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1.
Thamrong Lertudomphonwanit Michael P. Kelly Keith H. Bridwell Lawrence G. Lenke Steven J. McAnany Prachya Punyarat Timothy P. Bryan Jacob M. Buchowski Lukas P. Zebala Brenda A. Sides Karen Steger-May Munish C. Gupta 《The spine journal》2018,18(9):1612-1624
Background Context
Risk factors associated with rod fracture (RF) following adult spinal deformity (ASD) surgery fused to the sacrum remain debatable, and the impact of RF on patient-reported outcomes (PROs) after ASD surgery has not been investigated.Purpose
We aimed to evaluate the prevalence of and risk factors for RF and determine PROs changes associated with RF after ASD surgery fused to the sacrum.Study Design/Setting
A retrospective single-center cohort study was performed.Patient Sample
Patients undergoing long-construct posterior spinal fusions to the sacrum performed at a single institution by two senior spine surgeons from 2004 to 2014 were included.Outcome Measures
Patient demographics, radiographic parameters, and surgical factors were assessed for risk factors associated with RF. Oswestry Disability Index (ODI) and Scoliosis Research Society-30 (SRS-30) scores were assessed at baseline, 1 year postoperatively, and latest follow-up.Methods
Inclusion criteria were ASD patients age >18 who had ≥5 vertebrae instrumented and fused posteriorly to the sacrum and either development of RF or no development of RF with minimum 2-year follow-up. Patient characteristics, operative data, radiographic parameters, and PROs were analyzed at baseline and follow-up. Separate Cox proportional hazard models based on rod material and diameter were used to determine factors associated with RF.Results
Five hundred twenty-six patients (80%) were available for analysis. RF occurred in 97 (18.4%) patients (unilateral RF n=61 [63%]; bilateral RF n=36 [37%]). Risk factors for fracture of 5.5?mm cobalt chromium (CC) instrumentation (CC 5.5 model) included preoperative sagittal vertical axis (hazard ratio [HR] 1.07, 95% confidence interval [95% CI] 1.02–1.14 per 1-cm increase), preoperative thoracolumbar kyphosis (HR 1.02, 95% CI 1.01–1.04 per 1-degree increase), and number of levels fused for patients who received rhBMP-2 <12?mg per level fused (HR 1.48, 95% CI 1.20–1.82 per 1-level increase). Implants that were 5.5-mm CC constructs were at a higher risk for fracture than 6.35-mm stainless steel (SS) constructs (HR 8.49, 95% CI 4.26–16.89). The RF group had less overall improvement in SRS Satisfaction (0.93 vs. 1.32; p=.007) and SRS Self-image domain scores (0.72 vs. 1.02; p=.01). The bilateral RF group had less overall improvement in ODI (8.1 vs. 15.8; p=.02), SRS Subscore (0.51 vs. 0.85; p=.03), and SRS Pain domain scores (0.48 vs. 0.95; p=.02) compared with the non-RF group at final follow-up.Conclusions
The prevalence of all RF after index procedures was 18.4%, 37% for bilateral RF. Greater preoperative sagittal vertical axis, greater preoperative thoracolumbar kyphosis, increased number of vertebrae fused for patients who received rhBMP-2 <12?mg per level fused, and CC 5.5-mm rod were associated with RF. Less improvement in patient satisfaction and self-image was noted in the RF group. Furthermore, bilateral RF significantly affected PROs as measured by ODI and SRS Subscore at final follow-up. 相似文献2.
Justin K. Scheer Malla Keefe Virginie Lafage Michael P. Kelly Shay Bess Douglas C. Burton Robert A. Hart Amit Jain Baron S. Lonner Themistocles S. Protopsaltis Richard Hostin Christopher I. Shaffrey Justin S. Smith Frank Schwab Christopher P. Ames 《The spine journal》2017,17(10):1397-1405
Background Context
Current metrics to assess patients' health-related quality of life (HRQOL) may not reflect a true change in the patients' specific perception of what is most important to them.Purpose
This study aimed to describe the initial experience of a Patient Generated Index (PGI) in which patients create their own outcome domains.Study Design
This is a single-center prospective study.Patient Sample
Patients with adult spinal deformity (ASD) comprise the study sample.Outcome Measures
Oswestry Disability Index (ODI), Short Form-36 (SF-36 Physical Component Score [PCS] and Mental Component Score [MCS]), Scoliosis Research Society-22r (SRS-22r), and PGI.Methods
Oswestry Disability Index, SF-36, SRS-22r, and PGI were administered preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 and 2 years. PGI correlations with ODI, SF-36, SRS total score, free-text frequency analysis of PGI exact response with text in ODI and SRS-22r questionnaires, and the responsiveness (effect size [ES]) of the HRQOL metrics were analyzed. No funding was used for this study and there are no conflicts of interest.Results
A total of 59 patients with 209 clinical encounters produced 370 PGI written response topics that included affect or emotions, relationships, activities of daily life, personal care, work, and hobbies. Mean preoperative PGI score was 18.6±13.5 (0–71.7 out of 100 [best]), and mean scores significantly improved at every postoperative time point (p<.05). Preoperative PGI scores significantly correlated with preoperative ODI (r=?0.28, p=.03), MCS (r=0.48, p<.01), and SRS total (r=0.57, p<.01). Postoperative PGI scores correlated with all HRQOL measures (p<.0001): ODI (r=?0.65), PCS (r=0.50), MCS (r=0.55), and SRS total (r=0.63). PGI responses exactly matched ODI and SRS-22r text at 47.8% and 35.4%, respectively, and at 63.2% and 58.9%, respectively, for categories. Patient Generated Index ES at a minimum of 1-year follow-up was ?2.39, indicating substantial responsiveness (|ES|>0.8). Effect sizes for ODI, SRS-22r total, SF-36 PCS, and SF-36 MCS were 2.16, ?2.06, ?2.05, and ?0.80, respectively.Conclusions
The PGI is easy to administer and offers additional information about the patients' perspective not captured in standard HRQOL metrics. Patient Generated Index scores correlated with all of the standard HRQOL scores and were more responsive than ODI, SF-36, and SRS-22r, suggesting that the PGI may be a step closer to one HRQOL measure that better encompasses concerns and goals of the individual patients. 相似文献3.
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4.
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5.
Mitsuru Yagi Hideaki Ohne Tsunehiko Konomi Kanehiro Fujiyoshi Shinjiro Kaneko Masakazu Takemitsu Masafumi Machida Yoshiyuki Yato Takashi Asazuma 《The spine journal》2017,17(3):409-417
Background Context
Gait patterns and their relationship to demographic and radiographic data in patients with adult spinal deformity (ASD) have not been fully documented.Purpose
This study aimed to assess gait pattern in patients with ASD and the effect of corrective spinal surgery on gait.Design/Setting
This is a prospective case series.Patient Sample
The gait patterns of 33 consecutive women with ASD (age 67.1 years; body mass index [BMI] 22.5±2.5?kg/m2, Cobb angle 46.8±18.2°, coronal vertical axis [CVA] 1.5±3.7?cm, C7 sagittal vertical axis [SVA] 9.1±6.4?cm, pelvic incidence minus lumbar lordosis [PI?LL] 38.2±22.1°, and lean volume of the lower leg, 5.5±0.6?kg) before and after corrective surgery were compared with those of 33 age- and gender-matched healthy volunteers.Outcome Measures
Scoliosis Research Society Patient Questionnaire (SRS22r), Oswestry Disability Index (ODI), and forceplate analysis.Methods
All subjects underwent gait analysis on a custom-built forceplate using optical markers placed on all joints and spinal processes. Dual X-ray absorptiometry scores were used to calculate the lean composition of the lower legs. Subjects with ASD were followed for at least 2 years post operation.Results
Preop mean values showed that patients with ASD had a significantly worse gait velocity (54±10?m/min vs. 70.7±12.9?m/min, p<.01) and stride (97.8±13.4?cm vs. 115.3±15.1?cm, p<.01), but no difference was observed in the stance-to-swing ratio. The right and left ground reaction force vectors were also discordant in the ASD group (vertical direction; r=0.84 vs. r=.97, p=.01). The hip range of motion (ROM) was also significantly decreased in ASD. Correlation coefficient showed moderate correlations between the preoperative gait velocity and the gravity line (GL), PI, ROM of the lower extremity joints, and lean volume, and between the stride and the lean volume, GL, and PI?LL. Gait pattern, stride, and velocity all improved significantly in the patients with ASD after surgery, but were still not as good as in healthy volunteers. The SRS22r satisfaction domain correlated moderately with postoperative gait velocity (r=0.34).Conclusions
The patients with ASD had an asymmetric gait pattern and impaired gait ability compared with healthy volunteers. Gait ability correlated significantly with the GL, spinopelvic alignment, lower extremity joint ROM, and lean volume. The surgical correction of spinopelvic alignment and exercises to build muscle strength may improve the gait pattern and ability in patients with ASD. 相似文献6.
Philip K. Louie Steven M. Presciutti Stephanie E. Iantorno Daniel D. Bohl Kevin Shah Grant D. Shifflett Howard S. An 《The spine journal》2017,17(9):1264-1271
Background Context
Anterior cervical discectomy and fusion (ACDF) is a very common operative intervention for the treatment of cervical spine degenerative disease in those who have failed non-operative measures. However, studies examining long-term follow-up on patients who underwent ACDF reveal evidence of radiographic and clinical degenerative disc disease at the levels adjacent to the fusion construct. Consistent with other junctional regions of the spine, the cervicothoracic junction (CTJ) has significant morphologic variations. As a result, the CTJ undergoes significant static and dynamic stress. Given these findings, there has been some thought that ACDF down to C7 may experience additional risks for adjacent segment degeneration/disease (ASD) when compared with ASDFs that are cephalad to C7.Purpose
The goal of this study is to evaluate the rate of radiographic and clinical ASD in patients who have undergone single- or multilevel ACDF, down to C7.Study Design
This is a retrospective cohort study.Patient Sample
The sample included consecutive patients from a single orthopedic surgeon at one quaternary referral medical center who underwent an ACDF between January 2008 and November 2014. Indications for surgery included radiculopathy, myelopathy, or myeloradiculopathy in the setting of failed conservative treatments. Patients were excluded if they had an ACDF of which the caudal level was cephalad to C7 or if they had undergone a previous cervical fusion.Outcome Measures
Radiographic diagnosis of ASD was determined by the presence of disc space narrowing >50%, new or enlarged osteophytes, end plate sclerosis, or increased calcification of the anterior longitudinal ligament (ALL). Postoperatively, data were collected on the presence of new radicular or myelopathic symptoms indicative of pathology at C7–T1, indicating a diagnosis of clinical ASD.Methods
Demographic information was collected for all patients, which included age, sex, body mass index, smoking status, and Charleston Comorbidity Index (CCI). Several radiographic parameters were measured preoperatively, immediately postoperatively, and at the last follow-up: C2–C7 lordosis, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and T1 slope C2–C7 lordosis were measured using the Cobb angle between the inferior end plate of C2 to the inferior end plate of C7. Radiographic and clinical factors associated with ASD were analyzed postoperatively.Results
Four patients (4.8%) presented with clinical evidence of ASD, all of whom also showed signs of radiographic ASD and improved with conservative measures. No patients underwent reoperation for ASD at the C7–T1 junction. Thirty patients (36.1%) presented radiographic evidence of ASD. These were generally older (54.4 vs. 48.4 years; p=.014). There were neither significant differences in radiographic parameters nor between single- versus multilevel ACDFs and the development of ASD.Conclusions
The cervicothoracic junction may present with vulnerability to ASD given the junctional biomechanics. However, this study provides evidence that an ACDF with the caudal level of C7 does not incur additional risk of ASD, showing similar outcomes to ACDFs at other levels. 相似文献7.
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8.
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9.
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10.
11.
Hyun-Jin Park Chong-Suh Lee Sung-Soo Chung Se-Jun Park Wan-Seok Kim Jin-Sung Park Kyung-Joon Lee Chan-Ha Hwang 《The spine journal》2018,18(5):762-768
Background
The long-term results of heterotopic ossification (HO) following lumbar total disc replacement (TDR) and the corresponding clinical and radiological outcomes are unclear.Purpose
This study aimed to report the long-term results of HO following lumbar TDR and to analyze the clinical and radiological outcomes.Study Design/Setting
A retrospective case review was performed for the consecutive patients who underwent lumbar TDR.Patient Sample
The study included 48 patients (60 segments) who underwent lumbar TDR.Outcome Measures
The time and location of HO development, segmental range of motion (ROM) of index level, the visual analog scale (VAS), and the Oswestry Disability Index (ODI) were analyzed.Methods
Forty-eight patients (60 segments) were divided into HO and non-HO groups, and radiographs were used to measure the time and location of HO development. We compared segmental ROM between two groups using flexion-extension radiographs. Clinical outcomes were assessed using the VAS and the ODI. Furthermore, the segmental ROM, VAS, and ODI scores of each HO class were compared with those of the non-HO group.Results
The mean follow-up duration was 104.4 months. Heterotopic ossification was detected in 30 of 60 segments following lumbar TDR, and HO progression was noted in six segments. The mean segmental ROM was significantly lower in the HO group than in the non-HO group. The mean VAS and ODI scores were not significantly different between the two groups. Segmental ROM was significantly lower in the class III and IV of the HO group than in the non-HO group. The VAS and ODI scores were not significantly different among the different classes.Conclusions
We found that the incidence of HO is the highest within 12 months after lumbar TDR, and the incidence might increase 5 years after surgery. Furthermore, HO progressed over time. Segmental ROM was decreased in the HO groups; however, the limitation in motion might have little clinical influence. 相似文献12.
Jeffrey L. Gum Richard Hostin Chessie Robinson Michael P. Kelly Leah Yacat Carreon David W. Polly R. Shay Bess Douglas C. Burton Christopher I. Shaffrey Justin S. Smith Virginie LaFage Frank J. Schwab Christopher P. Ames Steven D. Glassman 《The spine journal》2017,17(1):96-101
Background Context
Over the past decade, the number of adult spinal deformity (ASD) surgeries has more than doubled in the United States. The complex surgeries needed to manage ASD are associated with significant resource utilization and high cost, making them a primary target for increased scrutiny. Accordingly, it is important to not only demonstrate value in ASD surgery as clinical effectiveness but also to translate outcome assessment to cost-effectiveness.Purpose
To compare the difference between Medicare allowable rates and the actual, direct hospital costs for ASD surgeries.Study Design
Longitudinal cohort.Patient Sample
Consecutive patients enrolled in an ASD database from a single institution.Outcome Measures
Short Form (SF)-6D.Methods
Consecutive patients enrolled in an ASD database from a single institution from 2008 to 2013 were identified. Direct hospital costs were collected from hospital administrative records for the entire inpatient episode of surgical care. Medicare allowable rates were calculated for the same inpatient stays using the year-appropriate Center for Medicare-Medicaid Services Inpatient Pricer Payment System Tool. The SF-6D, a utility index derived from the SF-36v1, was used to determine quality-adjusted life years (QALY). Costs and QALYs were discounted at 3.5% annually.Results
Of 580 surgical ASD patients eligible for 2-year follow up, 346 (60%) had complete baseline and 2-year data, and 60 were Medicare beneficiaries comprising the cohort for the present study. Mean SF-6D gained is 0.10 during year 1 after surgery and 0.02 at year 2, resulting in a cumulative SF-6D gain of 0.12 over 2 years. Mean Medicare allowable rate over the 2 years is $82,050 (range $42,383 to $220,749) and mean direct cost is $99,114 (range $28,447 to $217,717). Mean cost per QALY over 2 years is $683,750 using Medicare allowable rates and $825,950 using direct costs. This difference of $17,181 between the 2 cost calculation represents a 17% difference, which was statistically significant (p<.001).Conclusions
There is a significant difference in direct hospital costs versus Medicare allowable rates in ASD surgery and in turn, there is a similar difference in the cost per QALY calculation. Utilizing Medicare allowable rates not only underestimates (17%) the cost of ASD surgery, but it also creates inaccurate and unrealistic expectations for researchers and policymakers. 相似文献13.
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14.
Ehsan Jazini Jeffrey L. Gum Steven D. Glassman Charles H. Crawford Mladen Djurasovic Roge Kirk Owens John R. Dimar Katlyn E. McGraw Leah Y. Carreon 《The spine journal》2018,18(11):1969-1973
Background Context
Transforaminal lumbar interbody fusion (TLIF) and dual-approach anteroposterior (AP) are common techniques to achieve circumferential fusion for lumbar spondylolisthesis. It is unclear which approach is more cost-effective.Purpose
Our goal was to determine the incremental cost-effectiveness ratio (ICER) by calculating the cost per quality-adjusted life year (QALY) for each approach.Study Design/Setting
This study is a propensity-matched cost-effectiveness comparison.Patient Sample
Patients with lumbar spondylolisthesis undergoing single-level AP fusion or TLIF and enrolled in a prospective observational surgical database were included in this study.Outcome Measures
The outcome measures in this study were the Oswestry Disability Index (ODI) and the Short Form-6D (SF-6D).Methods
From a prospective surgical database, patients with lumbar spondylolisthesis undergoing single-level AP fusion were propensity matched to a TLIF cohort based on age, gender, body mass index, smoking status, workers compensation, preoperative ODI, and back and leg pain numeric scores. Quality-adjusted life years gained were determined using baseline and 1- and 2-yearpostoperative SF-6D scores. Cost was calculated from actual, direct hospital costs and included subsequent postsurgical costs (epidural spinal injections, spine-related emergency department visits, readmissions, and revision surgery).Results
Thirty-one cases of AP fusions were identified and propensity matched to 31 TLIF patients. Patients undergoing TLIF had a shorter mean operative time (270 vs. 328?minutes, p=.039) but no difference in estimated blood loss (526 vs. 548?cc, p=.804) or hospital length of stay (4.5 vs. 6.1 days, p=.146). Quality-adjusted life years gained at 2 years were also similar (0.140 vs. 0.130, p=.672). The mean index surgery and the total 2-year costs were lower for TLIF compared with AP (index: $29,428 vs. $31,466; final: $30,684 vs. $331,880). As overall costs were lower and QALYs gained were similar for TLIF compared with AP fusion, TLIF was the dominant intervention with an ICER of $116,327.Conclusions
Under our study parameters, surgical treatment of lumbar spondylolisthesis with TLIF is more cost-effective compared with AP fusion. Because of the short-term follow-up, the longevity of this should be further investigated. 相似文献15.
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16.
Background Context
Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.Purpose
The present study aims to investigate the efficacy of interlaminar epidural steroid administration in patients with multilevel lumbar disc pathology (LDP) and to assess the possible correlation of the procedure's success with age and body mass index (BMI).Study Design
A randomized controlled trial was performed.Patient Sample
We administered interlaminar epidural steroid to a total of 98 patients with multilevel LDP.Outcome Measures
The visual analog scale (VAS) and Oswestry Disability Index (ODI) scoring were performed on the study population at pretreatment (PRT), posttreatment, and 1, 3, 6, and 12 PRT months. A possible correlation of BMI and age with the procedure success was evaluated.Methods
The LA group (Group L, n=50) received 10?mL 0.25% bupivacaine, whereas the steroid+LA group (Group S, n=48) received 10?mL 0.25% bupivacaine+40?mg methylprednisolone at L4–L5 intervertebral space in prone position under the guidance of C-arm fluoroscopy.Results
There was no statistical difference in the PRT VAS and ODI scores between the groups (p<.05), whereas the VAS and ODI scores at 1, 3, 6, and 12 posttreatment months were higher in Group L, compared with Group S (p<.05). Age and BMI were not found to be related with the success of the procedure.Conclusions
Our study results showed that the VAS and ODI scores were lower in patients with multilevel LDP receiving steroid, following the administration of IL epidural injection. However, further studies are required to establish a robust conclusion on the dispersion of IL epidural injections in the epidural area and the dose of steroid. 相似文献17.
Louis Boissière Mitsuru Takemoto Anouar Bourghli Jean-Marc Vital Ferran Pellisé Ahmet Alanay Caglar Yilgor Emre Acaroglu Francisco Javier Perez-Grueso Frank Kleinstück Ibrahim Obeid 《The spine journal》2017,17(4):480-488
Background Context:
Many radiological parameters have been reported to correlate with patient's disability including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI?LL). European literature reports other parameters such as lumbar lordosis index (LLI) and the global tilt (GT). If most parameters correlate with health-related quality of life scores (HRQLs), their impact on disability remains unclear.Purpose
This study aimed to validate these parameters by investigating their correlation with HRQLs. It also aimed to evaluate the relationship between each of these sagittal parameters and HRQLs to fully understand the impact in adult spinal deformity management.Study Design
A retrospective review of a multicenter, prospective database was carried out.Patient Sample
The database inclusion criteria were adults (>18 years old) presenting any of the following radiographic parameters: scoliosis (Cobb ≥20°), SVA ≥5?cm, thoracic kyphosis ≥60° or PT ≥25°. All patients with complete data at baseline were included.Outcome Measures
Health-related quality of life scores, demographic variables (DVs), and radiographic parameters were collected at baseline.Methods
Differences in HRQLs among groups of each DV were assessed with analyses of variance. Correlations between radiographic variables and HRQLs were assessed using the Spearman rank correlation. Multivariate linear regression models were fitted for each of the HRQLs (Oswestry Disability Index [ODI], Scoliosis Research Society-22 subtotal score, or physical component summaries) with sagittal parameters and covariants as independent variables. A p<.05 value was considered statistically significant.Results
Among a total of 755 included patients (mean age, 52.1 years), 431 were non-surgical candidates and 324 were surgical candidates. Global tilt and LLI significantly correlated with HRQLs (r=0.4 and ?0.3, respectively) for univariate analysis. Demographic variables such as age, gender, body mass index, past surgery, and surgical or non-surgical candidate were significant predictors of ODI score. The likelihood ratio tests for the addition of the sagittal parameters showed that SVA, GT, T1 sagittal tilt, PI?LL, and LLI were statistically significant predictors for ODI score even adjusted for covariates. The differences of R2 values from Model 1 were 1.5% at maximum, indicating that the addition of sagittal parameters to the reference model increased only 1.5% of the variance of ODI explained by the models.Conclusion
GT and LLI appear to be independent radiographic parameters impacting ODI variance. If most of the parameters described in the literature are correlated with ODI, the impact of these radiographic parameters is less than 2% of ODI variance, whereas 40% are explained by DVs. The importance of radiographic parameters lies more on their purpose to describe and understand the malalignment mechanisms than their univariate correlation with HRQLs. 相似文献18.
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19.
Samrat Yeramaneni Christopher P. Ames Shay Bess Doug Burton Justin S. Smith Steven Glassman Jeffrey L. Gum Leah Carreon Amit Jain Corinna Zygourakis Ioannis Avramis Richard Hostin 《The spine journal》2018,18(10):1829-1836
Background Context
Adult spinal deformity (ASD) surgery is associated with significant resource utilization, costing more than $958 million in charges for Medicare patients and more than $1.7 billion in charges for managed care population in the last decade. Given the recent move toward bundled payment models, it is important to understand the various care components a patient receives over the course of a defined clinical episode, its associated cost, and the proportion of cost for each component toward the bundled payment.Purpose
To examine the degree and determinants of variation in inpatient episode-of-care (EOC) cost, resource utilization, and patient-reported outcomes for patients undergoing ASD surgery across four spine deformity centers in the United States.Study Design/Setting
Retrospective analysis of prospective, multicenter database.Patient Sample
Consecutive patients enrolled in an ASD database from four spinal deformity centers.Outcome Measures
Total in-patient EOC costs and Short Form (SF)-6D.Methods
The study used a multicenter database of 210 consecutively enrolled operative patients from 2008 to 2013 at four participating centers in the United States. Demographic, surgical, and direct cost data, expressed in 2013 dollars, for the entire inpatient EOC were obtained from administrative databases from the respective hospitals. Mixed models and multivariable linear regression were used to evaluate the impact of center on total costs adjusting for patient characteristics, length of stay (LOS), and surgical factors.Results
A total of 126 patients with complete baseline and 2-year follow-up data were included. The percentages of patients from each center were 36.5%, 7.1%, 24.6%, and 31.7%. Overall, the mean patient age was 58.4±12.6 years, 86% were women, and 94% were Caucasian. The proportion of total cost variation explained by the center at which the patient was treated was 17%. After adjusting for patient, LOS, and surgical factors the cost variation reduced to 4%. In multivariable analysis, each additional level fused increased total cost variation by $2,500, whereas recombinant human bone morphogenetic protein-2 (BMP) use and posterior-only surgical approach lowered total EOC costs by $10,500 and $9,400, respectively. No significant difference was observed in 2-year quality-adjusted life year across centers.Conclusions
Total EOC costs for ASD surgery varied significantly by center. Levels fused, BMP use, and surgical approach were the primary drivers of cost variation across centers. Differences in resource utilization had no impact on 2-year quality-adjusted life year improvement across centers. 相似文献20.
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