共查询到20条相似文献，搜索用时 31 毫秒
1.
Ho-Joong Kim Oh Hyo Kwon Bong-Soon Chang Choon-Ki Lee Heoung-Jae Chun Jin S. Yeom 《The spine journal》2018,18(1):115-121
Background Context
Even though catastrophizing can negatively moderate the outcome of surgery for lumbar spinal stenosis (LSS), it is still unclear whether pain catastrophizing is an enduring stable or a dynamic structure related to pain intensity after spine surgery.Purpose
The purpose of this study was to determine whether catastrophizing would change in patients who undergo spinal surgery for LSS.Study Design
A prospective observational cohort study was carried out.Study Sample
Patients who underwent spine surgery for LSS comprised the study sample.Outcome Measures
The Visual Analog Pain Scale (VAS) scores for back/leg pain, Oswestry Disability Index (ODI), and Pain Catastrophizing Scale (PCS) were the outcome measures.Methods
The present observational cohort consisted of 138 patients between the ages of 40 and 80 years who were scheduled to undergo surgery for LSS. Among them, a total of 96 patients underwent a 3-year assessment after surgery. The PCS questionnaire was used for pain catastrophizing assessment before and 3 years after surgery. The VAS for back and leg pain, and ODI were assessed 3 and 6 months, and 1 and 3 years after surgery. The correlations between variables were analyzed before and 3 years after surgery. To clarify the causal relationship, time-series and linear mixed models were also used.Results
At 3 years after surgery, ODI, VAS for back and leg pain, and PCS scores were significantly decreased. The correlation of PCS with VAS and ODI was significant both before and 3 years after surgery. The correlation between change in pain or disability and change in pain catastrophizing from preoperative to 3 years after surgery was also significant. In the causal relationship between pain and catastrophizing, overall changes in pain and disability were significant predictors of overall changes in pain catastrophizing from baseline to 3 year after surgery.Conclusion
The present study shows that pain catastrophizing can change in association with the improvement in pain intensity after spine surgery. Therefore, catastrophizing may not be an enduring stable construct, but a dynamic construct. 相似文献2.
Background Context
Percutaneous endoscopic lumbar discectomy (PELD) is one of minimally invasive techniques to treat patients with low back and radiating pain resulting from lumbosacral disc herniation (LDH).Purpose
The purpose of this study is to evaluate the clinical efficacy of PELD to treat patients with low back and radicular pain due to LDH and to investigate which clinical and radiological variables have the ability to predict clinical outcome after PELD.Study design/setting
This is a retrospective study design carried out at a spine hospital.Patient sample
The sample comprised 75 patients who had undergone PELD for treatment of low back and radiating leg pain resulting from LDH and who could be followed up for at least 12 months.Outcomes measures
Clinical outcomes were assessed using numeric rating scale for back and radiating leg pain (NRS back and leg), Oswestry Disability Index (ODI), and modified MacNab criteria at 1 month (short-term follow-up) and at least 12 months (long-term follow-up) after PELD.Methods
The patients were divided into successful and unsuccessful outcome groups according to improvement of NRS back, NRS leg, and ODI (%) at long-term follow-up period. We compared the various clinical and radiological variables between the two groups to identify which variables could be the prognostic factors of clinical outcomes of PELD. This analysis was performed in terms of whole population, the subgroup of dominant back pain, and the subgroup of dominant leg pain, respectively.Results
Significant improvements were observed in NRS back, NRS leg, ODI (%), and modified MacNab criteria at short-term and long-term follow-up after PELD. Positive straight leg raising (SLR) was significantly related to successful outcome as to NRS leg and ODI (%), and longer pain duration also showed significant relationship with unsuccessful outcomes as to NRS leg in whole population. Positive SLR had significant relationship with successful NRS leg as well as successful ODI (%) in the subgroup of dominant leg pain.Conclusions
PELD was an effective treatment in patients with back and leg pain due to LDH. Positive SLR had the predictive ability to successful reduction of radiating leg pain and successful functional improvement. Longer pain duration was also related to unsuccessful reduction of radiating leg pain. 相似文献3.
Feng Shen Ho-Joong Kim Na-Kyoung Lee Heoung-Jae Chun Bong-Soon Chang Choon-Ki Lee Jin S. Yeom 《The spine journal》2018,18(11):2018-2024
Background Context
Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS.Purpose
The purpose of the present study was to examine the influence of HGS on surgical outcomes after surgery for patients with DLSS.Study Design
This is an observational study.Patient Sample
Patients who underwent spine surgery for DLSS were included in the study.Outcome Measures
Oswestry Disability Index (ODI), EuroQOL (EQ-5D), and visual analog scale (VAS) scores for back or leg pain were assessed.Materials and Methods
A total of 172 consecutive patients who underwent spine surgery for DLSS were included in the present study. Patients were assigned to either high HGS group (≥26?kg for men and ≥18?kg for women, n=124) or low HGS group (<26?kg for men and <18?kg for women, n=48) based on their preoperative HGS performance. Oswestry Disability Index, EQ-5D, and VAS scores for back and leg pain were assessed and compared between two groups preoperatively, 3 and 6 months after surgery. The primary outcome measure was baseline-adjusted ODI scores 6 months after surgery. The secondary outcome measures, including the overall ODI score, EQ-5D score, VAS score for back and leg pain, were assessed at each time point during the 6-month follow-up period.Results
As primary outcome, baseline-adjusted ODI scores were significantly lower in the high HGS group than in the low HGS group 6 months after surgery. In the secondary outcome measurements, the ODI, EQ-5D, and VAS scores for back and leg pain improved significantly with time after surgery in both groups. The effects of HGS group on the overall changes in the ODI and EQ-5D scores during the 6-month period were significantly different between the two groups; however, they were not significantly different on VAS score for back and leg pain. The pattern of change in the ODI during the follow-up period was significantly different between the two groups.Conclusions
Patients with preoperative high HGS display better surgical outcome in terms of disability and health status 6 months after spine surgery. Preoperative HGS can act as a predictor of surgical outcome in patients with DLSS. 相似文献4.
R. Kirk Owens Leah Y. Carreon Erica F. Bisson Mohamad Bydon Eric A. Potts Steven D. Glassman 《The spine journal》2018,18(9):1632-1636
Background Context
Although lumbar disc herniation (LDH) classically presents with lower extremity radiculopathy, there are patients who have substantial associated back pain.Purpose
The present study aims to determine if patients with LDH with substantial back pain improve with decompression alone.Study Design
This is a longitudinal observational cohort study.Patient Sample
Patients enrolled in the Quality and Outcomes Database with LDH and a baseline back pain score of ≥5 of 10 who underwent single- or two-level lumbar discectomy only.Outcome Measures
Back and leg pain scores (0–10), Oswestry Disability Index (ODI), and EuroQoL 5D were measured.Methods
Standard demographic and surgical variables were collected, as well as patient-reported outcomes at baseline and at 3 and 12 months postoperatively.Results
The mean age of the cohort was 49.8 years and 1,195 (52.8%) were male. Mean body mass index was 30.1?kg/m2. About half of the patients (1,103, 48.8%) underwent single-level discectomy and the other half (1,159, 51.2%) had two-level discectomy. Average blood loss was 44?cc. Most of the patients (2,217, 98%) were discharged home with routine postoperative care. The average length of stay was 0.53 days. At 3 and 12 months postoperatively, there were statistically significant (p<.000) improvements in back pain (from 7.7 to 2.9 to 3.2), leg pain (from 7.5 to 2.3 to 2.5), and ODI (from 26.2 to 11.6 to 11.2). Patients with a single-level discectomy, compared with patients with a two-level discectomy, had similar improvements in 3- and 12-month back pain, leg pain, and ODI scores.Conclusions
Patients with LDH who have substantial back pain can be counseled to expect improvement in their back pain scores 12 months after a discectomy. 相似文献5.
6.
Andrew N. Tuck Melissa B. Scribani Scott D. Grainger Celeste A. Johns Reginald Q. Knight 《The spine journal》2018,18(8):1398-1405
Background Context
Preoperative depression is increasingly understood as an important predictor of patient outcomes after spinal surgery. In this study, we examine the relationship between depression and patient-reported functional outcomes (PRFOs), including disability and pain, at various time points postoperatively.Purpose
The objective of this study was to analyze the use of depression, as measured by the 9-Item Patient Health Questionnaire (PHQ-9), as a means of assessing postoperative patient-reported disability and pain.Study Design/Setting
This study includes an analysis of prospective non-randomized spine registry compiled through an academic multispecialty group practice model.Patient Sample
A total of 1,000 spinal surgery patients from an affiliated surgical registry, enrolled from January 2010 onward, were included in this study.Outcome Measures
Pain was assessed via the visual analog scale (VAS) for leg or back pain. Disability was measured by the Oswestry Disability Index (ODI). Depression was measured by the PHQ-9.Methods
Patient data were collected preoperatively and at 1, 4, 10, and 24 months postoperatively. Data were analyzed via analysis of variance and Pearson correlation coefficient.Results
All patient stratifications analyzed experienced improvements in pain and ability postoperatively, as measured by the VAS and the ODI, respectively. Moderately and severely depressed patients (as measured by preoperative PHQ-9) experienced decreases in the mean PHQ-9 score of ?6.00 and ?7.96 24 months after surgery, respectively.Conclusions
In all groups, spinal surgery was followed by relief of pain and improved PRFO. Preoperative depression, as measured by the PHQ-9, predicted postoperative PRFO. Patients with moderate to severe depression as measured by the PHQ-9 experienced large mean decreases in the PHQ-9 score postoperatively. As a psychosocial metric, the PHQ-9 is a useful method of assessing value-added service of a spinal surgery. 相似文献7.
Susana Núñez-Pereira Alba Vila-Casademunt Montse Domingo-Sàbat Juan Bagó Emre R. Acaroglu Ahmet Alanay Ibrahim Obeid Francisco Javier Sánchez Pérez-Grueso Frank Kleinstück Ferran Pellisé 《The spine journal》2018,18(6):926-934
Background Context
Revision surgery represents a major event for patients undergoing adult spinal deformity (ASD) surgery. Previous reports suggest that ASD surgery has minimal or no impact on health-related-quality of life (HRQOL) outcomes.Purpose
The present study aims to investigate the impact of early reoperations within the first year on HRQOL and on the likelihood of reaching the minimally clinically important difference (MCID) after ASD surgery.Design
This is a retrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery patients included in a multicenter, international database.Patient Sample
The present study included 280 patients from a multicenter international prospective database.Outcome Measure
Oswestry Disability Index (ODI), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22), MCID were evaluated in this work.Methods
Consecutive surgical patients with ASD recruited prospectively in six different centers from four countries with a minimum 2-year follow-up were stratified into two groups: R (revision surgery within the first year) and NR (no revision). Health-related-quality of life (ODI, SF-36, SRS-22) was assessed and compared at 6-month, 1-year, and 2-year follow-up stages. Statistical analysis included chi-square tests, Student t tests, and linear mixed models.Results
Forty-three patients (R Group) received 46 revision surgeries. Nineteen patients (41.3%) had implant-related complications, 9 patients (19.6%) had deep surgical site infections, 9 patients (19.6%) had proximal junctional kyphosis, 3 patients (6.5%) had hematoma, and 6 patients (13%) had other complications. Baseline characteristics differed between groups.At 6 months, all HRQOL scores improved in both groups, except in the SF-36 Mental Component Summary and SRS-22 mental health domain in the R Group. At 1 year, ODI and SRS-22 improvement was significantly greater in the NR Group, exceeding the reported MCID. At the 2-year follow-up, ODI, SRS-22, SF-36 MCS, and SF-36 PCS improvement was similar in both groups. However, postoperative change was only above the MCID for SF-36 PCS, ODI, and SRS-22 in the NR Group.Conclusions
Early unanticipated revision surgery has a negative impact on mental health at 6 months and reduces the chances of reaching an MCID improvement in SRS-22, SF-36 PCS, and ODI at the 2-year follow-up. 相似文献8.
Jan Triebel Greta Snellman Bengt Sandén Fredrik Strömqvist Yohan Robinson 《The spine journal》2017,17(5):656-662
Background Context
Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.Purpose
This study investigates whether gender affects clinical outcome after lumbar fusion.Study Design
This is a national registry cohort study.Patient sample
Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP.Outcome measures
Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery.Methods
Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.Results
Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19–1.61, p<.01) and back pain (OR=1.20,95% CI:1.03–1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05–1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively.Conclusions
Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery. 相似文献9.
Background Context
Waddell Signs (WS), introduced as a method to establish patients with substantial psychosocial components to their low back pain, carry a negative association despite no literature evaluating whether physical disease is associated with them.Purpose
To compare lumbar magnetic resonance imaging (MRI) findings between the patients with and without WS.Study Design
Retrospective cohort study based on prospectively collected data.Patient Sample
Thirty patients aged 35 to 55 years with an Oswestry Disability Index (ODI) score >50 randomly selected such that there was an even distribution of patients based on the number of WS.Outcome Measures
ODI and Short Form-12 scores, number of WS, presence and severity of spinal pathology.Methods
MRIs were reviewed by three spine specialists blinded to clinical exam findings, number of WS, and patient identity. Type and severity of pathology and presence of surgical and non-surgical lesions were assessed, and findings were rank ordered based on the overall impression of the pathology. There was no external funding or potential conflicts of interest for this study.Results
There were significantly more individual pathologic findings in patients without WS (p=.02). However, there was no difference in the severity of pathology based on WS (p=.46). Furthermore, the rank ordering based on overall impression of severity showed no difference between the patients with and without WS (p=.20). Although 100% of the patients without WS showed pathologic findings on MRI, 70% of WS patients also had significant pathology on MRI. The prevalence of spondylolisthesis, stenosis, and disc herniation was similar (p=.41, p=.22, and p=.43, respectively). The prevalence and mean number of lesion amenable to surgery did not differ based on presence of WS (p=.21 and p=.18, respectively).Conclusions
Patients with WS present a difficult diagnostic challenge for the physician as their organic symptoms are often coexistent with emotional fear avoidance behavior. Although there is more overall pathology in patients without WS, a significant number of these patients appear to have comparable spinal pathology with equivalent severity, which may be contributing to patients' symptoms and disability. Presence of these non-organic symptoms often makes us doubt these patients. However, as part of effective treatment, physicians should better understand both the physical and psychological components of patient disability. 相似文献10.
Silky Chotai Clinton J. Devin Kristin R. Archer Mohamad Bydon Matthew J. McGirt Hui Nian Frank E. Harrell Robert S. Dittus Anthony L. Asher 《The spine journal》2017,17(12):1783-1793
Background
Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported Oswestry Disability Index (ODI) scores at baseline and 12 months on satisfaction with outcomes following spine surgery is not well documented.Purpose
This study aimed to determine the impact of patient disability (ODI) scores at baseline and 12 months on satisfaction with outcomes following surgery.Study Design
Analysis of prospectively collected longitudinal web-based multicenter data.Patient Sample
Patients undergoing elective surgery for degenerative lumbar disease were entered into a prospective multicenter registry.Outcome Measures
Primary outcome measures were ODI, North American Spine Society satisfaction (NASS) questionnaire.Methods
Baseline and 12-month ODI scores were recorded. Satisfaction at 12 months after surgery was measured using NASS questionnaire. Multivariable proportional odds logistic regression analysis was conducted to determine the impact of baseline and 12-month ODI on satisfaction with outcomes.Results
Of the total 5,443 patients, 64% (n=3,460) were satisfied at a level where surgery met their expectations (NASS level 1) at 12 months after surgery. After adjusting for all baseline and surgery-specific variables, the 12-month ODI score had the highest impact (Wald χ2=1,555, 86% of the total χ2) on achieving satisfaction with outcomes compared with baseline ODI scores (Wald χ2=93, 5% of the total χ2). The level of satisfaction decreases with increasing 12-month ODI score. Greater change in ODI is required to achieve a better satisfaction level when the patient starts with a higher baseline ODI score.Conclusion
Absolute 12-month ODI following surgery had a significant association on satisfaction with outcomes 12 months after surgery. Patients with higher baseline ODI required a larger change in ODI score to achieve satisfaction. No single measure can be used as a sole yardstick to measure quality of care after spine surgery. Satisfaction may be used in conjunction with baseline and 12-month ODI scores to provide an assessment of the quality of spine surgery provided in a patient centric fashion. 相似文献11.
Yvonne Lindbäck Hans Tropp Paul Enthoven Allan Abbott Birgitta Öberg 《The spine journal》2018,18(8):1347-1355
Background Context
Surgery because of disc herniation or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have beneficial effect on outcome after surgery.Purpose
The aim was to study if presurgery physiotherapy improves function, pain, and health in patients with degenerative lumbar spine disorder scheduled for surgery.Study Design
A single-blinded, two-arm, randomized controlled trial (RCT).Patient Sample
A total of 197 patients were consecutively included at a spine clinic. The inclusion criteria were patients scheduled for surgery because of disc herniation, spinal stenosis, spondylolisthesis, or degenerative disc disease (DDD), 25–80 years of age.Outcome Measures
Primary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity, and treatment effect.Methods
Patients were randomized to either presurgery physiotherapy or standardized information, with follow-up after the presurgery intervention as well as 3 and 12 months post surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared.Results
The presurgery physiotherapy group had better ODI, visual analog scale (VAS) back pain, EuroQol-5D (EQ-5D), EQ-VAS, Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA), Self-Efficacy Scale (SES), and Hospital Anxiety and Depression Scale (HADS) depression scores and activity level compared with the waiting-list group after the presurgery intervention. The improvements were small, but larger than the study-specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D, and FABQ-PA, and almost in line with MCIC in ODI and Physical Component Summary (PCS) in the physiotherapy group. Post surgery, the only difference between the groups was higher activity level in the physiotherapy group compared with the waiting-list group.Conclusions
Presurgery physiotherapy decreases pain, risk of avoidance behavior, and worsening of psychological well-being, and improves quality of life and physical activity levels before surgery compared with waiting-list controls. These results were maintained only for activity levelspost surgery. Still, presurgery selection, content, dosage of exercises, and importance of being active in a presurgery physiotherapy intervention is of interest to study further to improve long-term outcome. 相似文献12.
Iina Tuomainen Maarit Pakarinen Timo Aalto Sanna Sinikallio Heikki Kröger Heimo Viinamäki Olavi Airaksinen 《The spine journal》2018,18(3):458-463
Background Context
Depression is associated with greater postoperative disability in patients with lumbar spinal stenosis (LSS). No previous studies have reported the association in a 10-year follow-up.Purpose
To evaluate the association between preoperative and postoperative depressive symptoms and the surgical outcome among patients with LSS in a 10-year follow-up. In addition, we examined the effects of the depressive burden on the surgical outcome.Design
A prospective observational follow-up study.Patient Sample
A total of 102 patients with LSS underwent decompressive surgery, and 72 of the original sample participated in the 10-year follow-up study.Outcome measures
Self-report measures: the Oswestry Disability Index (ODI) and visual analog scale (VAS).Methods
Data were collected using a questionnaire that was administered seven times during the study period. Depressive symptoms were measured with the Beck Depressive Inventory (BDI). The depressive burden was calculated by summing the preoperative and all follow-up BDI scores. Statistical analysis included cross-sectional group comparisons and linear mixed models. The authors report no conflicts of interest related to this work.Results
The high depressive burden group had a poorer outcome for pain, disability, and the walking distance at the 10-year follow-up. In linear mixed models, a higher preoperative BDI score associated with higher disability. Furthermore, higher postoperative BDI scores and the depressive burden were associated with higher disability and pain in the 10-year follow-up.Conclusions
Patients with LSS with even slightly elevated depressive symptoms have an increased risk of postoperative pain and disability in a 10-year follow-up. To improve the surgical outcome among these patients, screening for depression both preoperatively and during the rehabilitation following surgery is important. 相似文献13.
Background Context
Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD).Purpose
The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR).Study design
The design of this investigation was a cohort study with 1-year postrehabilitation follow-up.Study setting
The subjects participated in MMR at a Swedish rehabilitation clinic during 2009–2015.Patient sample
The patients had experienced a whiplash trauma (WAD grade I–II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR.Outcome measures
Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up.Methods
The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR).Results
Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up.Conclusion
For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD. 相似文献14.
Elliot I. Layne Darren M. Roffey Matthew J. Coyle Philippe Phan Stephen P. Kingwell Eugene K. Wai 《The spine journal》2018,18(4):614-619
Background Context
Clinical practice guidelines (CPGs) are designed to ensure that evidence-based treatment is easily put into action. Whether patients and clinicians follow these guidelines is equivocal.Purpose
The objectives of this study were to examine how many patients complaining of low back pain (LBP) underwent evidence-based medical interventional treatment in line with CPG recommendations before consultation with a spine surgeon, and to evaluate any associations between adherence to CPG recommendations and baseline factors.Study Design/Setting
This is a cross-sectional cohort analysis at a tertiary care center.Patient Sample
A total of 229 patients were referred for surgical consultation for an elective lumbar spinal condition.Outcome Measures
The outcome measures include the number of CPG-recommended treatments undertaken by patients at or before the time of referral, the validated pain score, the EuroQol-5D (EQ-5D) health status, and the Oswestry Disability Index (ODI) score.Methods
Questionnaires assessing demographic and functional characteristics as well as overall health care use were sent to patients immediately after their referral was received by the surgeon's office.Results
Medications were the most common modality before consultation (74.2% of patients), of which 46.3% received opioids. The number of medications taken was significantly related to a higher ODI score (R=0.23, p=.0004), a higher pain score (R=0.15, p=.026), and a lower EQ-5D health status (R=?0.15, p=.024). In contrast, a lower pain score (7.2 vs. 7.7, p=.037) and a lower ODI score (26.6 vs. 29.9, p=.0023) were associated with performing adequate amounts of exercise. There was a significant association between lower numbers of treatments received and higher numerical pain rating scores (R=?0.14, p=.035). The majority (61.1%) of patients received two or less forms of treatment.Conclusions
Evidence-based medical interventional treatments for patients with LBP are not being taken advantage of before spine surgery consultation. If more patients were to undertake CPG-endorsed conservative modalities, it may result in fewer unnecessary referrals from primary care physicians, and patients might not deteriorate as much while lingering on long wait lists. Further studies incorporating knowledge translation or health system pathway changes are necessary. 相似文献15.
Kyoung-Tae Kim Dae-Chul Cho Joo-Kyung Sung Chi Heon Kim Hyun Kang Du Hwan Kim 《The spine journal》2017,17(2):203-210
Background Context
Lumbar spinal stenosis (LSS) can hinder a patient's physical activity, which in turn can impair glucose tolerance and body weight regulation in patients with type 2 diabetes mellitus (DM-2). Therefore, successful lumbar surgery could facilitate glycemic control and body weight regulation.Purpose
This study aimed to evaluate the effects of postoperative improvement in physical activity on body mass index (BMI) and hemoglobin A1c (HbA1c) level in patients with LSS and DM-2 over a 2-year follow-up period.Study Design
Prospective longitudinal observational study.Patient Sample
Patients with LSS and DM-2.Outcome Measures
Visual analogue scale (VAS) scores for back pain and leg pain, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (JOABPEQ) sections, BMI, and blood analysis for HbA1c were carried out.Methods
A total of 119 patients were enrolled for analysis of the effect of successful decompression surgery on changes in HbA1c levels and BMI. The VAS score, ODI score, JOA score, JOABPEQ, BMI, HbA1c were reassessed at 6 months, 1 year, and 2 years after surgery. Additionally, correlations between changes in HbA1c and changes in the ODI, JOA, JOABPEQs, and BMI were analyzed.Results
The overall values of HbA1c before and at 6 months, 1 year, and 2 years after the surgery were 7.08±0.94%, 6.58±0.87%, 6.59±0.79%, and 6.59±0.79%, respectively (p-values; 6 months: .024; 1 year: .021; 2 years: .038). In the not well-controlled sugar (non-WCS) group (preoperative HbA1c>6.5%), the difference between pre- and postoperative HbA1c was highly statistically significant (p<.01). The overweight group (preoperative BMI≥25) showed statistically significant BMI reduction in the second year after surgery (p=.034). The postoperative HbA1c changes are strongly correlated with the improvements of ODI, JOA, and JOABPEQ after surgery.Conclusions
The present study demonstrates that in patients with DM-2 and LSS, successful lumbar surgery may facilitate glycemic control by enabling an increase in the patient's level of physical activity. Additionally, it could help reduce body weight in overweight (BMI>25) patients with DM-2 and LSS. 相似文献16.
Elliott J. Kim Silky Chotai David P. Stonko Joseph B. Wick Byron J. Schneider Matthew J. McGirt Clint J. Devin 《The spine journal》2017,17(4):511-517
Background Context
Medical interventional modalities such as lumbar epidural steroid injections (LESIs) are often used in the setting of lumbar spine disorders where other conservative measures have failed. Concomitant depression can lead to worse outcomes in lumbar spine pathology. A number of studies have demonstrated an association between preoperative depression and poor outcomes following surgery, but the effect of depression on outcomes following medical interventional modalities is poorly understood.Purpose
To evaluate the differences in patient-reported outcomes (PROs) between depressed and non-depressed patients undergoing LESI.Study Design/Setting
This study is an analysis of a prospective longitudinal registry database at a single academic institution.Patient Sample
All patients undergoing LESI from 2012 to 2014 were eligible for enrollment into a prospective, web-based registry. Eligible patients had radicular pain, correlative imaging findings of degenerative pathology, and failed 6 weeks of conservative care.Outcome Measures
The PROs measured included the (1) numeric rating scale for back pain (NRS-BP), (2) numeric rating scale for leg pain (NRS-LP), (3) disease-specific physical disability—Oswestry Disability Index (ODI), and (4) preference-based health status—EuroQol-5D (EQ-5D).Materials and Methods
Patients who met the inclusion criteria underwent LESI. Patient-reported outcomes were collected at baseline and at 12 months following treatment. Based on previously validated values for the Zung Depression Scale (ZDS) as a screening tool for depression, patients were dichotomized into non-depressed (ZDS score ≤33) and depressed (ZDS score >33). The PRO change scores from baseline to 12 months were calculated. The mean absolute and change scores between the groups were compared using Student t test. Multivariable linear regression analysis for ODI, EQ-5D, NRS-LP, and NRS-BP was performed.Results
A total of 161 patients with complete 12-month follow-up were included. Seventy-one patients (44%) were classified as depressed and 90 patients (56%) were classified as non-depressed. The mean baseline PRO scores were significantly worse in depressed patients compared with non-depressed patients: ODI (p<.001), NRS-BP (p=.013), NRS-LP (p<.001), and EQ-5D (p=.001). The mean absolute scores at 12 months were significantly lower in the depressed versus non-depressed patients: ODI (p<.001), NRS-BP (p=.001), NRS-LP (p=.05), and EQ-5D (p=.003). However, there was no difference in mean change scores observed at 12 months between the depressed and non-depressed cohorts: ODI (p=.42), NRS-BP (p=.31), NRS-LP (p=.25), EQ-5D (p=.14). Adjusting for pre-procedure variables, the higher ZDS score was associated with higher disability (ODI) at 12 months.Conclusions
Depression led to worse absolute scores for PROs and is associated with higher disability following LESI. However, patients with depressive symptoms can expect similar improvement in PROs at 12 months. 相似文献17.
Stefan Loske Corina Nüesch Kimberly Sara Byrnes Oliver Fiebig Stefan Schären Annegret Mündermann Cordula Netzer 《The spine journal》2018,18(12):2195-2204
Background Context
We aimed to fully understand the extent of limitations associated with symptomatic lumbar spinal stenosis (LSS) and the functional outcome of its treatment, including not only function during daily activities (eg, using the 6-minute walk test [6MWT]) but also the quality of function that should be objectively assessed.Purpose
This study was performed to test the hypothesis that the Oswestry Disability Index (ODI) score, the walking distance during the 6MWT (6-minute walking distance [6MWD]), and gait quality (spatiotemporal parameters and gait asymmetry) will improve postoperatively and achieve normal values; to determine if changes in gait parameters correlate with changes in Oswestry Disability Index (ODI) score; and to ascertain if patients' gait quality will diminish during the 6MWT, reflected by changes in gait parameters during the 6MWT.Study Design/Setting
This is a prospective observational study with intervention.Patient Sample
The sample comprised patients with symptomatic LSS.Outcome Measures
The ODI score, gait quality (spatiotemporal and asymmetry), and walking performance (walking distance during the 6MWT) were the outcome measures.Methods
Patients with symptomatic LSS were analyzed on the day before surgery and 10 weeks and 12 months postoperatively. Functional disability in daily life was assessed by the ODI. Spatiotemporal and kinematic gait parameters were recorded with an inertial sensor system during the 6MWT, and the 6MWD was determined. Gait asymmetry was defined as 100*|right-left|/(0.5*(|right+left|)).Results
The ODI decreased by 17.9% and 23.9% and 6MWD increased by 21?m and 26?m from baseline to 10-week and 12-month follow-up, respectively. Gait quality did not change during the 6MWT at any assessment or between assessments. Compared with the control group, patients walked less during the 6MWT, and gait quality differed between patients and the control group at baseline and 10-week follow-up but not at 12-month follow-up. Change in gait quality explained 39% and 73% of variance in change in ODI from baseline to 10-week and to 12-month follow-up, respectively.Conclusions
Changes in gait quality explained a large portion of variance in changes in the ODI, indicating that patients with symptomatic LSS perceive their compromised gait quality as functional limitations. Gait data obtained by instrumented gait analysis contain information on gait quality that can be helpful for evaluating functional limitations in patients with LSS, the outcome of decompression surgery, and the development of patient-specific rehabilitation regimens. 相似文献18.
Xiaofei Cheng Kai Zhang Xiaojiang Sun Changqing Zhao Hua Li Bin Ni Jie Zhao 《The spine journal》2017,17(8):1127-1133
Background Context
Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures.Purpose
This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis.Study Design
This is a prospective cohort study.Patient Sample
This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF.Outcome Measures
Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score.Methods
The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168).Results
There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group.Conclusions
When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery. 相似文献19.
Robby De Pauw Iris Coppieters Tanneke Palmans Lieven Danneels Mira Meeus Barbara Cagnie 《The spine journal》2018,18(8):1406-1416
Background Context
Motor impairment is a key sign in patients with traumatic (whiplash-associated disorder [WAD]) and non-traumatic (idiopathic neck pain [INP]) neck pain.Purpose
This study aimed to analyze differences in motor impairment between two patient groups and to assess the association between motor performance and self-reported symptoms.Study Design
This is a case-control study.Patient Sample
A total of 38 patients with chronic INP, 35 patients with chronic WAD, and 30 healthy pain-free controls were included in the study.Outcome Measures
Outcome measures used in this study were mobility (°), strength (N), repositioning accuracy (°), endurance (seconds), sway velocity (cm/s), sway area (cm2), and neuromuscular control.Methods
Group differences of motor impairment, together with questionnaires to evaluate pain intensity, fear avoidance, pain catastrophizing, symptoms of central sensitization, and disability, were analyzed with analysis of covariance, including age as a covariate.Results
Motor impairment was observed in both patient groups with a higher degree in patients with chronic WAD. These impairments were moderately linked to self-reported disability and were in most cases associated with pain, fear avoidance, and symptoms of central sensitization (|ρ| ranging from 0.28 to 0.59).Conclusions
Motor impairment should be addressed when treating both groups of patients, keeping in mind the association with self-reported pain and disability, fear-avoidance, and central sensitization. 相似文献20.
Maria M. Wertli Ulrike Held Angela Lis Marco Campello Sherri Weiser 《The spine journal》2018,18(8):1463-1474