1
|
Bagó J, Matamalas A, Pizones J, Betegón J, Sánchez-Raya J, Pellisé F. Back Pain in Adolescents and Young Adults with Idiopathic Scoliosis-Identifying Factors Associated with Significant Pain-A Multivariate Logistic Regression Analysis. J Clin Med 2024; 13:2366. [PMID: 38673638 PMCID: PMC11051538 DOI: 10.3390/jcm13082366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Previous data show that patients with idiopathic scoliosis (IS) can be classified into two groups according to pain intensity. This paper aims to determine which factors can independently predict the likelihood of belonging to a high-level pain group. (2) Methods: The study used a prospective, multicenter, cross-sectional design. Two-hundred and seventy-two patients with IS (mean age 18.1 years) (females 83.5%) were included. The sample was divided into two groups. The PAIN group comprised 101 patients (37.1%) with an average NRS of 5.3. The NO-PAIN group consisted of 171 patients (62.9%) with an average NRS of 1.1. Data on various factors such as comorbidities, family history, curve magnitude, type of treatment, absenteeism, anxiety, depression, kinesiophobia, family environment, and social relationships were collected. Statistical analysis consisted of multivariate logistic regression analysis to identify independent predictors of high-level pain. (3) Results: In the final model, including modifiable and non-modifiable predictors, age (OR 1.07 (1.02-1.11)); Absenteeism (OR 3.87 (1.52-9.87)), HAD anxiety (OR 1.18 (1.09-1.29)) and an indication for surgery (OR 2.87 (1.28-6.43)) were associated with an increased risk of pain. The overall model is significant at p = 0.0001 level and correctly predicts 72.6% of the responses. (4) Conclusions: Age, an indication for surgery, anxiety, and work/school absenteeism are the variables that independently determine the risk of belonging to the high-level pain group (NRS > 3).
Collapse
Affiliation(s)
- Juan Bagó
- Spine Group, Vall d’Hebron Institut de Recerca (VHIR), Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | | | - Javier Pizones
- Orthopaedic Surgery, Hospital La Paz, 28046 Madrid, Spain;
| | - Jesús Betegón
- Orthopaedic Surgery, Complejo Asistencial Universitario, 24008 León, Spain;
| | - Judith Sánchez-Raya
- Physical Medicine and Rehabilitation, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| |
Collapse
|
2
|
Sweda R, Mannion AF, O'Riordan D, Haschtmann D, Loibl M, Kleinstück F, Jeszenszky D, Galbusera F, Fekete TF. A decade of experience in over 300 surgically treated spine patients with long-term oral anticoagulation: a propensity score matched cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1360-1368. [PMID: 38381387 DOI: 10.1007/s00586-024-08134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/12/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The aim of this study was to investigate the risks and outcomes of patients with long-term oral anticoagulation (OAC) undergoing spine surgery. METHODS All patients on long-term OAC who underwent spine surgery between 01/2005 and 06/2015 were included. Data were prospectively collected within our in-house Spine Surgery registry and retrospectively supplemented with patient chart and administrative database information. A 1:1 propensity score-matched group of patients without OAC from the same time interval served as control. Primary outcomes were post-operative bleeding, wound complications and thromboembolic events up to 90 days post-surgery. Secondary outcomes included intraoperative blood loss, length of hospital stay, death and 3-month post-operative patient-rated outcomes. RESULTS In comparison with the control group, patients with OAC (n = 332) had a 3.4-fold (95%CI 1.3-9.0) higher risk for post-operative bleeding, whereas the risks for wound complications and thromboembolic events were comparable between groups. The higher bleeding risk was driven by a higher rate of extraspinal haematomas (3.3% vs. 0.6%; p = 0.001), while there was no difference in epidural haematomas and haematoma evacuations. Risk factors for adverse events among patients with OAC were mechanical heart valves, posterior neck surgery, blood loss > 1000 mL, age, female sex, BMI > 30 kg/m2 and post-operative PTT levels. At 3-month follow-up, most patients reported favourable outcomes with no difference between groups. CONCLUSION Although OAC patients have a higher risk for complications after spine surgery, the risk for major events is low and patients benefit similarly from surgery.
Collapse
Affiliation(s)
- Romy Sweda
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne F Mannion
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dave O'Riordan
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Daniel Haschtmann
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Markus Loibl
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Frank Kleinstück
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dezső Jeszenszky
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Fabio Galbusera
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamás F Fekete
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| |
Collapse
|
3
|
Hofstetter L, Mikhail J, Lalji R, Kurmann A, Rabold L, Côté P, Tricco AC, Pagé I, Hincapié CA. Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review. J Clin Epidemiol 2024; 165:111217. [PMID: 37952699 DOI: 10.1016/j.jclinepi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Effective measurement and monitoring of health status in patients with spine-related musculoskeletal (MSK) disorders are essential for providing appropriate care and improving outcomes. Minimal clinical datasets are standardized sets of key data elements and patient-centered outcomes that can be measured and recorded during routine clinical care. Our scoping review aimed to identify and map current evidence on minimal clinical datasets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. STUDY DESIGN AND SETTING We followed the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations and Theses Global, and medRxiv preprint repository were searched from database inception to August 1, 2021. Two reviewers independently screened titles and abstracts, full-text articles, and charted the evidence. Findings were synthesized and summarized descriptively. RESULTS After screening 5,583 citations and 301 full-text articles, 104 studies about 32 individual minimal clinical datasets were included. Most minimal clinical datasets were developed for patient populations with spine-involving inflammatory arthritis, nonspecific or degenerative spinal pain, and MSK disorders in general. The minimal clinical datasets varied substantially in terms of the author-reported time-to-complete (1-48 minutes) and the number of items (5-100 items). Fifty percent of the datasets involved healthcare professionals in their development process, and only 28% involved patients. Health domain items were most frequently linked to the components of activities and participation (43.9%) and body functions (28.6%), according to the International Classification of Functioning, Disability, and Health. There is no standardized definition of minimal clinical datasets to measure and monitor health status of patients with spine-related MSK disorders in routine clinical practice. Common core elements identified were practicality, feasibility in a busy routine practice, time efficiency, and the capability to be used across different healthcare settings. CONCLUSION Due to the absence of a standard definition for minimal clinical datasets for patients with spine-related MSK disorders, there is a lack of consistency in the selection of key data elements and patient-centered outcomes that should be included. More research on the implementation and feasibility of minimal clinical datasets in routine care settings is warranted and needed. It is essential to involve all relevant partners in the development process of minimal clinical datasets to ensure successful implementation and adoption in routine primary care.
Collapse
Affiliation(s)
- Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Astrid Kurmann
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Lorene Rabold
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrea C Tricco
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) - Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
4
|
Gojsevic M, Shariati S, Chan AW, Bonomo P, Zhang E, Kennedy SKF, Rajeswaran T, Rades D, Vassiliou V, Soliman H, Lee SF, Wong HCY, Rembielak A, Oldenburger E, Akkila S, Azevedo L, Chow E. Quality of life in patients with malignant spinal cord compression: a systematic review. Support Care Cancer 2023; 31:736. [PMID: 38055061 DOI: 10.1007/s00520-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature. METHODS A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC. RESULTS The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future. CONCLUSION This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.
Collapse
Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elwyn Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing-Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Agata Rembielak
- The University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
5
|
Leopold VJ, Warminski N, Löchel J, Labbus K, Pumberger M, Zahn RK. Validation of the Subjective Spine Value: A new single item score for the assessment of spine-specific function. Arch Orthop Trauma Surg 2023; 143:6497-6501. [PMID: 37318631 PMCID: PMC10541823 DOI: 10.1007/s00402-023-04941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Spinal function can be assessed through different patient reported outcome measures (PROMs). PURPOSE The aim of the present study was to evaluate a novel single-item score for the assessment of spinal function: The Subjective Spine Value (SSpV). It was hypothesized that the SSpV correlates with the established scores Oswestry disability index (ODI) and Core Outcome Measures Index (COMI). METHODS Between 08/2020 and 11/2021 151 consecutive patients were prospectively enrolled and completed a questionnaire with the ODI, COMI as well as the SSpV. Patients were divided into 4 groups depending on their specific pathology (Group 1: Degenerative pathologies, Group 2: Tumor, Group 3: Inflammatory / Infection, Group 4: Trauma). Pearson correlation coefficient was used to evaluate correlation between the SSpV and the ODI and COMI separately. Floor and ceiling effects were evaluated. RESULTS Overall, the SSpV correlated significantly with both ODI (p = < 0.001; r = - 0.640) and COMI (p = < 0.001; r = - 0.640). This was also observed across all investigated groups (range - 0.420-0.736). No relevant floor or ceiling effects were noticed. CONCLUSIONS The SSpV is a valid single-item score for the assessment of spinal function. The SSpV offers a useful tool to efficiently assess spinal function in a variety of spinal pathologies. LEVEL OF EVIDENCE I, prospective cohort study.
Collapse
Affiliation(s)
- Vincent J. Leopold
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Nikolas Warminski
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Jannis Löchel
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Kirsten Labbus
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Robert K. Zahn
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| |
Collapse
|
6
|
Bergin SM, Abd-El-Barr MM, Gottfried ON, Goodwin CR, Shaffrey CI, Than KD. Measuring Outcomes in Spinal Deformity Surgery. Neurosurg Clin N Am 2023; 34:689-696. [PMID: 37718115 DOI: 10.1016/j.nec.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Outcome assessment in adult spinal deformity has evolved from radiographic analysis of curve correction to patient-centered perception of health-related quality-of-life. Oswestry Disability Index and the Scoliosis Research Society-22 Patient Questionnaire are the predominantly used patient-reported outcome (PRO) measurements for deformity surgery. Correction of sagittal alignment correlates with improved PRO. Functional outcomes and accelerometer measurements represent newer methods of measuring outcomes but have not yet been widely adopted or validated. Further adoption of a minimum set of core outcome domains will help facilitate international comparisons and benchmarking, and ultimately enhance value-based healthcare.
Collapse
Affiliation(s)
- Stephen M Bergin
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Khoi D Than
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA.
| |
Collapse
|
7
|
Álvarez-Galovich L, Ley Urzaiz L, Martín-Benlloch JA, Calatayud Pérez J. Recommendations for enhanced post-surgical recovery in the spine (REPOC). Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:83-93. [PMID: 36240991 DOI: 10.1016/j.recot.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Enhanced recovery after surgery (ERAS) constitutes a multimodal approach, based on available scientific evidence, that achieves better patient's functionality, reduces pain, and even lowers financial costs. The present consensus statement proposes the standards for the implementation of ERAS programs to lumbar fusion surgery, a meant benchmark we call REPOC. METHODOLOGY A multidisciplinary group of experts was set up ad hoc to review consensus recommendations for lumbar arthrodesis, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS As a result, 23 recommendations were selected throughout the preoperative, intraoperative, and postoperative phases of the surgical procedure. A 29-item checklist was also drawn up to implement REPOC protocols in spinal surgeries. CONCLUSIONS This list of recommendations will facilitate the implementation of this multimodal approach as a safe and effective tool for reducing adverse events in our environment.
Collapse
Affiliation(s)
- L Álvarez-Galovich
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - L Ley Urzaiz
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J A Martín-Benlloch
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna. Hospital Universitario Dr. Peset de Valencia, Valencia, España
| | - J Calatayud Pérez
- Servicio de Neurocirugía, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| |
Collapse
|
8
|
Alvarez-Galovich L, Ley Urzaiz L, Martín-Benlloch JA, Calatayud Pérez J. [Translated article] Recommendations for enhanced post-surgical recovery in the spine (REPOC). Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T83-T93. [PMID: 36535345 DOI: 10.1016/j.recot.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Enhanced recovery after surgery (ERAS) constitutes a multimodal approach, based on available scientific evidence, that achieves better patient's functionality, reduces pain, and even lowers financial costs. The present consensus statement proposes the standards for the implementation of ERAS programmes to lumbar fusion surgery, a meant benchmark we call REPOC. METHODOLOGY A multidisciplinary group of experts was set up ad hoc to review consensus recommendations for lumbar arthrodesis, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS As a result, 23 recommendations were selected throughout the preoperative, intraoperative, and postoperative phases of the surgical procedure. A 29-item checklist was also drawn up to implement REPOC protocols in spinal surgeries. CONCLUSIONS This list of recommendations will facilitate the implementation of this multimodal approach as a safe and effective tool for reducing adverse events in our environment.
Collapse
Affiliation(s)
- L Alvarez-Galovich
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - L Ley Urzaiz
- Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J A Martín-Benlloch
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Columna. Hospital Universitario Dr. Peset de Valencia, Valencia, Spain
| | - J Calatayud Pérez
- Servicio de Neurocirugía, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
9
|
Saravi B, Ülkümen S, Lang G, Couillard-Després S, Hassel F. Case-matched radiological and clinical outcome evaluation of interlaminar versus microsurgical decompression of lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07551-5. [PMID: 36729245 DOI: 10.1007/s00586-023-07551-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Endoscopic spine surgery is a globally expanding technique advocated as less invasive for spinal stenosis treatment compared to the microsurgical approach. However, evidence on the efficiency of interlaminar full-endoscopic decompression (FED) vs. conventional microsurgical decompression (MSD) in patients with lumbar spinal stenosis is still scarce. We conducted a case-matched comparison for treatment success with consideration of clinical, laboratory, and radiologic predictors. METHODS We included 88 consecutive patients (FED: 36/88, 40.9%; MSD: 52/88, 59.1%) presenting with lumbar central spinal stenosis. Surgery-related (operation time, complications, length of stay (LOS), American Society of Anesthesiologists physical status (ASA) score, C-reactive protein (CRP), white blood cell count, side of approach (unilateral/bilateral), patient-related outcome measures (PROMs) (Oswestry disability index (ODI), numeric rating scale of pain (NRS; leg-, back pain), EuroQol questionnaire (eQ-5D), core outcome measures index (COMI)), and radiological (dural sack cross-sectional area, Schizas score (SC), left and right lateral recess heights, and facet angles, respectively) parameters were extracted at different time points up to 1-year follow-up. The relationship of PROMs was analyzed using Spearman's rank correlation. Surgery-related outcome parameters were correlated with patient-centered and radiological outcomes utilizing a regression model to determine predictors for propensity score matching. RESULTS Complication (most often residual sensorimotor deficits and restenosis due to hematoma) rates were higher in the FED (33.3%) than MSD (13.5%) group (p < 0.05), while all complications in the FED group were observed within the first 20 FED patients. Operation time was higher in the FED, whereas LOS was higher in the MSD group. Age, SC, CRP revealed significant associations with PROMs. We did not observe significant differences in the endoscopic vs. microsurgical group in PROMs. The correlation between ODI and COMI was significantly high, and both were inversely correlated with eQ-5D, whereas the correlations of these PROMs with NRS findings were less pronounced. CONCLUSIONS Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach. Although FED was associated with higher complication rates in our single-center study experience, the distribution of complications indicated surgical learning curves to be the main factor of these findings. Future long-term prospective studies considering the surgical learning curve are warranted for reliable comparisons of these techniques.
Collapse
Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany. .,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany.
| | - Sara Ülkümen
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre - Albert-Ludwigs-University of Freiburg, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
| | - Sébastien Couillard-Després
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, Freiburg, Germany
| |
Collapse
|
10
|
Linhart C, Neuwieser D, Kussmaul AC, Degen N, Greiner A, Kammerlander C, Suero EM. Effect of angular correction during posterior instrumentation of spinal fractures on postoperative outcomes and quality of life. Technol Health Care 2022; 30:1417-1422. [PMID: 35661032 DOI: 10.3233/thc-213616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posterior instrumentation using pedicle screws and rods is the most commonly used technique for the treatment of thoracolumbar fractures of the spine. The procedure aims to restore the neurologic and biomechanical functions of the spine and allows for early mobilization and rapid reintegration into society. It is unclear whether the magnitude of correction has an effect on postoperative outcomes. OBJECTIVE We aimed to determine whether the magnitude of sagittal angular correction during posterior instrumentation of the spine had an effect on postoperative quality of life, pain and function outcomes as measured using the EQ5D-3L and the Core Outcome Measures Index (COMI) instruments. We also aimed to quantify the correlation between EQ5D-3L and COMI scores. METHODS We analyzed the pre- and postoperative radiographs of 52 patients who underwent percutaneous pedicle screw placement for thoracolumbar fractures, as well as their self-reported EQ5D-3L and COMI quality of life, pain and functional outcome scores. Regression models were constructed to estimate the effect that the magnitude of Cobb angle correction had on postoperative outcomes. We also estimated the correlation between EQ5D-3L and COMI scores. RESULTS The median EQ5D-3L TTO score was 0.9 (range, -0.1 to 1). The median COMI score was 3.1 (range, 0 to 10). There was no significant effect of the magnitude of correction on EQ5d-3L TTO scores (p= 0.3379; R= 0.36) or on COMI scores (p= 0.3379; R= 0.15). Age and bone mineral density were not found to be significant predictors of outcome (p= 0.05). There was a strong correlation between the EQ5D-3L TTO and COMI scores (r=-0.62). CONCLUSION The magnitude of Cobb angle correction during pedicle screw instrumentation of thoracolumbar fractures did not influence quality of life, pain or function outcomes. There was good correlation between EQ5D-3L TTO scores and COMI scores.
Collapse
Affiliation(s)
- Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Dominik Neuwieser
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Adrian C Kussmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Degen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Christian Kammerlander
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany.,AUVA Traumahospital Styria Graz, Austria
| | - Eduardo M Suero
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
11
|
Gadjradj PS, Arjun Sharma JRJ, Harhangi BS. Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series. Acta Neurochir (Wien) 2022; 164:1209-1216. [PMID: 35098351 DOI: 10.1007/s00701-021-05100-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/18/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Percutaneous transforaminal endoscopic discectomy (PTED) is increasing in popularity as a minimally invasive procedure to treat sciatica caused by lumbar disc herniation. The objective of the current study is to evaluate safety of and satisfaction with the use of local anesthesia and conscious sedation during PTED. METHODS During a 12-month inclusion period, patients were prospectively included in this single center case series. Inclusion criteria consisted of sciatica lasting for at least 6 weeks, which was not responsive to conservative treatment. PTED was performed using dexmedetomidine as sedative and lidocaine as local anesthesia. Measurements included the numeric rating scale (NRS, from 0 to 10) for leg pain, back pain, COMI-back, and NRS for anxiety of anesthesia and perioperative continuously monitored hemodynamics. Furthermore, satisfaction with the sedation was scored by patients, surgeons, and anesthesiologists. RESULTS Ninety-two consecutive patients were enrolled. Of all patients, 18.5% had anxiety for undergoing surgery under local anesthesia. All but one patient underwent PTED successfully. There was one case of conversion due to severe, uncontrollable back pain during surgery. Throughout the procedure, hemodynamic parameters showed no clinically relevant change compared to baseline. Anesthesiologic complications were three cases (3.4%) of self-limiting hypoxia and five cases (8.6%) of nausea and/or vomiting. Surgeons and anesthesiologists had a high satisfaction rate (> 87%) with the conscious sedation during the procedure, while satisfaction with sedation was scored 8.4 ± 2.2 by patients. CONCLUSIONS PTED performed under local anesthesia and conscious sedation is safe and effective to treat sciatica and yields high satisfaction rates from surgeons, anesthesiologists, and patients.
Collapse
|
12
|
One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050606. [PMID: 35630022 PMCID: PMC9144472 DOI: 10.3390/medicina58050606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal-invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre-op), 3-weeks postoperative (post-op), 1-year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c-reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1−4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10-L2 (12/68) and TH11-L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post-op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3-week and 1-year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal-invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow-up. PROMs were not significantly associated with clinicopathological characteristics, technique-related variables, or the number of targeted levels.
Collapse
|
13
|
Matamalas A, Figueras C, Pizones J, Moreno-Manzanaro L, Betegón J, Esteban M, Pellisé F, Sanchez-Raya J, Sanchez-Marquez JM, Bagó J. How back pain intensity relates to clinical and psychosocial factors in patients with idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1006-1012. [PMID: 35128586 DOI: 10.1007/s00586-022-07117-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A pain intensity of 3 can reliably distinguish idiopathic scoliosis (IS) patients with acceptable pain or not. This research aims to analyze psychosocial, family and quality of life differences in patients according to their pain status. MATERIAL AND METHODS Patients with IS, without previous surgery, Cobb ≥ 30° and age (12-40) were included in the study. They completed the questionnaires Numerical Rate Scale (NRS), Tampa Scale for Kinesiophobia (TSK)-11, SRS22r, Hospital Anxiety-Depression Scale (HADS), COMI item 7 (work/school absenteeism) and family APGAR. Comorbidities and family health history were collected. Analysis of covariance was performed to compare means between the PAIN (NRS > 3), (NRS < = 3) groups controlling for the effect of age and the magnitude of the curve. RESULTS In total, 272 patients were included. 37.1% belonged to the PAIN group (PG). The PG showed a significantly higher Cobb grade and age than the NO-PAIN group. After controlling for these variables, the PG had worse pain, mental health and SRS22-subtotal values. However, they did not differ in function or self-image. PG showed higher levels of kinesiophobia, anxiety, depression, absenteeism from work/school and impact on social/family environment. PG patients reported a higher prevalence of comorbidities and family history of nonspecific spinal pain. CONCLUSIONS Patients with IS and unacceptable pain constitute a group with a different incidence of psychological, social, family and comorbidities factors than those with acceptable pain. In contrast, the severity of IS was not substantially different between the groups. This profile is similar to that observed in patients with nonspecific spinal pain.
Collapse
Affiliation(s)
- Antonia Matamalas
- Orthopaedic Surgery Department, Spine Unit, Hospital Vall D'Hebrón, Passeig de la Vall d'Hebron 119- 129, 08035, Barcelona, Spain
| | - Clara Figueras
- Fundacio Institut de Recerca Vall Hebron, Vall D'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Departament de Cirurgia, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Javier Pizones
- Orthopaedic Surgery Department, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Lucia Moreno-Manzanaro
- Orthopaedic Surgery Department, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jesús Betegón
- Orthopaedic Surgery Department, Spine Unit, Complejo Asistencial Universitario de León (CAULE), Calle Altos de nava, s/n, 24001, León, Spain
| | - Marta Esteban
- Orthopaedic Surgery Department, Spine Unit, Complejo Asistencial Universitario de León (CAULE), Calle Altos de nava, s/n, 24001, León, Spain
| | - Ferran Pellisé
- Orthopaedic Surgery Department, Spine Unit, Hospital Vall D'Hebrón, Passeig de la Vall d'Hebron 119- 129, 08035, Barcelona, Spain
| | - Judith Sanchez-Raya
- Physical Medicine and Rehabilitation Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jose Miguel Sanchez-Marquez
- Orthopaedic Surgery Department, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Juan Bagó
- Orthopaedic Surgery Department, Spine Unit, Hospital Vall D'Hebrón, Passeig de la Vall d'Hebron 119- 129, 08035, Barcelona, Spain
| |
Collapse
|
14
|
Pellisé F, Serra-Burriel M, Vila-Casademunt A, Gum JL, Obeid I, Smith JS, Kleinstück FS, Bess S, Pizones J, Lafage V, Pérez-Grueso FJS, Schwab FJ, Burton DC, Klineberg EO, Shaffrey CI, Alanay A, Ames CP. Quality metrics in adult spinal deformity surgery over the last decade: a combined analysis of the largest prospective multicenter data sets. J Neurosurg Spine 2022; 36:226-234. [PMID: 34598152 DOI: 10.3171/2021.3.spine202140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The reported rate of complications and cost of adult spinal deformity (ASD) surgery, associated with an exponential increase in the number of surgeries, cause alarm among healthcare payers and providers worldwide. The authors conjointly analyzed the largest prospective available ASD data sets to define trends in quality-of-care indicators (complications, reinterventions, and health-related quality of life [HRQOL] outcomes) since 2010. METHODS This is an observational prospective longitudinal cohort study. Patients underwent surgery between January 2010 and December 2016, with > 2 years of follow-up data. Demographic, surgical, radiological, and HRQOL (i.e., Oswestry Disability Index, SF-36, Scoliosis Research Society-22r) data obtained preoperatively and at 3, 6, 12, and 24 months after surgery were evaluated. Trends and changes in indicators were analyzed using local regression (i.e., locally estimated scatterplot smoothing [LOESS]) and adjusted odds ratio (OR). RESULTS Of the 2286 patients included in the 2 registries, 1520 underwent surgery between 2010 and 2016. A total of 1151 (75.7%) patients who were treated surgically at 23 centers in 5 countries met inclusion criteria. Patient recruitment increased progressively (2010-2011 vs 2015-2016: OR 1.64, p < 0.01), whereas baseline clinical characteristics (age, American Society of Anesthesiologists class, HRQOL scores, sagittal deformity) did not change. Since 2010 there has been a sustained reduction in major and minor postoperative complications observed at 90 days (major: OR 0.59; minor: OR 0.65; p < 0.01); at 1 year (major: OR 0.52; minor: 0.75; p < 0.01); and at 2 years of follow-up (major: OR 0.4; minor: 0.80; p < 0.01) as well as in the 2-year reintervention rate (OR 0.41, p < 0.01). Simultaneously, there has been a slight improvement in the correction of sagittal deformity (i.e., pelvic incidence-lumbar lordosis mismatch: OR 1.11, p = 0.19) and a greater gain in quality of life (i.e., Oswestry Disability Index 26% vs 40%, p = 0.02; Scoliosis Research Society-22r, self-image domain OR 1.16, p = 0.13), and these are associated with a progressive reduction of surgical aggressiveness (number of fused segments: OR 0.81, p < 0.01; percent pelvic fixation: OR 0.66, p < 0.01; percent 3-column osteotomies: OR 0.63, p < 0.01). CONCLUSIONS The best available data show a robust global improvement in quality metrics in ASD surgery over the last decade. Surgical complications and reoperations have been reduced by half, while improvement in disability increased and correction rates were maintained, in patients with similar baseline characteristics.
Collapse
Affiliation(s)
- Ferran Pellisé
- 1Spine Research Unit, Vall d'Hebron Research Institute, Barcelona
- 2Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miquel Serra-Burriel
- 3Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | | - Jeffrey L Gum
- 4Norton Leatherman Spine Center, Louisville, Kentucky
| | - Ibrahim Obeid
- 5Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Justin S Smith
- 6Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | | | - Shay Bess
- 8Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Javier Pizones
- 9Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Virginie Lafage
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Frank J Schwab
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas C Burton
- 11Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric O Klineberg
- 12Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | | | - Ahmet Alanay
- 14Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Christopher P Ames
- 15Department of Neurosurgery, University of California, San Francisco, California
| |
Collapse
|
15
|
Hartmann S, Lang A, Lener S, Abramovic A, Grassner L, Thomé C. Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome. Neurosurg Rev 2022; 45:3417-3426. [PMID: 36064875 PMCID: PMC9492567 DOI: 10.1007/s10143-022-01845-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 08/09/2022] [Indexed: 02/03/2023]
Abstract
Instrumented stabilization with intersomatic fusion can be achieved by open (O-TLIF) or minimally invasive (MIS-TLIF) transforaminal surgical access. While less invasive techniques have been associated with reduced postoperative pain and disability, increased manipulation and insufficient decompression may contradict MIS techniques. In order to detect differences between both techniques in the short-term, a prospective, controlled study was conducted. Thirty-eight patients with isthmic or degenerative spondylolisthesis or degenerative disk disease were included in this prospective, controlled study (15 MIS-TLIF group vs. 23 O-TLIF group) after failed conservative treatment. Patients were examined preoperatively, on the first, third, and sixth postoperative day as well as after 2, 4, and 12 weeks postoperatively. Outcome parameters included blood loss, duration of surgery, pre- and postoperative pain (numeric rating scale [NRS], visual analog scale [VAS]), functionality (Timed Up and Go test [TUG]), disability (Oswestry Disability index [ODI]), and quality of life (EQ-5D). Intraoperative blood loss (IBL) as well as postoperative blood loss (PBL) was significantly higher in the O-TLIF group ([IBL O-TLIF 528 ml vs. MIS-TLIF 213 ml, p = 0.001], [PBL O-TLIF 322 ml vs. MIS-TLIF 30 ml, p = 0.004]). The O-TLIF cohort showed significantly less leg pain postoperatively compared to the MIS-TLIF group ([NRS leg 3rd postoperative day, p = 0.027], [VAS leg 12 weeks post-op, p = 0.02]). The MIS group showed a significantly better improvement in the overall ODI (40.8 ± 13 vs. 56.0 ± 16; p = 0.05). After 3 months in the short-term follow-up, the MIS procedure tends to have better results in terms of patient-reported quality of life. MIS-TLIF offers perioperative advantages but may carry the risk of increased nerve root manipulation with consecutive higher radicular pain, which may be related to the learning curve of the procedure.
Collapse
Affiliation(s)
- Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Anna Lang
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Lukas Grassner
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| |
Collapse
|
16
|
Abstract
STUDY DESIGN Prospective, multi-centric, cross-sectional study. OBJECTIVE To analyze the construct validity of the Tampa Scale of Kinesiophobia (TSK) in a cohort of patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF THE BACKGROUND DATA Back pain is not uncommon in AIS. The fear of movement (kinesiophobia) in response to pain is related to back pain. TSK psychometric properties in AIS patients have not been properly analyzed. METHODS Patients with AIS and no prior spine surgery were prospectively included. They fulfilled the Spanish version of the TSK-11 questionnaire, a pain intensity numerical rating scale (NRS), refined SRS-22 (SRS-22r), the Hospital Anxiety and Depression Scale (HADS), and item 7 of the Core Outcome Measurement Index (COMI). The sample was split into two groups for the statistical analysis: adolescents and young adults. Cronbach alpha was used to assess internal consistency. Discriminant and concurrent validity were obtained by computing Pearson correlation coefficients between the TSK score and several criterion measures. RESULTS A total of 275 patients were included-198 adolescents (mean age of 14.6 yrs) and 77 young adults (mean age of 26.9 yrs). The Cobb of largest curve means were 44.9° and 48.9°, respectively. In the adolescent group, the TSK mean (±SD) was 21.5 (±5.93), with a floor effect of 2.5%. In the adult group, the TSK mean was 24.2 (±6.63), with a floor effect of 3.9%. The ceiling effect was 0% in both groups. Cronbach alphas for the adolescent and adult groups were 0.76 and 0.79, respectively. No correlation was found in any group between the TSK score and the curve magnitude or pattern (Lenke classification). The TSK was significantly correlated with HAD depression and SRS-22r in both groups. However, these correlations were weaker in adolescents. In adults, the TSK also significantly correlates with NRS and work/school absenteeism. CONCLUSION The Spanish version of TSK-11 is a reliable and valid instrument to analyze kinesiophobia in AIS. However, the weak correlation between kinesiophobia and pain intensity, disability, and emotional condition in adolescents requires further study.Level of Evidence: 4.
Collapse
|
17
|
Gadjradj PS, Chalaki M, van Tulder MW, Harhangi BS. Cross-cultural adaptation and psychometric validation of the Dutch version of the Core Outcome Measures Index for the back (COMI -back) in patients undergoing surgery for degenerative disease of the lumbar spine. BRAIN & SPINE 2021; 1:100004. [PMID: 36247389 PMCID: PMC9560685 DOI: 10.1016/j.bas.2021.100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are the preferred outcomes measured in patients with lumbar spinal degenerative diseases. As PROMs can be lengthy and therefore pose a burden to patients and researchers, short and standardized PROMs are needed, such as the Core Outcome Measures Index (COMI). RESEARCH QUESTION Is the Dutch version of the COMI-back a reliable and responsive PROM to measure outcomes in lumbar degenerative spinal surgery? METHODS After translating and cross-cultural adapting the COMI-back into Dutch, patients who were on the waiting-list for lumbar decompression surgery in a secondary referral center, were enrolled in the validation study. Patients completed a baseline booklet consisting of the COMI-back, likert scales measuring back and leg pain, the Roland-Morris Disability questionnaire, the EuroQoL-5 dimensions and the WHO-Quality-of-Life-BREF questionnaire to test construct validity. Within 2 weeks and before undergoing surgery, patients completed the COMI-back again, to measure test-retest stability. Three months after surgery, a global treatment outcome (GTO) question and the COMI-back were completed to test responsiveness. RESULTS The COMI-back was successfully translated and adapted into Dutch. One-hundred-thirty-five patients completed the baseline booklet, 93 the test-retest questionnaire and 102 the responsiveness questionnaire. The COMI-summary score and four of five COMI-domains, showed good to very good correlation to the reference questionnaires (ρ > 0.41). The COMI-back showed a good test-retest stability with an intraclass correlation coefficient of 0.81 for the summary score. Furthermore, the standard error of agreement was 0.65 and the minimal detectable change was 1.8 points. The ROC-curve showed an area under the curve of 0.89 (95% CI 0.82 to 0.95). CONCLUSION The Dutch version of the COMI-back has satisfactory psychometric properties and is a reliable and responsive patient-reported outcome measure in patients undergoing surgery for lumbar degenerative disease.
Collapse
Key Words
- COMI, Core Outcomes Measures Index
- Core outcomes measurement index
- Dutch
- EQ5D, EuroQol-5 dimensions
- ICC, Intraclass correlation coefficient
- Low back pain
- MDC, Minimum detectable change
- PROM, Patient-reported outcome measure
- Patient reported outcome measure
- RMDQ, Roland-Morris Disability Questionnaire
- ROC, Receiver-operating characteristic
- SEM, Standard errors of measurement agreement
- SRM, Standardized response mean
- Validation
- WHOQoL-BREF, World Health Organization Quality of Life-BREF questionnaire
Collapse
Affiliation(s)
- Pravesh S. Gadjradj
- Department of Neurosurgery, Park MC, Rotterdam, the Netherlands
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Mehrman Chalaki
- Department of Neurosurgery, Park MC, Rotterdam, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Maurits W. van Tulder
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Biswadjiet S. Harhangi
- Department of Neurosurgery, Park MC, Rotterdam, the Netherlands
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
18
|
The aging spine: the effect of vertebral fragility fracture on sagittal alignment. Arch Osteoporos 2021; 16:109. [PMID: 34236526 DOI: 10.1007/s11657-021-00975-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our study investigates the relationship, in the aging population, between vertebral fractures, spinal alignment, and quality of life. Kyphotic fractures were related to more significant disability and impaired spinopelvic alignment. The spinal malalignment was strongly associated with fractures in the thoracolumbar junction vertebrae and the absence of powerful compensatory mechanisms as thoracic hypokyphosis and lower lumbar hyperlordosis. INTRODUCTION In adult spine deformity (ASD), the sagittal imbalance is defined by the deformity in the sagittal plane that causes the need for greater use of muscle strength to maintain an upright static posture or walking. Fragility vertebral fractures (VF) and ASD are frequent causes of spinal morbidity in the elderly. The prevalence of both ASD and VF increases with aging. Although these two clinical conditions insist on the same population, little is known about the interactions between sagittal imbalance and vertebral fracture (VF) deformity. The aim of our work is to examine the associations between vertebral fractures, sagittal alignment, and their impact on the quality of life scores in elderly patients. METHODS A retrospective cohort study of 110 patients of both sexes, from a spine surgery waiting list, with at least one VF with ≥ 5° of kyphosis and a full-standing X-ray. INDEPENDENT VARIABLES the presence of VF with kyphotic deformity ≥ 10°, fracture level, degree of kyphosis (deformity) of the fracture, number of fractures, spinopelvic angular parameters, demographic parameters, and scales of evaluation of the health-related quality of life. RESULTS A total of 110 patients with mean age 73.8 ± 5.2, of which 70 women (63%) were included in the study. Subjects with at least one VF ≥ 10° presented greater disability and an overall worse sagittal spinal alignment (no VF10° vs VF10°: TPA 21.30 ± 11.5 vs 26.51 ± 12.6, p = 0.041) and more disability (no VF10° vs VF10°: ODI 41.91 ± 16.9 vs 54.67 ± 15.8, p < 0.001) than patients with less degree of vertebral deformity. Significant compensatory mechanisms involved the thoracic area and the lower lumbar region. CONCLUSION Kyphotic VFs were associated with severe alterations of sagittal spine alignment and perceived disability. Subjects with sagittal imbalance have a greater degree of deformity in the thoracolumbar junction area. Thoracic hypokyphosis and lower lumbar hyperlordosis are effective compensatory mechanisms in case of lumbar or thoracic fracture, respectively.
Collapse
|
19
|
Hasan GA, Raheem HQ, Qutub A, Wais YB, Katran MH, Shetty GM. Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience. Int J Spine Surg 2021; 15:591-599. [PMID: 33985997 DOI: 10.14444/8080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The literature is lacking on the incidence and management of pyogenic spondylodiscitis (PS) following routine elective surgical procedures. This study aimed to analyze the presentation and treatment outcome in patients with PS following nonspinal surgeries at a tertiary care center with a minimum follow-up of 12 months. METHODS The demographic, clinical-radiologic features, and treatment outcomes in 40 patients with a diagnosis of PS following nonspinal surgical procedures were retrospectively reviewed and analyzed. RESULTS The mean age at presentation was 36.4 ± 11.8 years, with 80% of patients being female. The common surgical procedures associated with PS were cesarean delivery (30%), gastric sleeve surgery (12.5%), and dilatation and curettage (12.5%). The tissue biopsy culture was positive in 82.5% of patients. A total of 26 patients (65%) were treated with conservative management and 14 patients (35%) were treated surgically. The mean pretreatment Core Outcome Measure Index score significantly decreased at 12 months (P < .0001) after treatment. The mean pretreatment erythrocyte sedimentation rate (P < .0001) and C-reactive protein (P < .0001) levels significantly decreased at 12 months after treatment. CONCLUSIONS With most patients with PS following nonspinal surgeries treated with conservative management, excellent clinical outcomes were achieved in all patients at 12 months after treatment. The diagnosis of PS should be considered in patients presenting with low back pain (LBP) with a recent history of undergoing a nonspinal surgical procedure. Patients who undergo surgical procedures are an important "at-risk" patient population, and early diagnosis and treatment can help achieve excellent clinical outcomes. Further studies are required to determine risk factors and possible perioperative precautions that can be taken to prevent PS in patients who undergo nonspine surgeries. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Pyogenic spondylodiscitis should be suspected in patients presenting with LBP after a recent non-spinal surgical procedure. Early diagnosis and treatment can help achieve excellent clinical outcomes in these patients.
Collapse
Affiliation(s)
- Ghazwan A Hasan
- Department of Orthopaedic Surgery, Al-Kindi Teaching Hospital, Baghdad, Iraq
| | | | | | | | | | - Gautam M Shetty
- Orthopaedic & Knee Clinic, Mumbai, India.,AIMD Research, Mumbai, India
| |
Collapse
|
20
|
Otadi K, Nakhostin Ansari N, Sharify S, Fakhari Z, Sarafraz H, Aria A, Rasouli O. Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial. BMC Sports Sci Med Rehabil 2021; 13:20. [PMID: 33663607 PMCID: PMC7934526 DOI: 10.1186/s13102-021-00250-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. METHODS The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. RESULTS Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher's exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). CONCLUSIONS Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. TRIAL REGISTRATION The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on September 10, 2020 as IRCT20090228001719N8 .
Collapse
Affiliation(s)
- Khadijeh Otadi
- grid.411705.60000 0001 0166 0922Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- grid.411705.60000 0001 0166 0922Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Sharify
- grid.411705.60000 0001 0166 0922Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Fakhari
- grid.411705.60000 0001 0166 0922Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Sarafraz
- grid.412237.10000 0004 0385 452XOccupational Medicine Department, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amir Aria
- Prana Physiotherapy Clinic, Tehran, Iran
| | - Omid Rasouli
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
21
|
Gum JL, Carreon LY, Glassman SD. State-of-the-art: outcome assessment in adult spinal deformity. Spine Deform 2021; 9:1-11. [PMID: 33037596 DOI: 10.1007/s43390-020-00220-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022]
Abstract
Adult spinal deformity (ASD) is a diagnosis that encompasses heterogeneous disorders with an increasing prevalence. This increasing prevalence may be due to greater patient longevity or greater awareness of available treatments. Outcome assessment in ASD has evolved over the last 3 decades from physician-based assessments to a patient-centered perception of improvement. Outcome assessment that is reliable, accurate and responsive to change is especially important in ASD, as surgical treatment is known to carry a high cost and complication rate Glassman (Spine Deform 3:199-203, 2015); Glassman (Spine (Phila Pa 1976) 32: 2764-2770, 2007); Smith (J Neurosurg Spine 25:1-14, 2016). In an era of value-based care, diagnosis associated with such heterogeneity and high cost must provide sound evidence to support the cost versus outcome ratio. Numerous general health and disease specific patient-reported outcome measures (PROMs) have been utilized in ASD. We discuss these instruments in detail in the following state-of-the-art review.
Collapse
Affiliation(s)
- Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA.
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA
| |
Collapse
|
22
|
Moon RDC, Srikandarajah N, Clark S, Wilby MJ, Pigott TD. Primary lumbar decompression using ultrasonic bone curette compared to conventional technique. Br J Neurosurg 2020; 35:775-779. [PMID: 32930607 DOI: 10.1080/02688697.2020.1817321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The ultrasonic bone curette (Bone Scalpel) is a novel technique in neurosurgery for bony dissection. This study aimed to evaluate its use against conventional techniques for primary lumbar decompression. MATERIALS AND METHODS This study was a retrospective cohort comparison, using Spine Tango Registry data. All patients undergoing a primary procedure for lumbar decompression secondary to degenerative disease during a 2-year period (2014-2016) were identified, split into age and gender matched cohorts utilising either bone scalpel or conventional techniques intra-operatively. RESULTS Ninety-three patients were identified within each cohort, which did not differ significantly in terms of age, gender, BMI, number of operative vertebral levels or seniority of the principal surgeon. The incidence of intra-operative blood loss >100 ml was significantly reduced within the bone scalpel cohort (16.1% bone scalpel, 34.4% conventional, p = 0.04). There was no difference in the incidence of iatrogenic dural breach (9.7% bone scalpel, 16.1% conventional, p = 0.27). There was no significant difference in pre-operative Core Outcomes Measures Index (COMI) between the cohorts (7.91 bone scalpel, 8.02 conventional, p = 0.67) and both cohorts demonstrated a significant reduction in mean COMI at 24 months (bone scalpel p = 0.004, conventional p = <0.001). No difference in mean COMI existed between either cohort at any point across the 24-month post-operative period (p = 0.18). CONCLUSIONS The use of ultrasonic bone curette for primary lumbar decompression is associated with reduced intra-operative blood loss compared to conventional techniques, alongside a comparable safety profile and equivalent patient reported outcomes.
Collapse
Affiliation(s)
- Richard D C Moon
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,North Bristol NHS Trust, Bristol, UK
| | | | - Simon Clark
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Tim D Pigott
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
23
|
Komesh S, Nakhostin Ansari N, Naghdi S, Alaei P, Hasson S, Kordi R. Responsiveness and longitudinal validity of the Persian version of COMI to physiotherapy in patients with non-specific chronic low back pain. Scand J Pain 2020; 20:483-490. [PMID: 32101531 DOI: 10.1515/sjpain-2019-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/24/2020] [Indexed: 02/05/2023]
Abstract
Background and aims The Core Outcome Measures Index (COMI) is a short, self-reported questionnaire for assessing important outcomes in patients with low back pain (LBP). The present study was conducted to explore the responsiveness and longitudinal validity of the Persian COMI (COMI-P) in patients with non-specific chronic LBP. Methods In this prospective cohort study of patients with non-specific chronic LBP receiving physiotherapy, patients completed a booklet containing the COMI-P, Persian Functional Rating Index (FRI-P), and a visual analogue scale (VAS) for pain before and after the end of ten-sessions of physiotherapy. Patients also completed a global rating of change scale (GRCS) at the end of the physiotherapy. Responsiveness was examined by means of internal responsiveness methods [t-test, standard effect size (SES); standardized response mean (SRM), and Guyatt responsiveness index (GRI)] and external responsiveness methods [correlation with external criteria and receiver operating characteristics (ROC) curve]. Results Fifty patients with a mean age of 50.62 ± 13.8 years participated. The paired t-test showed significant changes in COMI-P scores (p < 0.001). The effect sizes for COMI-P were large (range 0.96-1.23). The score changes for the COMI-P revealed significant correlations with FRI-P (r = 0.67, p < 0.001), the VAS (r = 0.65, p < 0.001), and the GRCS (r = 0.34, p = 0.02). The COMI-P change scores showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (r = 0.83, p < 0.001). The ROC area under the curve for the COMI-P based on the dichotomized SDC criterion was perfect. The minimal clinically important change was estimated 2.15 points (sensitivity 94% and specificity 100%). Conclusions The COMI-P appears to have responsiveness and longitudinal validity in detecting changes after physiotherapy for non-specific chronic LBP. An improvement of 2.15 points in COMI-P total score is required to be interpreted as minimally clinically important change in individual patients.
Collapse
Affiliation(s)
- Shiva Komesh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Alaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Severijns P, Overbergh T, Thauvoye A, Baudewijns J, Monari D, Moke L, Desloovere K, Scheys L. A subject-specific method to measure dynamic spinal alignment in adult spinal deformity. Spine J 2020; 20:934-946. [PMID: 32058084 DOI: 10.1016/j.spinee.2020.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/19/2019] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Two-dimensional static radiography currently forms the golden standard in spinal alignment measurement in adult spinal deformity (ASD). However, these static measurements offer no information on dynamic spinal behavior. To fully understand the functionality and compensation strategies of ASD patients, tools to assess dynamic spinal alignment are needed. PURPOSE Therefore, the aim of this study was to introduce, validate and assess the reliability of a new kinematic model to measure dynamic spinal parameters in ASD based on a polynomial function, taking into account the subject-specific anatomy. STUDY DESIGN Validation and reliability study OUTCOME MEASURES: Radiographic parameters, spinal kinematics and range of motion (ROM), Scoliosis Research Society Outcome Questionnaire (SRS-22), Core Outcome Measures Index (COMI). METHODS Spinal alignment of 23 ASD patients and 18 controls was measured using both x-rays and motion capture. Marker positions were corrected to the underlying anatomy and a polynomial function was fitted through these corrected marker positions. By comparing the polynomial method to x-ray measurements concurrent validity was assessed. Test-retest, inter- and intrarater reliability during standing and sit-to-stand (STS) were assessed on a subsample of eight ASD patients and eight controls. RESULTS The results showed good to excellent correlations (r>0.75) between almost all x-ray and anatomy-corrected polynomial parameters. Anatomy correction consistently led to better correlations than no correction. Intraclass correlation coefficients for the polynomial method were good to excellent (>0.75) between sessions and between and within raters and comparable or even better than radiographic measurements. Also, during STS reliability was excellent. Fair to moderate correlations were found between spinal ROM during STS and quality of life, measured with SRS-22 and COMI. CONCLUSIONS The results of this study indicate the polynomial method, with subject-specific anatomy correction, can measure spinal alignment in a valid and reliable way using motion capture in both healthy and deformed spines. This method makes it possible to extend evaluation in ASD from mainly static, by means of x-ray measurements, to dynamic and functional assessments. CLINICAL SIGNIFICANCE Eventually, this newly obtained dynamic spinal alignment information might lead to new insights in clinical decision-making and new treatment strategies, based and oriented on dynamic parameters and functionality.
Collapse
Affiliation(s)
- Pieter Severijns
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium.
| | - Thomas Overbergh
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Anaïsse Thauvoye
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jana Baudewijns
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Davide Monari
- Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium; Department of Mechanical Engineering, Faculty of Engineering, KU Leuven, Leuven, Belgium
| | - Lieven Moke
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium; Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Granström H, Langborg A, Mannion AF, Rasmussen-Barr E. Cross-cultural adaption and validation of the Swedish version of the Core Outcome Measures Index for low-back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1445-1452. [DOI: 10.1007/s00586-019-06271-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 09/22/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose
There is a wide selection of instruments and questionnaires available, but many are time consuming in their administration, for patients, practitioners and researchers alike. The Core Outcome Measures Index (COMI) is a short, self-administrated, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back pain. The purpose of this study was to cross-culturally adapt the COMI from English to Swedish and to test the face and construct validity and reproducibility of its results in patients with low-back pain.
Methods
Participants (n = 102) were included from primary and secondary care. The participants reported moderate pain and disability levels. All participants filled in the COMI, the Oswestry Disability Index and the EQ5D at baseline. Forty-nine filled in the COMI again after 7 days for the reproducibility part of the study.
Results
The instrument was successfully forward and back-translated. In the validation process, there were low floor/ceiling effects, with the exception of the symptom-specific well-being (floor) and work disability (ceiling) items. The specific COMI domains and whole score correlated significantly with the chosen reference scale scores to the hypothesised extent (Rho 0.30–0.60 and > 0.60 respectively). COMI reached ICC 0.63 (95% CI 0.42–0.77) in the reproducibility test and the separate items, ICC 0.41–0.78.
Conclusions
The Swedish COMI shows acceptable psychometric properties and is thus suitable to use as a short instrument for measuring important domains in patients with low-back pain. A future study should investigate the instrument's sensitivity to measure change after treatment.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
26
|
The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity. Spine (Phila Pa 1976) 2020; 45:E25-E36. [PMID: 31842109 DOI: 10.1097/brs.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional case-control study design. OBJECTIVE This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL. SUMMARY OF BACKGROUND DATA Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required. METHODS After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant. RESULTS The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020). CONCLUSION In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane. LEVEL OF EVIDENCE 2.
Collapse
|
27
|
Nagata K, Oshima Y, Nakamoto H, Sakamoto R, Ohtomo N, Izuka M, Nakajima K, Yoshimoto T, Fujii T, Matsudaira K, Tanaka S, Oka H. Validity of the Japanese Core Outcome Measures Index (COMI)-Back for thoracic and lumbar spine surgery: a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1435-1444. [PMID: 31845032 DOI: 10.1007/s00586-019-06249-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the psychometric properties of the Japanese version of the Core Outcome Measures Index-Back (COMI-Back), only recently published according to the established linguistic and cultural conversion guidelines, in patients undergoing spine surgery. METHODS We recruited 145 patients who underwent thoracic or lumbar spine surgery in one of the five specific tertiary care institutions. They were asked to complete a booklet questionnaire (the COMI-Back, the Numerical Rating Scale for pain, the Short Form-12, Euro-QOL-5 dimensions, and Oswestry Disability Index) at baseline and 12 months postoperatively to investigate floor/ceiling effect, construct validity, and postoperative responsiveness. The patients were also asked to answer an anchor question (Global Treatment Outcome) to analyze the minimum clinically important difference (MCID) by receiver operating characteristics curves. Of the 145 patients, 112 completed the study. Another group of 59 volunteers with chronic symptoms completed the questionnaire twice within a 7-14-day interval for the test-retest reproducibility. RESULTS The COMI summary score displayed no notable floor or ceiling effects. Except for symptom-specific well-being, the individual COMI domains and the COMI summary score correlated as expected with the scores of the chosen reference measures (ρ = 0.4-0.8). A similar trend was observed between the pre-/postoperative changes in the COMI score and those in the reference measures. The MCID for the COMI summary score was 2.5. The intraclass correlation coefficient and minimum detectable change (MDC95%) were 0.93 and 1.26, respectively. CONCLUSION The Japanese COMI-Back was a reliable and responsive questionnaire in our Japanese patients undergoing thoracic/lumbar spine surgery. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryuji Sakamoto
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211 Kozukue-Chō, Kōhoku-Ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Nozomu Ohtomo
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Masaaki Izuka
- Department of Spine Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8453, Japan
| | - Koji Nakajima
- Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan
| | - Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
28
|
Sabou S, Carrasco R, Verma R, Siddique I, Mohammad S. The clinical and radiological outcomes of multilevel posterior lumbar interbody fusion in the treatment of degenerative scoliosis: a consecutive case series with minimum 2 years follow up. JOURNAL OF SPINE SURGERY 2019; 5:520-528. [PMID: 32043002 DOI: 10.21037/jss.2019.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. Methods We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Results Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Conclusions Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.
Collapse
Affiliation(s)
- Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, Manchester, UK.,Biology, Medicine and Health (BMH), The University of Manchester, Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| |
Collapse
|
29
|
Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve. Acta Neurochir (Wien) 2019; 161:2415-2420. [PMID: 31650331 DOI: 10.1007/s00701-019-04079-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. METHODS The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. RESULTS Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). CONCLUSIONS In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.
Collapse
|
30
|
DEDÉA JEFERSON, TELES ALISSONROBERTO, FALAVIGNA ASDRUBAL. SURGERY FOR ADULT SPINAL SCOLIOSIS: DO THE BENEFITS OUTWEIGH THE RISKS? COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191803187303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Around 6% of the elderly population over 65 years of age are affected by adult spinal deformity (ASD). The increasing prevalence of ASD with aging has prompted discussion regarding the use of various techniques for its treatment, such as surgery and conservative treatment. The objective of this study is to investigate whether surgical treatment demonstrates significant benefits as compared to conservative treatment. A literature review was conducted, focusing on the most relevant papers on the topic published in the last five years. Surgical treatment, which costs an average of US$ 99,114 per procedure, enables almost instant improvement of the pain and disability of ASD. The rate of perioperative complications in ASD is approximately 7.5%, and the average improvement in back pain is 6.2 times higher in the surgical approach than in conservative treatment. In addition, the use of modern operative techniques, such as minimally invasive surgery (MIS), reduces the complications and greatly improves patients’ quality of life, compared to open surgery. Therefore, the expected benefits of surgical treatment meets the patient’s expectations by eliminating the pain caused by ASD. Although surgical treatment has a higher cost and a greater risk of complications, the use of minimally invasive techniques give the ASD patient a better quality of life. Level of evidence III; Non-Systematic Review.
Collapse
|
31
|
Fekete TF, Mannion AF, Haschtmann D, Loibl M, Kleinstück FS, Jeszenszky DJ. Back Pain and Its Change After Surgery in Adolescents and Young Adults With Idiopathic Scoliosis. Spine Deform 2019; 7:754-758. [PMID: 31495476 DOI: 10.1016/j.jspd.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/27/2019] [Accepted: 02/05/2019] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective analysis of prospectively collected data from patients aged 12-30 years, operated for AIS in our hospital from 2005 to 2014 and registered in our local patient outcomes database linked to EUROSPSINE's Spine Tango Registry. OBJECTIVES To investigate whether in patients with AIS and notable back pain surgery is associated with significant pain relief and whether age influences outcome. SUMMARY OF BACKGROUND DATA Few studies have investigated the association between adolescent idiopathic scoliosis and back pain and the influence of age on the relief of back pain after surgical correction of the deformity. METHODS Preoperatively and up to two years' postoperatively, patients completed the Core Outcome Measures Index, which includes two 0-10 scales for back pain and leg/buttock pain. A score of 4/10 or more is considered "relevant pain." RESULTS We identified 85 patients with AIS (74 (87%) females) in the database; 60 were aged 12-18 years (mean 15.5 ± 1.7 years) and 25 were 19-30 years (mean 22.5 ± 3.1 years). There were no significant differences (p > .05) between the age groups for coronal Cobb angles of the main curves or Lenke curve types, and these curves showed no correlation with pain intensity (p > .05). Back pain was correlated with age (r = 0.31, p = .004). Preoperatively, 42% patients had a back pain score of ≥4/10 (52% in adults, 38% in adolescents). Just 8% patients had a leg pain score of ≥4/10 (16% in adults, 5% in adolescents). Those with notable back pain showed a significant (p < .0001) improvement two years after surgery. However, 24% of patients with no back pain at baseline showed a worsening of pain by 2 (out of 10) points or more two years postoperatively. There was no significant difference in the extent of improvement in older and younger patients (p = .22). CONCLUSION In patients undergoing surgery for correction of AIS, back pain is correlated with age. In those with relevant back pain at baseline, surgery is associated with a statistically significant and clinically relevant reduction of pain 24 months later, in skeletally mature young adults and adolescents alike. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Tamás F Fekete
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
| | - Anne F Mannion
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Daniel Haschtmann
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Markus Loibl
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | | | | |
Collapse
|
32
|
Spinal Fusion in Parkinson's Disease Patients: A Propensity Score-Matched Analysis With Minimum 2-Year Surveillance. Spine (Phila Pa 1976) 2019; 44:E846-E851. [PMID: 30817740 DOI: 10.1097/brs.0000000000002998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To compare outcomes and complication rates between patients with and without Parkinson's disease (PD) patients undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA There is limited literature evaluating the impact of PD on long-term outcomes after thoracolumbar fusion surgery for ASD. METHODS Patients admitted from 2009 to 2011 with diagnoses of ASD who underwent any thoracolumbar fusion procedure with a minimum 2-year follow-up surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. A 1:1 propensity score-match by age, Deyo score, and number of fused vertebral levels was conducted before comparing surgical outcomes of patients with ASD with and without PD. Univariate analysis compared demographics, complications, and subsequent revision. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes (covariates: age, sex, Deyo Index score, and PD diagnosis). RESULTS A total of 576 propensity score-matched patients were identified (PD: n = 288; no-PD: n = 288), with a mean age of 69.7 years (PD) and 70.2 years (no-PD). Each cohort had comparable distributions of age, sex, race, insurance provider, Deyo score, and number of levels fused (all P > 0.05). Patients with PD incurred higher total charges across ASD surgery-related visits ($187,807 vs. $126,610, P < 0.001), yet rates of medical complications (35.8% PD vs. 34.0% no-PD, P = 0.662) and revision surgery (12.2% vs. 10.8%, P > 0.05) were comparable. Postoperative mortality rates were comparable between PD and no-PD cohorts (2.8% vs. 1.4%, P = 0.243). Logistic regression identified nine-level or higher spinal fusion as a significant predictor for an increase in total complications (odds ratio = 5.64); PD was not associated with increased odds of any adverse outcomes. CONCLUSION Aside from higher hospital charges incurred, patients with PD experienced comparable overall complication and revision rates to a propensity score-matched patient cohort without PD from the general population undergoing thoracolumbar fusion surgery. These results can support management of concerns and postoperative expectations in this patient cohort. LEVEL OF EVIDENCE 3.
Collapse
|
33
|
Pellisé F, Serra-Burriel M, Smith JS, Haddad S, Kelly MP, Vila-Casademunt A, Sánchez Pérez-Grueso FJ, Bess S, Gum JL, Burton DC, Acaroğlu E, Kleinstück F, Lafage V, Obeid I, Schwab F, Shaffrey CI, Alanay A, Ames C. Development and validation of risk stratification models for adult spinal deformity surgery. J Neurosurg Spine 2019; 31:587-599. [PMID: 31252385 DOI: 10.3171/2019.3.spine181452] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/27/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO). METHODS Two models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis. RESULTS The final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%-75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs. CONCLUSIONS The creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.
Collapse
Affiliation(s)
- Ferran Pellisé
- 1Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Miquel Serra-Burriel
- 2Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Justin S Smith
- 3Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Sleiman Haddad
- 1Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Michael P Kelly
- 4Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Alba Vila-Casademunt
- 5Spine Research Unit, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Shay Bess
- 7Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Jeffrey L Gum
- 8Norton Leatherman Spine Center, Louisville, Kentucky
| | - Douglas C Burton
- 9Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Frank Kleinstück
- 11Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Virginie Lafage
- 12Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Ibrahim Obeid
- 13Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Frank Schwab
- 12Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Christopher I Shaffrey
- 3Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Ahmet Alanay
- 14Department of Orthopedics and Traumatology, Acıbadem University, Istanbul, Turkey; and
| | - Christopher Ames
- 15Department of Neurosurgery, University of California, San Francisco, California
| |
Collapse
|
34
|
Sabou S, Lagaras A, Verma R, Siddique I, Mohammad S. Comparative study of multilevel posterior interbody fusion plus anterior longitudinal ligament release versus classic multilevel posterior interbody fusion in the treatment of adult spinal deformities. J Neurosurg Spine 2019; 31:46-52. [PMID: 30952136 DOI: 10.3171/2019.1.spine18754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sagittal imbalance and loss of lumbar lordosis are the main drivers of functional disability in adult degenerative scoliosis. The main limitations of the classic posterior lumbar interbody fusion technique are increased risk of neurological injury and suboptimal correction of the segmental lordosis. Here, the authors describe the radiological results of a modified posterior lumbar interbody fusion and compare the results with a historical cohort of patients. METHODS Eighty-two consecutive patients underwent surgical treatment for degenerative scoliosis/kyphosis in a single tertiary referral center for complex spinal surgery. Fifty-five patients were treated using the classic multilevel posterior lumbar interbody fusion (MPLIF) technique and 27 were treated using the modified MPLIF technique to include a release of the anterior longitudinal ligament (ALL) and the annulus. A radiographic review of both series of patients was performed by two independent observers. Functional outcomes were obtained, and patients were registered in the European Spine Tango registry. RESULTS The mean L4-5 disc angle increased by 3.14° in the classic MPLIF group and by 12.83° in MPLIF plus ALL and annulus release group. The mean lumbar lordosis increased by 15.23° in the first group and by 25.17° in the second group. The L4-S1 lordosis increased on average by 4.92° in the classic MPLIF group and increased by a mean of 23.7° in the MPLIF plus ALL release group when both L4-5 and L5-S1 segments were addressed. There were significant improvements in the Core Outcome Measures Index and EQ-5D score in both groups (p < 0.001). There were no vascular or neurological injuries observed in either group. CONCLUSIONS The authors' preliminary results suggest that more correction can be achieved at the disc level using posterior-based ALL and annulus release in conjunction with posterior lumbar interbody fusion. They demonstrate that ALL and annulus release can be performed safely using a posterior-only approach with minimal risk of vascular injury. However, the authors recommend that this approach should only be used by surgeons with considerable experience in anterior and posterior spinal surgery.
Collapse
|
35
|
Angus M, Jackson K, Smurthwaite G, Carrasco R, Mohammad S, Verma R, Siddique I. The implementation of enhanced recovery after surgery (ERAS) in complex spinal surgery. JOURNAL OF SPINE SURGERY 2019; 5:116-123. [PMID: 31032446 DOI: 10.21037/jss.2019.01.07] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background This paper aims to review the introduction of an enhanced recovery after surgery (ERAS) service within complex spinal surgery, with an aim to assess if this is a cost effective way to improve the overall experience of such complex surgery. Methods The ERAS model was defined and followed within a regional centre for complex spinal surgery in the UK. Outcomes such as length of stay (LOS) and satisfaction were measured before and after implementation of the service. Results LOS was reduced and both patient and staff satisfaction improved following the implementation of the ERAS service. Conclusions The ERAS model can successfully be implemented within complex spinal surgery, to help improve satisfaction and reduce cost.
Collapse
Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly Jackson
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Glyn Smurthwaite
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Roberto Carrasco
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Saeed Mohammad
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
36
|
Yuksel S, Ayhan S, Nabiyev V, Domingo-Sabat M, Vila-Casademunt A, Obeid I, Perez-Grueso FS, Acaroglu E. Minimum clinically important difference of the health-related quality of life scales in adult spinal deformity calculated by latent class analysis: is it appropriate to use the same values for surgical and nonsurgical patients? Spine J 2019; 19:71-78. [PMID: 30010046 DOI: 10.1016/j.spinee.2018.07.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Health-related quality of life (HRQOL) parameters have been shown to be reliable and valid in patients with adult spinal deformity (ASD). Minimum clinically important difference (MCID) has become increasingly important to clinicians in evaluating patients with a threshold of improvement that is clinically relevant. PURPOSE To calculate MCID and minimum detectable change (MDC) values of total scores of the Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI), Physical Component Summary (PCS), Mental Component Summary (MCS) of the Short Form 36 (SF-36), and Scoliosis Research Society 22R (SRS-22R) in surgically and nonsurgically treated ASD patients who have completed an anchor question at pretreatment and 1-year follow-up. STUDY DESIGN/SETTING Prospective cohort. PATIENT SAMPLE Surgical and nonsurgical patients from a multicenter ASD database. OUTCOME MEASURES Self-reported HRQOL measures (COMI, ODI, SF-36, SRS-22R, and anchor question). METHODS A total of 185 surgical and 86 nonsurgical patients from a multicenter ASD database who completed pretreatment and 1-year follow-up HRQOL scales and the anchor question at the first year follow-up were included. The anchor question was used to determine MCID for each HRQOL measure. MCIDs were calculated by an anchor-based method using latent class analysis (LCA) and MDCs by a distribution-based method. RESULTS All differences between means of baseline and first year postoperative total score measures for all scales demonstrated statistically significant improvements in the overall population as well as the surgically treated patients but not in the nonsurgical group. The calculated MDC and MCID values of HRQOL parameters in the entire study population were 1.34 and 2.62 for COMI, 10.65 and 14.31 for ODI, 6.09 and 7.33 for SF-36 PCS, 6.14 and 4.37 for SF-36 MCS, and 0.42 and 0.71 for SRS-22R. The calculated MCID values for surgical and non-surgical treatment groups were 2.76 versus 1.20 for COMI, 14.96 versus 2.45 for ODI, 7.83 versus 2.15 for SF-36 PCS, 5.14 versus 2.03 for SF-36 MCS, and 0.94 versus 0.11 for SRS-22R; the MDC values for surgical and nonsurgical treatment groups were 1.22 versus 1.51 for COMI, 10.27 versus 9.45 for ODI, 5.16 versus 6.77 for SF-36 PCS, 6.05 versus 5.67 for SF-36 MCS, and 0.38 versus 0.43 for SRS-22R. CONCLUSIONS This study has demonstrated that MCID calculations for the HRQOL scales in ASD using LCA yield values comparable to other studies that had used different methodologies. The most important finding was the significantly different MCIDs for COMI, ODI, SF-36 PCS and SRS-22 in the surgically and nonsurgically treated cohorts. This finding suggests that a universal MCID value, inherent to a specific HRQOL for an entire cohort of ASD may not exist. Use of different MCIDs for surgical and nonsurgical patients may be warranted.
Collapse
Affiliation(s)
- Selcen Yuksel
- Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Selim Ayhan
- ARTES Spine Center, Ankara, Turkey; Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | | | | | | | | | | | -
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
37
|
Ayhan S, Yuksel S, Nabiyev V, Adhikari P, Villa-Casademunt A, Pellise F, Perez-Grueso FS, Alanay A, Obeid I, Kleinstueck F, Acaroglu E. The Influence of Diagnosis, Age, and Gender on Surgical Outcomes in Patients With Adult Spinal Deformity. Global Spine J 2018; 8:803-809. [PMID: 30560031 PMCID: PMC6293420 DOI: 10.1177/2192568218772568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of prospectively collected data from a multicentric database. OBJECTIVES To determine the clinical impact of diagnosis, age, and gender on treatment outcomes in surgically treated adult spinal deformity (ASD) patients. METHODS A total of 199 surgical patients with a minimum follow-up of 1 year were included and analyzed for baseline characteristics. Patients were separated into 2 groups based on improvement in health-related quality of life (HRQOL) parameters by minimum clinically important difference. Statistics were used to analyze the effect of diagnosis, age, and gender on outcome measurements followed by a multivariate binary logistic regression model for these results with statistical significance. RESULTS Age was found to affect SF-36 PCS (Short From-36 Physical Component Summary) score significantly, with an odds ratio of 1.017 (unit by unit) of improving SF-36 PCS score on multivariate analysis (P < .05). The breaking point in age for this effect was 37.5 years (AUC = 58.0, P = .05). A diagnosis of idiopathic deformity would increase the probability of improvement in Oswestry Disability Index (ODI) by a factor of 0.219 and in SF-36 PCS by 0.581 times (P < .05). Gender was found not to have a significant effect on any of the HRQOL scores. CONCLUSIONS Age, along with a diagnosis of degenerative deformity, may have positive effects on the likelihood of improvement in SF-36 PCS (for age) and ODI (for diagnosis) in surgically treated patients with ASD and the breaking point of this effect may be earlier than generally anticipated. Gender does not seem to affect results. These may be important in patient counseling for the anticipated outcomes of surgery.
Collapse
Affiliation(s)
- Selim Ayhan
- ARTES Spine Center, Ankara, Turkey,Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | | | | | | | | | | | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | | | - Emre Acaroglu
- ARTES Spine Center, Ankara, Turkey,Emre Acaroglu, ARTES Spine Center, Iran
Caddesi, 45/2, Kavaklidere 06700, Cankaya, Ankara, Turkey.
| | | |
Collapse
|
38
|
Abstract
STUDY DESIGN Multicenter, prospective study of consecutive adult spinal deformity (ASD) patients. OBJECTIVE To evaluate back and leg pain as a combined score in ASD and compare their relative and cumulative correlations with health-related quality of life (HRQOL) and sagittal parameters. SUMMARY OF BACKGROUND DATA Pain and disability are commonly reported in patients with ASD. This can affect their back, their legs or both. ASD-associated pain has been correlated with numerous HRQOL scores and radiological parameters. METHODS Preoperative pain intensity was assessed with a Numerical Rating Scale (NRS) for individual back and leg pain as well as a combined score, NRS20 (0-20, back plus leg pain).This yielded a range of static measures in all patients with ASD with differing burdens of disease. Linear regression analysis was performed to calculate the correlation between pain and HRQOL scores (Scoliosis Research Society 22, 36-Item Short Form Health Survey Physical Component Summary, 36-Item Short Form Health Survey Mental Component Summary, Core Outcome Measures Index, and Oswestry Disability Index), and radiological spinopelvic parameters (sagittal and coronal planes). RESULTS A total of 1309 patients were included in this study. A combined score (NRS20) was better correlated with HRQOL (P < 0.01 for all) and sagittal parameters (P < 0.01 for all) than individual back or leg pain scores. Evaluation of the relative contributions of back and leg pain demonstrate a higher correlation with HRQOL scores for back pain and a higher correlation with sagittal parameters for leg pain. The distribution of NRS20 pain scores demonstrated three clear patterns of pain: back pain only, moderate back pain with varying mild-moderate leg pain, and severe equivalent back and leg pain. Similar values were noted for nonoperative and operative patients. CONCLUSION The distribution and intensity of pain and its correlations with clinical and radiological parameters provide insight into the pathogenesis of ASD. A combined score has a simple yet valuable contribution to the assessment of symptoms in ASD. LEVEL OF EVIDENCE 3.
Collapse
|
39
|
The impact of deep surgical site infection on surgical outcomes after posterior adult spinal deformity surgery: a matched control study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2518-2528. [DOI: 10.1007/s00586-018-5583-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
|
40
|
Performance on Balance Evaluation Systems Test (BESTest) Impacts Health-Related Quality of Life in Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2018; 43:637-646. [PMID: 28858190 DOI: 10.1097/brs.0000000000002390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single-center study. OBJECTIVE Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA Recent insights suggest that demographic variables have a stronger impact on health-related quality of life than 2D radiographic spinopelvic parameters in ASD patients. METHODS Nine healthy volunteers and 36 ASD patients following inclusion criteria were recruited. Demographics, Scoliosis Research Society Score-22r (SRS-22r), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), 2D radiographic spinopelvic measurements, and performance on Balance Evaluation Systems Test (BESTest), and Trunk Control Measurement Scale (TCMS) were determined for each subject. Nonparametric tests, Spearman correlations, univariate, and stepwise-like linear multivariate regression analysis were performed. RESULTS BESTest and TCMS had significant lower values in the ASD group versus the control group (P = 0.000). In the ASD group, Cumulative Illness Rating Scale (CIRS) correlated fair to ODI, COMI (0.441 ≥ r ≥ 0.383, P < 0.021) and to SRS-22-r (r = -0.335, P = 0.046), Mini Mental State Examination correlated fair to COMI (r = -0.352, P = 0.035), "Pelvic Incidence minus Lumbar Lordosis" correlated fair to ODI (r = 0.361, P = 0.031), BESTest correlated moderate to ODI and COMI (r ≤ -0.505; P ≤ 0.002), TCMS correlated fair to ODI (r = -0.356; P = 0.033). CIRS and BESTest were significant predictive variables for COMI based on univariate analysis in ASD patients. Multivariate regression analysis including demographics, 2D static radiographic parameters, and dynamic balance scales identified BESTest as single independent variable (P = 0.000) to predict COMI (adjusted R = 0.285) in ASD patients. CONCLUSION BESTest has a higher potential than demographic and 2D radiographic spinopelvic parameters to predict quality of life in ASD patients. Further research is necessary to identify the impact of ASD on quality of life. LEVEL OF EVIDENCE 3.
Collapse
|
41
|
Pellisé F, Vila-Casademunt A, Núñez-Pereira S, Domingo-Sàbat M, Bagó J, Vidal X, Alanay A, Acaroglu E, Kleinstück F, Obeid I, Pérez-Grueso FJS, Lafage V, Bess S, Ames C, Mannion AF. The Adult Deformity Surgery Complexity Index (ADSCI): a valid tool to quantify the complexity of posterior adult spinal deformity surgery and predict postoperative complications. Spine J 2018; 18:216-225. [PMID: 28684347 DOI: 10.1016/j.spinee.2017.06.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/19/2017] [Accepted: 06/27/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In 2008, Mirza et al. designed and validated the first and only index capable of quantifying the complexity of spine surgery. However, this index is not fully applicable to adult spinal deformity (ASD) surgery as it does not include the surgical techniques most commonly used and most strongly associated with perioperative complications in patients with ASD. PURPOSE The objective of this study is to develop an "Adult Deformity Surgery Complexity Index" (ADSCI) to quantify objectively the complexity of the ASD posterior surgery. STUDY DESIGN/SETTING This is an expert consensus (Delphi process) and retrospective analysis of prospectively collected data using multiple regression models. PATIENT SAMPLE Patients were prospectively enrolled in two comparable multicenter ASD databases sharing the same inclusion criteria. OUTCOME MEASURES The ADSCI was internally and externally validated using R2 for intraoperative bleeding and length of surgery. Receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to assess the sensitivity and specificity of ADSCI. METHODS The development and validation of ADSCI was based on the construction and comparison of three different tools: ADSCI score was constructed by three rounds of expert consensus (ADSCI-Delphi) and two multiple regression models (ADSCI-RM-Simple and ADSCI-RM-Mixed). Their predictive capability was compared by means of R2 values in the same subrogated of surgical complexity as in the Mirza index validation: intraoperative bleeding and duration of surgery. Sensitivity and specificity were evaluated using ROC curves and AUC analysis. The external validity was also examined by evaluating its predictive capability in another multicenter ASD database of comparable patients in the United States. RESULTS At the time of the study, the database included 1,325 patients. Four hundred seventy-five patients were eligible for the study, having been treated surgically using a posterior approach only (52.2 years standard deviation 20; 77.7% women; 85.4% American Society of Anesthesiologists I/II). Fifty-one international experts participated in the Delphi consensus process. The surgical variables selected by consensus and included in the equation were divided into actions and factors. Actions selected were number of fused segments, decompressions, interbody fusions, and cemented levels; number and type of posterior osteotomies; and use of pelvic fixation. The factors included were implant density, revision surgery, and team experience. ADSCI-RM-Mixed (regression model with Delphi formula interactions) provided the best estimates and predictive value, well above Mirza's invasiveness index. The ADSCI-RM-Mixed, with greater AUCs (>0.70), was also the most sensitive and specific for both of the dependent variables studied and for complication prediction. ADSCI-RM-Mixed obtained also the highest R2 value in the validation cohort in predicting blood loss (R2=0.34) and surgical time (R2=0.26) with effect sizes similar to those for the derivation cohort. CONCLUSIONS The ADSCI is the first tool to be specifically developed for the preoperative assessment of the complexity of ASD surgery. This study confirms its validity, specificity, and sensitivity, and shows that it has greater predictive capability than the more generic Mirza invasiveness index. The ADSCI should be useful for quantitatively estimating the increased risk associated with more invasive surgery and adjusting for surgical case-mix when making safety comparisons in ASDS.
Collapse
Affiliation(s)
| | | | | | | | - Juan Bagó
- Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Ahmet Alanay
- Acıbadem University School of Medicine, Istanbul, Turkey
| | | | | | | | | | | | - Shay Bess
- Presbyterian/St. Luke's Medical Center, Denver, CO, USA
| | | | | | -
- Vall d'Hebron Institute of Research, Barcelona, Spain
| |
Collapse
|
42
|
Van Lerbeirghe J, Van Lerbeirghe J, Van Schaeybroeck P, Robijn H, Rasschaert R, Sys J, Parlevliet T, Hallaert G, Van Wambeke P, Depreitere B. Cross-cultural adaptation and validation of the Dutch version of the core outcome measures index for low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:76-82. [PMID: 28819894 DOI: 10.1007/s00586-017-5255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/16/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The core outcome measures index (COMI) is a validated multidimensional instrument for assessing patient-reported outcome in patients with back problems. The aim of the present study is to translate the COMI into Dutch and validate it for use in native Dutch speakers with low back pain. METHODS The COMI was translated into Dutch following established guidelines and avoiding region-specific terminology. A total of 89 Dutch-speaking patients with low back pain were recruited from 8 centers, located in the Dutch-speaking part of Belgium. Patients completed a questionnaire booklet including the validated Dutch version of the Roland Morris disability questionnaire, EQ-5D, the WHOQoL-Bref, the Numeric Rating Scale (NRS) for pain, and the Dutch translation of the COMI. Two weeks later, patients completed the Dutch COMI translation again, with a transition scale assessing changes in their condition. RESULTS The patterns of correlations between the individual COMI items and the validated reference questionnaires were comparable to those reported for other validated language versions of the COMI. The intraclass correlation for the COMI summary score was 0.90 (95% CI 0.84-0.94). It was 0.75 and 0.70 for the back and leg pain score, respectively. The minimum detectable change for the COMI summary score was 1.74. No significant differences were observed between repeated scores of individual COMI items or for the summary score. CONCLUSION The reproducibility of the Dutch translation of the COMI is comparable to that of other validated spine outcome measures. The COMI items correlate well with the established item-specific scores. The Dutch translation of the COMI, validated by this work, is a reliable and valuable tool for spine centers treating Dutch-speaking patients and can be used in registries and outcome studies.
Collapse
Affiliation(s)
- J Van Lerbeirghe
- Department of Neurosurgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - J Van Lerbeirghe
- Department of Orthopedic Surgery, AZ Sint-Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium
| | - P Van Schaeybroeck
- Department of Neurosurgery, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - H Robijn
- Department of Orthopedic Surgery, Regional Hospital Heilig Hart Tienen, Kliniekstraat 45, 3300, Tienen, Belgium
| | - R Rasschaert
- Department of Neurosurgery, Sint-Jozef Hospital, Kasteelstraat 23, 2880, Bornem, Belgium
| | - J Sys
- Department of Orthopedic Surgery, AZ Sint Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - T Parlevliet
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - G Hallaert
- Department of Neurosurgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - P Van Wambeke
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - B Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| |
Collapse
|
43
|
Faraj SSA, van Hooff ML, Holewijn RM, Polly DW, Haanstra TM, de Kleuver M. Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2084-2093. [PMID: 28534221 DOI: 10.1007/s00586-017-5125-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE Adult spinal deformity (ASD) causes severe disability, reduces overall quality of life, and results in a substantial societal burden of disease. As healthcare is becoming more value based, and to facilitate global benchmarking, it is critical to identify and standardize patient-reported outcome measures (PROMs). This study aims to identify the current strengths, weaknesses, and gaps in PROMs used for ASD. METHODS Studies were included following a systematic search in multiple bibliographic databases between 2000 and 2015. PROMs were extracted and linked to the outcome domains of WHO's International Classification of Functioning and Health (ICF) framework. Subsequently, the clinimetric quality of identified PROMs was evaluated. RESULTS The literature search identified 144 papers that met the inclusion criteria, and nine frequently used PROMs were identified. These covered 29 ICF outcome domains, which could be grouped into three of the four main ICF chapters: body function (n = 7), activity and participation (n = 19), environmental factors (n = 3), and body structure (n = 0). A low quantity (n = 3) of papers was identified that studied the clinimetric quality of PROMs. The Scoliosis Research Society (SRS)-22 has the highest level of clinimetric quality for ASD. CONCLUSIONS Outcome domains related to mobility and pain were well represented. We identified a gap in current outcome measures regarding neurological and pulmonary function. In addition, no outcome domains were measured in the ICF chapter body structure. These results will serve as a foundation for the process of seeking international consensus on a standard set of outcome domains, accompanied PROMs and contributing factors to be used in future clinical trials and spine registries.
Collapse
Affiliation(s)
- Sayf S A Faraj
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Roderick M Holewijn
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, USA
| | - Tsjitske M Haanstra
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopedics, Radboud University Medical Center, Huispost 611, 6500HB, Nijmegen, The Netherlands.
| |
Collapse
|