the disc, in relation to clinical symptoms before and after discectomy for lumbar disc herniation.MethodsDisc tissue was embedded in paraffin and stained with haematoxylin and CD68. Subsequently, tissue samples were categorized for degree of inflammation. Type of MC was scored on MRI at baseline. Roland Disability Questionnaire (RDQ) score and visual analogue scale for back pain and leg pain separately were considered at baseline and 1-year follow-up post-surgery. Main and interaction effects of MC and inflammation were tested against clinical outcome questionnaires. In addition, this analysis was repeated in bulging and extruded discs separately.ResultsDisc material and MRI’s of 119 patients were retrieved and analysed. Forty-eight patients demonstrated mild inflammation, 45 showed moderate inflammation, and 26 showed considerable inflammation. In total, 49 out of 119 patients demonstrated MC. Grade of disc inflammation did not associate with the presence of MC. At baseline, no main or interaction effects of MC and inflammation were found on the clinical scores. However, during follow-up after discectomy, significant interaction effects were found for RDQ score: Only in patients with MC at baseline, patients remained significantly more disabled (3.2 points p = 0.006) if they showed considerable disc inflammation compared to patients with mild inflammation. The additional analysis showed similar results in extruded discs, but no significant effects in bulging discs.ConclusionsAn interaction effect of MC and disc inflammation by macrophages is present. Only in patients with MC, those with considerable inflammation recover less satisfactory during follow-up after surgery.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

Patient Reported Outcomes Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System

Abstract INTRODUCTION Canada has a universal health care system that is government funded and access to specialist care requires a referral by general practitioners. The United States utilizes a blended public and private payer system where insured patients can directly access specialists. The purpose of this study is to investigate whether there are differences in outcomes in the two systems. METHODS Surgical lumbar disc herniation patients treated between 2013 and 2016 in Canada that were enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry. The Canadian cohort was compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient reported outcomes (PROs) were compared at 3 mo and 1 yr postoperatively. RESULTS The CSORN cohort consisted of 703 patients and the SPORT cohort was made up of 573 patients. The rate of females in each cohort was similar (47.2% vs 46.4%, P = .78), however, patients in the CSORN cohort were older (46.2 13.2 vs 41.6 10.9, P < .001), had a higher rate of smoking (32.0% vs 22.8%, P < .001), and were more likely to be employed (66.9% vs 61.3%, P = .034). The CSORN cohort had a slightly lower Owestry Disability score at baseline (50.515.1 vs 55.7 19.6, P < .01) but had a higher proportion of patients with a symptom duration greater than 6 mo (44.5% vs 21.1%, P < .0001). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 mo (74.8% vs 65.3%, P = .003) and 1 yr (81.4% vs 68.7%, P < .001). Improvements in back and leg pain followed similar trajectories. CONCLUSION Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) reported higher rates of satisfaction at 3 mo and 1 yr postoperatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery.

Reoperations After First Lumbar Disk Herniation Surgery with or without Implantation of Mechanical Annular Closure Device

Reoperations After First Lumbar Disk Herniation Surgery with or without Implantation of Mechanical Annular Closure Device

Pestle needling at Yāoyángguān-Bāzhèn points for intractable lumbodynia after lumbar disc herniation surgery: A randomized controlled trial

ObjectiveTo observe the differences of clinical efficacy of intractable lumbodynia after lumbar disc herniation surgery treated by pestle needling at Yāoyángguān Bāzhèn points, electroacupuncture and western medication. MethodsA total of 210 patients with intractable lumbodynia after lumbar disc herniation were randomly divided into pestle needle group, electroacupuncture group and western medication group, with 70 cases in each group. The pestle needle group was treated with pestle needle poking Yāoyángguān-Bāzhèn (GV3-Bāzhèn) points. The electroacupuncture group was treated with conventional electroacupuncture, and the western medication group was treated with oral diclofenac sodium dual release enteric-coated capsules (Difene). The pestle needle group and the electroacupuncture group were treated once a day, and there was 1 day of rest after 6 days of treatment, and a course of treatment included 7 days, and a total of 3 courses of treatment were performed. The western medication group took 1 Difene capsule (75 mg) at a time, with once a day continuing for 21 days. Visual Analog Scale (VAS), Pain Rating Index (PRI) and Present Pain Intensity (PPI) were used to observe the improvement of pain before and after treatment, and the waist muscle tone was examined and the clinical efficacy was observed. ResultsThe post-treatment VAS, PRI, and PPI scores of the three groups were all lower than pre-treatment, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in VAS, PRI and PPI scores between pestle needle group and western medication group (all P > 0.05). Meanwhile, they were all lower than the electroacupuncture group, and the differences were statistically significant (both P < 0.05). After treatment, the waist muscle tone of the three groups was higher than that pre-treatment, and the differences were statistically significant (all P < 0.05). After treatment, the waist muscle tone of the pestle needle group was higher than the electroacupuncture group, and the electroacupuncture group was higher than the western medication group, and the differences were statistically significant (both P < 0.05). The total effective rate was 88.57% in the pestle needle group, 80% in the electroacupuncture group, and 77.14% in the western medication group, and there were no statistically significant differences among the groups (P > 0.05). ConclusionsPestle needle poking GV3-Bāzhèn points can effectively relieve intractable lumbodynia after lumbar disc herniation surgery, decrease VAS, PRI, PPI scores and relieve waist muscle tone, and the effect was remarkable.

Predicting nonroutine discharge after elective spine surgery: external validation of machine learning algorithms.

Nonroutine discharge after elective spine surgery increases healthcare costs, negatively impacts patient satisfaction, and exposes patients to additional hospital-acquired complications. Therefore, prediction of nonroutine discharge in this population may improve clinical management. The authors previously developed a machine learning algorithm from national data that predicts risk of nonhome discharge for patients undergoing surgery for lumbar disc disorders. In this paper the authors externally validate their algorithm in an independent institutional population of neurosurgical spine patients. Medical records from elective inpatient surgery for lumbar disc herniation or degeneration in the Transitional Care Program at Brigham and Women's Hospital (2013-2015) were retrospectively reviewed. Variables included age, sex, BMI, American Society of Anesthesiologists (ASA) class, preoperative functional status, number of fusion levels, comorbidities, preoperative laboratory values, and discharge disposition. Nonroutine discharge was defined as postoperative discharge to any setting other than home. The discrimination (c-statistic), calibration, and positive and negative predictive values (PPVs and NPVs) of the algorithm were assessed in the institutional sample. Overall, 144 patients underwent elective inpatient surgery for lumbar disc disorders with a nonroutine discharge rate of 6.9% (n = 10). The median patient age was 50 years and 45.1% of patients were female. Most patients were ASA class II (66.0%), had 1 or 2 levels fused (80.6%), and had no diabetes (91.7%). The median hematocrit level was 41.2%. The neural network algorithm generalized well to the institutional data, with a c-statistic (area under the receiver operating characteristic curve) of 0.89, calibration slope of 1.09, and calibration intercept of -0.08. At a threshold of 0.25, the PPV was 0.50 and the NPV was 0.97. This institutional external validation of a previously developed machine learning algorithm suggests a reliable method for identifying patients with lumbar disc disorder at risk for nonroutine discharge. Performance in the institutional cohort was comparable to performance in the derivation cohort and represents an improved predictive value over clinician intuition. This finding substantiates initial use of this algorithm in clinical practice. This tool may be used by multidisciplinary teams of case managers and spine surgeons to strategically invest additional time and resources into postoperative plans for this population.

Relationship of endplate changes and low back pain after discectomy

ObjectivesDiscectomy is a conventional surgery for lumbar disc herniation. However, recurrence and residual back pain are the main postoperative complications. The contribution of endplate changes to the occurrence of these complications remains controversial. This study aimed to investigate the effect of endplate changes after discectomy. Patients and MethodsWe conducted a retrospective evaluation of 128 patients who had endplate changes after undergoing discectomy in our hospital. The patients were divided into three groups according to severity of abnormality according the Weishaupt classification (mild, moderate, and severe). The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to evaluate the efficacy of different surgical methods. ResultsSeventeen patients dropped out of the follow-up study. Satisfactory efficacy was observed in most patients, but 16 patients underwent reoperation. Significant differences were observed among the three groups in terms of low back pain severity and ODI (p < 0.05), but not radicular leg pain severity. The severe group had a higher recurrence rate of disc herniation (23.5%) than the mild and moderate groups (10.3% and 10.4%, respectively). ConclusionDiscectomy had a noticeable efficacy. However, severe endplate changes, which indicated fissures on the endplate, damaged the lumbar stability and resulted in a higher recurrence rate and residual back pain. For such cases, internal fixation surgery should be considered.

Impact of tramadol abuse on clinical outcome of lumbar discectomy patients’

Background dataLittle data exists regarding the effect of chronic preoperative tramadol abuse on the clinical outcomes after surgery. Lumbar discectomy is a very common procedure that has a predictably high success rate for relief of radicular pain. In addition, the patient population presenting for this procedure has a high propensity for preoperative narcotic use. PurposeThe study aims to identify an association between preoperative tramadol abuse and clinical outcome after lumbar discectomy. Study designA descriptive controlled, non-randomized, clinical study. Patients and methodsSixty patients underwent surgery for lumbar disc herniation. They were divided into two groups; control group and tramadol abuse group. Each group included 30 patients. They were operated between 2015 and 2016. Participants were evaluated pre-operatively and post-operatively every three months. Strict history taking regarding preoperative and postoperative pain medication utilization, operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. ResultsIn Tramadol abuse group, 12 (40%) continued to use tramadol after surgery. Tramadol abuse group showed worse clinical outcome parameters including worse VAS for low back pain and lower limb pain, worse Prolo economic, functional rating scale. In addition, tramadol abuse group showed significantly higher complications rate in the early post-operative and during the follow up period. ConclusionTramadol abuse before lumbar discectomy was found to be associated with continued tramadol abuse after surgery and worse functional outcomes following surgery. Surgeons may want to counsel their patients about the potential for inferior clinical outcomes if narcotics were used before surgery.

Cost‐effectiveness of combination therapy (Mechanical Diagnosis and Treatment and Transforaminal Epidural Steroid Injections) among patients with an indication for a Lumbar Herniated Disc surgery: Protocol of a randomized controlled trial

ObjectivesThe general consensus is that surgical treatment is advised when conservative methods fail in patients with lumbosacral radicular syndrome (LRS). Preliminary evidence from our pilot study indicates that combination therapy (mechanical diagnosis therapy and transforaminal epidural injections) can prevent surgical treatment in patients on the waiting list for surgery. The pilot study lacked a control group, and therefore, firm conclusions pertaining to effects could not be made. This study aims to determine if combination therapy, performed while being on the waiting list for lumbar herniated disc surgery, is effective and cost‐effective compared with usual care (i.e., no intervention while being on the waiting list) among patients with a magnetic resonance imaging (MRI)‐confirmed indication for a lumbar herniated disc surgery.MethodsA randomized controlled trial will be conducted with an economic evaluation. Patients aged 18 and above with incapacitating LRS, with leg pain and an MRI confirmed indication for lumbar disc hernia surgery, will be recruited from seven Dutch hospitals. While being on the waiting list for lumbar herniated disc surgery, patients will be randomized to either the combination therapy or usual care group. The primary outcome measure is the number of patients undergoing lumbar disc surgery during 12‐month follow‐up. Secondary outcomes include back and leg pain intensity (numeric pain rating scale), physical functioning (Roland Morris Disability Questionnaires‐23), self‐perceived recovery (global perceived effect), and health‐related quality of life (EuroQol Five Dimensions Health Questionnaire (EQ‐5D‐5L) and 12‐Item Short Form Health Survey (SF‐12)). For the economic evaluation, societal and health care costs will be measured. Measurements moments are baseline, 1, 2, 4, 6, 9, and 12 months. Data will be analysed according to the intention‐to‐treat principle.ConclusionNo randomized controlled trials have evaluated the effectiveness and cost‐effectiveness of combination therapy compared with usual care in patients with an indication for lumbar herniated disc surgery, which emphasizes the importance of this study.

Development of machine learning algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation

BACKGROUND CONTEXTSpine surgery has been identified as a risk factor for prolonged postoperative opioid use. Preoperative prediction of opioid use could improve risk stratification, shared decision-making, and patient counseling before surgery. PURPOSEThe primary purpose of this study was to develop algorithms for prediction of prolonged opioid prescription after surgery for lumbar disc herniation. STUDY DESIGN/SETTINGRetrospective, case-control study at five medical centers. PATIENT SAMPLEChart review was conducted for patients undergoing surgery for lumbar disc herniation between January 1, 2000 and March 1, 2018. OUTCOME MEASURESThe primary outcome of interest was sustained opioid prescription after surgery to at least 90 to 180 days postoperatively. METHODSFive models (elastic-net penalized logistic regression, random forest, stochastic gradient boosting, neural network, and support vector machine) were developed to predict prolonged opioid prescription. Explanations of predictions were provided globally (averaged across all patients) and locally (for individual patients). RESULTSOverall, 5,413 patients were identified, with sustained postoperative opioid prescription of 416 (7.7%) at 90 to 180 days after surgery. The elastic-net penalized logistic regression model had the best discrimination (c-statistic 0.81) and good calibration and overall performance; the three most important predictors were: instrumentation, duration of preoperative opioid prescription, and comorbidity of depression. The final models were incorporated into an open access web application able to provide predictions as well as patient-specific explanations of the results generated by the algorithms. The application can be found here: https://sorg-apps.shinyapps.io/lumbardiscopioid/ CONCLUSIONPreoperative prediction of prolonged postoperative opioid prescription can help identify candidates for increased surveillance after surgery. Patient-centered explanations of predictions can enhance both shared decision-making and quality of care.

Can a Successful Outcome After Surgery for Lumbar Disc Herniation Be Defined by the Oswestry Disability Index Raw Score?

Study Design:Prospective multicenter cohort study.Objective:To investigate (1) the discriminative ability and cutoff estimates for success 12 months after surgery for lumbar disc herniation on the Oswestry Disability Index (ODI) raw score compared with a change and a percentage change score and (2) to what extent these clinical outcomes depend on the baseline disability.Methods:A total of 6840 patients operated for lumbar disc herniation from the Norwegian Registry for Spine Surgery (NORspine) were included. In receiver operating characteristic (ROC) curve analyses, a global perceived effect (GPE) scale (1-7) was used an external anchor. Success was defined as categories 1-2, “completely recovered” and “much better.” Cutoffs for success for subgroups with different preoperative disability were also estimated.Results:When defining success after surgery for lumbar disc herniation, the accuracy (sensitivity, specificity, area under the curve, 95% CI) for the ODI raw score (0.83, 0.87, 0.930, 0.924-0.937) was comparable to the ODI percentage change score (0.85, 0.85, 0.925, 0.918-0.931), and higher than the ODI change score (0.79, 0.73, 0.838, 0.830-0.852). The cutoff for success was highly dependent on the amount of baseline disability (low-high), with cutoffs ranging from 13 to 28 for the ODI raw score and 39% to 66% for ODI percentage change. The ODI change score (points) was not as accurate.Conclusion:The 12-month ODI raw score, like the ODI percentage change score, can define a successful outcome with excellent accuracy. Adjustment for the baseline ODI score should be performed when comparing outcomes across groups, and one should consider using cutoffs according to preoperative disability (low, medium, high ODI scores).

The Association Between Preoperative MRI Findings and Surgical Revision Within Three Years After Surgery for Lumbar Disc Herniation.

This cohort study was an analysis of prospectively collected data in the DaneSpine Database. The objective was to determine whether preoperative magnetic resonance imaging (MRI) findings were associated with the frequency of surgical revision due to recurrent lumbar disc herniation (LDH) within 3 years after first-time, single-level, simple lumbar discectomy. Because of a risk of poorer outcome in patients receiving revision surgery compared with first-time discectomy, there is a need to identify patients with LDH in risk of surgical revision prior to the primary discectomy. The association between preoperative MRI findings and revision surgery in patients with LDH has not been thoroughly studied. Following an interobserver reliability study preoperative MRIs were evaluated. Potential predictive variables for surgical revision were evaluated using univariate and multivariate logistic regression analysis. Also, a sum-score of the number of MRI findings at the involved level was assessed. In a study population of 451 operated patients, those who had surgical revision were significantly younger and were significantly less likely to have vertebral endplate signal changes Type 2 (OR 0.36 (95% CI 0.15-0.88)) or more than five MRI findings (OR 0.45 (95% CI 0.21-0.95)) at the involved level than the patients not undergoing surgical revision. Surgical revision was not significantly associated with any other MRI findings. In general, preoperative MRI findings have a limited explanatory value in predicting surgical revision within 3 years after first-time, single-level, simple lumbar discectomy. Both the single variable VESC Type 2 and a sum-score > 5 MRI findings at the operated level were found to be negatively associated with patients undergoing surgical revision. 3.

Efficacy and Safety of Ultrasound-guided Lateral Thoracolumbar Interfascial Plane Block (TLIPB) for Postoperative Pain in Patients Undergoing Herniated Lumbar Disc Surgery

Efficacy and Safety of Ultrasound-guided Lateral Thoracolumbar Interfascial Plane Block (TLIPB) for Postoperative Pain in Patients Undergoing Herniated Lumbar Disc Surgery

Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients

BACKGROUND CONTEXTThe opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort. PURPOSEWe sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts. STUDY DESIGN/SETTINGRetrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURESSustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery. METHODSThe performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use. RESULTSAmong 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0–53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1–4.2) in the low-risk group (scores <30), 17.2% (15.6–18.7) in the intermediate-risk group (scores 30–60), and 46.0% (36.2–55.9) in the high-risk group (scores >60). CONCLUSIONSWe have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.

Predicting Non-Routine Discharge After Elective Spine Surgery: External Validation of Machine Learning Algorithms Using Institutional Data

Abstract INTRODUCTION Non-routine discharge after elective spine surgery negatively impacts patient outcomes and increases healthcare costs. Preoperative prediction in this population could improve discharge planning. We previously developed an algorithm that predicts non-home discharge after elective spine surgery. Here, we validate our algorithm in an institutional population of neurosurgical spine patients from a Transitional Care Program (TCP) at an academic, tertiary care center. METHODS Medical records from elective inpatient surgery for lumbar disc herniation or degeneration in the TCP program (2013–2015) were retrospectively reviewed. Variables included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) class, preoperative functional status, number of fusion levels and discharge disposition. The discrimination and calibration of the previous algorithm was assessed in the independent sample, using Python 3.0 software. RESULTS A total of 144 patients underwent elective inpatient surgery for lumbar disc disorders with a non-home discharge rate of 10 (7%). The algorithm generalized well to the institutional data with c-statistic 0.89, calibration slope 1.09 and calibration intercept −0.08. This was comparable to performance in the derivation cohort and substantiates initial use of this algorithm in clinical practice. Prospective validation of this algorithm and comparison to other existing discharge prediction models is ongoing. CONCLUSION This institutional external validation of a previously developed machine learning algorithm suggests a reliable method for identifying lumbar disc disorder patients at risk for non-routine discharge. This tool can be used by multidisciplinary teams of case management and spine surgeons to strategically invest additional time and resources into postoperative plans for this population.

Related factors of urinary incontinence among patients with surgery for lumbar disc herniation

Objective To explore the related factors of urinary incontinence among patients with surgery for lumbar disc herniation (LDH) . Methods From 1st June 2017 to 31st May 2018, we selected 336 medical records of LDH patients with surgical therapy at a ClassⅢ Grade A hospital and a ClassⅡ Grade A hospital in Shanghai by convenience sampling. Single factor analysis and multiple factors analysis were used to patients' basic data, diagnosis, segments of LDH, symptoms, complications, types of surgery, types of anesthesia, laboratory examination, patient-controlled analgesia and indwelling urinary catheters. Results A total of 336 medical records of LDH patients were investigated with 29.5% for the incidence of urinary incontinence. Multiple factors analysis showed that the independent risk factors of patients with surgery for LDH included 9 factors involving the childbearing history, complications (diabetes, heart disease, cerebral infarction, lumbar spinal stenosis) , symptoms (constipation and urinary tract infection) , indwelling urinary catheters and indwelling days (P<0.05) . Conclusions The incidence of urinary incontinence of patients with surgery for LDH is high and is related to many factors. Medical staff should carry out screening in time and early intervention for high-risk patients according to related factors to reduce the incidence of urinary incontinence. Key words: Urinary incontinence; Lumbar disc herniation; Related factors

Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery — a prospective cohort study

BACKGROUND CONTEXTLumbar disc herniation (LDH) is associated with great morbidity and significant socioeconomic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with nonoperative management. However, for some patients in whom pain and disability are unacceptable, surgical intervention provides effective clinical relief. Currently, there is little consensus in the medical community on the timing of surgery for patients suffering from radicular pain due to LDH. Multiple studies suggest that prolonged symptom duration adversely affects clinical outcome. PURPOSEThe aim of this study is to evaluate if prolonged symptom duration is correlated with less favorable outcome following surgery for LDH. STUDY DESIGN/SETTINGConsecutive series of patients from a single-center, multisurgeon, tertiary spine practice. PATIENT SAMPLEConsecutive series of patients who underwent surgery for LDH. OUTCOME MEASURESOswestry Disability Index (ODI), EuroQol-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain (0–100). METHODSPatients with a first-episode LDH were included. Data were prospectively collected in DaneSpine, the Danish National Spine Registry. Subjects were divided into three groups based on their preoperative self-reported duration of leg pain: <3 months, 3 to 12 months, and >12 months. Associations between patient-reported outcomes (PROs), perioperative complications and duration of symptoms were evaluated. Statistical significance level was set at p value <.01. RESULTSThere were 2,144 patients included in the study, with complete 1-year follow-up on 1,694 patients (79%) and a reoperation rate of 8.4%. Incidence of surgical complications, specifically dural tears, was higher with increasing duration of leg pain; however, this did not reach statistical significance (p=.039). Prolonged preoperative symptoms adversely influenced all PROs (EQ-5D, ODI, VAS) 1 year after surgery (p=.001). Furthermore, reoperation rates increased with longer duration of preoperative symptoms. A statistically significant trend (p=.008) of increasing incidence of reoperation was found with increasing length of symptom duration. CONCLUSIONSDelayed surgical intervention results in inferior outcomes and increased reoperation rates. Patients who had surgery within the first 3 months of leg pain achieved significantly better outcome 1 year after surgery when compared to the other groups.

Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation.

The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470-477.

Clinical outcomes research in spine surgery: what are appropriate follow-up times?

In BriefThe time course required for the patient-reported outcomes of pain, physical function, and mental health to reach a recovery plateau after elective lumbar spine surgery was assessed utilizing a prospectively maintained multicenter registry. The work is important as it demonstrates that specific health dimensions follow different recovery plateaus and it provides evidence that a 2-year postoperative follow-up is not required to accurately assess the treatment effect of established surgeries for lumbar spinal pathologies.