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Singh A, von Vogelsang AC, El-Hajj VG, Buwaider A, Fletcher-Sandersjöö A, Pettersson-Segerlind J, Edström E, Elmi-Terander A. Health-Related Quality of Life and Return to Work after Surgery for Spinal Schwannoma: A Population-Based Cohort Study. Cancers (Basel) 2024; 16:1882. [PMID: 38791960 PMCID: PMC11120162 DOI: 10.3390/cancers16101882] [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: 04/12/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Spinal schwannomas are the second most common primary intradural spinal tumor. This study aimed to assess health-related quality of life (HRQoL) and the frequency of return to work after the surgical treatment of spinal schwannomas. HRQoL was compared to a sample of the general population. Patients operated for spinal schwannomas between 2006 and 2020 were identified in a previous study and those alive at follow-up (171 of 180) were asked to participate. Ninety-four (56%) responded and were included in this study. Data were compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. An analysis for any potential non-response bias was performed and showed no significant differences between the groups. HRQoL was equal between the spinal schwannoma sample and the general population sample in all but one dimension; men in the spinal schwannoma sample reported more moderate problems in the usual activities dimension than men in the general population (p = 0.020). In the schwannoma sample, there were no significant differences between men and women in either of the dimensions EQ-5Dindex or EQVAS. Before surgery, a total of 71 (76%) were working full-time and after surgery almost all (94%) returned to work, most of them within 3 months of surgery. Eighty-nine (95%) of the patients responded that they would accept the surgery for their spinal schwannoma if asked again today. To conclude, surgical treatment of spinal schwannomas is associated with good HRQoL and with a high frequency of return to work.
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Affiliation(s)
- Aman Singh
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
| | | | | | - Ali Buwaider
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Jenny Pettersson-Segerlind
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
- Sweden Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
- Sweden Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
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2
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Zhang Y, Liu W, Zhao J, Wang D, Peng F, Cui S, Wang B, Shi Z, Liu B, He D, Yang Z. Improving pedicle screw path planning by vertebral posture estimation. Phys Med Biol 2023; 68:185011. [PMID: 37442124 DOI: 10.1088/1361-6560/ace753] [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: 02/04/2023] [Accepted: 07/13/2023] [Indexed: 07/15/2023]
Abstract
Objective.Robot-assisted pedicle screw placement in spinal surgery can reduce the complications associated with the screw placement and reduce the hospital return counts due to malfunctions. However, it requires accurate planning for a high-quality procedure. The state-of-the-art technologies reported in the literature either ignore the anatomical variations across vertebrae or require substantial human interactions. We present an improved approach that achieves pedicle screw path planning through multiple projections of a numerically re-oriented vertebra with the estimated posture.Approach.We proposed an improved YOLO-type neural network model (YOLOPOSE3D) to estimate the posture of a vertebra before pedicle path planning. In YOLOPOSE3D, the vertebral posture is given as a rotation quaternion and 3D location coordinates by optimizing the intersection over union of the vertebra with the predicted posture and the actual posture. Then, a new local coordinate system is established for the vertebra based on the estimated posture. Finally, the optimal pedicle screw path trajectory is determined from the multiple projections of the vertebra in the local coordinates.Main results.The experimental results in difficult cases of scoliosis showed that the new YOLOPOSE3D network could accurately detect the location and posture of the vertebra with average translation and orientation errors as small as 1.55 mm and 2.55°. The screw path planning achieved 83.1% success rate without breaking the pedicle cortex for the lumbar vertebral L1-L5, which is better than that of a doctor's manual planning, 82.4%. With the clinical class A requirement to allow less than 2 mm out of the pedicle cortex, the success rate achieved nearly 100%.Significance.The proposed YOLOPOSED3D method can accurately determine the vertebral postures. With the improved posture prior, better clinical outcomes can be achieved for pedicle screw placement in spine internal fixation procedures.
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Affiliation(s)
- Yunxian Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Wenhai Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Jingwei Zhao
- Spine Surgery Department, Beijing Jishuitan Hospital, Captial Medical University, Beijing, People's Republic of China
| | - Dan Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Fan Peng
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Shangqi Cui
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Binbin Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Zhe Shi
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
| | - Bo Liu
- Spine Surgery Department, Beijing Jishuitan Hospital, Captial Medical University, Beijing, People's Republic of China
| | - Da He
- Spine Surgery Department, Beijing Jishuitan Hospital, Captial Medical University, Beijing, People's Republic of China
| | - Zhi Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People's Republic of China
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3
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Rundell SD, Saito A, Meier EN, Danyluk ST, Jarvik JG, Seebeck K, Friedly JL, Heagerty PJ, Johnston SK, Smersh M, Horn ME, Suri P, Cizik AM, Goode AP. The Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment (PROSPECTS) study: protocol for an inception cohort study. BMC Musculoskelet Disord 2022; 23:692. [PMID: 35864487 PMCID: PMC9306038 DOI: 10.1186/s12891-022-05598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common degenerative condition that contributes to back and back-related leg pain in older adults. Most patients with symptomatic LSS initially receive non-operative care before surgical consultation. However, there is a scarcity of data regarding prognosis for patients seeking non-surgical care. The overall goal of this project is to develop and evaluate a clinically useful model to predict long-term physical function of patients initiating non-surgical care for symptomatic LSS. Methods This is a protocol for an inception cohort study of adults 50 years and older who are initiating non-surgical care for symptomatic LSS in a secondary care setting. We plan to recruit up to 625 patients at two study sites. We exclude patients with prior lumbar spine surgeries or those who are planning on lumbar spine surgery. We also exclude patients with serious medical conditions that have back pain as a symptom or limit walking. We are using weekly, automated data pulls from the electronic health records to identify potential participants. We then contact patients by email and telephone within 21 days of a new visit to determine eligibility, obtain consent, and enroll participants. We collect data using telephone interviews, web-based surveys, and queries of electronic health records. Participants are followed for 12 months, with surveys completed at baseline, 3, 6, and 12 months. The primary outcome measure is the 8-item PROMIS Physical Function (PF) Short Form. We will identify distinct phenotypes using PROMIS PF scores at baseline and 3, 6, and 12 months using group-based trajectory modeling. We will develop and evaluate the performance of a multivariable prognostic model to predict 12-month physical function using the least absolute shrinkage and selection operator and will compare performance to other machine learning methods. Internal validation will be conducted using k-folds cross-validation. Discussion This study will be one of the largest cohorts of individuals with symptomatic LSS initiating new episodes of non-surgical care. The successful completion of this project will produce a cross-validated prognostic model for LSS that can be used to tailor treatment approaches for patient care and clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05598-x.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA, 98195-6490, USA. .,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA. .,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
| | - Ayumi Saito
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA, 98195-6490, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Eric N Meier
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Jeffrey G Jarvik
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA.,Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Kelley Seebeck
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA, 98195-6490, USA.,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
| | - Patrick J Heagerty
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Sandra K Johnston
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Monica Smersh
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA, 98195-6490, USA
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Pradeep Suri
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA, 98195-6490, USA.,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.,Division of Rehabilitation Care Services, Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA.,Seattle Epidemiologic Research and Information Center, Veteran Affairs Puget Sound Health Care System,, Seattle, WA, USA
| | - Amy M Cizik
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
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4
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Toivonen L, Pekkanen L, Neva MH, Kautiainen H, Kyrölä K, Marttinen I, Häkkinen A. Disability, Health-Related Quality of Life and Mortality in Lumbar Spine Fusion Patients-A 5-Year Follow-Up and Comparison With a Population Sample. Global Spine J 2022; 12:1052-1057. [PMID: 33203243 PMCID: PMC9210235 DOI: 10.1177/2192568220972977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective follow-up study. OBJECTIVES We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. METHODS 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. RESULTS The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was -26 (95% CI: -24 to -28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. CONCLUSIONS Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population.
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Affiliation(s)
- Leevi Toivonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Leevi Toivonen, Department of Orthopedics and Traumatology, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland.
| | - Liisa Pekkanen
- Department of Orthopedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Marko H. Neva
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Hannu Kautiainen
- Unit of Family Practice, Central Finland Health Care District, Jyväskylä, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Kati Kyrölä
- Department of Orthopedics and Traumatology, Central Finland Health Care District, Jyväskylä, Finland
| | - Ilkka Marttinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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5
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Trager RJ, Cupler ZA, DeLano KJ, Perez JA, Dusek JA. Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA. BMJ Open 2022; 12:e058769. [PMID: 35697464 PMCID: PMC9196200 DOI: 10.1136/bmjopen-2021-058769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that utilisation of CSMT for newly diagnosed rLBP is associated with reduced odds of benzodiazepine prescription through 12 months' follow-up. DESIGN Retrospective cohort study. SETTING National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query. PARTICIPANTS Adults aged 18-49 with an index diagnosis of rLBP were included. Serious aetiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded. Patients were assigned to cohorts according to CSMT receipt or absence. Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation. OUTCOME MEASURES The number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months' follow-up prematching and postmatching. RESULTS After matching, there were 9206 patients (mean (SD) age, 37.6 (8.3) years, 54% male) per cohort. Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). After matching, the OR (95% CI) of benzodiazepine prescription at 3 months was 0.56 (0.50 to 0.64), at 6 months 0.61 (0.55 to 0.68) and 12 months 0.67 (0.62 to 0.74). Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings. CONCLUSIONS These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. Benzodiazepine prescription for rLBP should be further examined in a randomised trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kayla J DeLano
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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6
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Williamson E, Boniface G, Marian IR, Dutton SJ, Garrett A, Morris A, Hansen Z, Ward L, Nicolson PJA, Rogers D, Barker KL, Fairbank J, Fitch J, French DP, Comer C, Mallen CD, Lamb SE. The clinical effectiveness of a physiotherapy delivered physical and psychological group intervention for older adults with neurogenic claudication: the BOOST randomised controlled trial. J Gerontol A Biol Sci Med Sci 2022; 77:1654-1664. [PMID: 35279025 PMCID: PMC9373932 DOI: 10.1093/gerona/glac063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Neurogenic claudication (NC) is a debilitating spinal condition affecting older adults’ mobility and quality of life. Methods A randomized controlled trial of 438 participants evaluated the effectiveness of a physical and psychological group intervention (BOOST program) compared to physiotherapy assessment and tailored advice (best practice advice [BPA]) for older adults with NC. Participants were identified from spinal clinics (community and secondary care) and general practice records and randomized 2:1 to the BOOST program or BPA. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data were also collected at 6 months. Other outcomes included ODI walking item, 6-minute walk test (6MWT), and falls. The primary analysis was intention-to-treat. Results The average age of participants was 74.9 years (standard deviation [SD] 6.0) and 57% (246/435) were female. There was no significant difference in ODI scores between treatment groups at 12 months (adjusted mean difference [MD]: −1.4 [95% confidence intervals (CI) −4.03, 1.17]), but, at 6 months, ODI scores favored the BOOST program (adjusted MD: −3.7 [95% CI −6.27, −1.06]). At 12 months, the BOOST program resulted in greater improvements in walking capacity (6MWT MD: 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD: −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio: 0.6 [95% CI 0.40, 0.98]) compared to BPA. No serious adverse events were related to either treatment. Conclusions The BOOST program substantially improved mobility for older adults with NC. Future iterations of the program will consider ways to improve long-term pain-related disability. Clinical Trials Registration Number: ISRCTN12698674
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Affiliation(s)
- Esther Williamson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK.,College of Medicine and Health, University of Exeter
| | - Graham Boniface
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Susan J Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Angela Garrett
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Alana Morris
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Zara Hansen
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
| | - Philippa J A Nicolson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | - David Rogers
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Karen L Barker
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK.,Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy Fairbank
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christine Comer
- University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust, Otley, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter
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7
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Young JJ, Jensen RK, Hartvigsen J, Roos EM, Ammendolia C, Juhl CB. Prevalence of multimorbid degenerative lumbar spinal stenosis with knee or hip osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:177. [PMID: 35209884 PMCID: PMC8876450 DOI: 10.1186/s12891-022-05104-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/09/2022] [Indexed: 12/30/2022] Open
Abstract
Background Musculoskeletal multimorbidity is common and coexisting lumbar spinal stenosis (LSS) with knee or hip osteoarthritis (OA) has been reported. The aim of this review was to report the prevalence of multimorbid degenerative LSS with knee or hip OA based on clinical and/or imaging case definitions. Methods Literature searches were performed in MEDLINE, EMBASE, CENTRAL, and CINAHL up to May 2021. Studies involving adults with cross-sectional data to estimate the prevalence of co-occurring LSS with knee or hip OA were included. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers. Results were stratified according to index and comorbid condition, and by case definitions (imaging, clinical, and combined). Results Ten studies from five countries out of 3891 citations met the inclusion criteria. Sample sizes ranged from 44 to 2,857,999 (median 230) and the mean age in the included studies range from 61 to 73 years (median 66 years). All studies were from secondary care or mixed settings. Nine studies used a combined definition of LSS and one used a clinical definition. Imaging, clinical, and combined case definitions of knee and hip OA were used. The prevalence of multimorbid LSS and knee or hip OA ranged from 0 to 54%, depending on the specified index condition and case definitions used. Six studies each provided prevalence data for index LSS and comorbid knee OA (prevalence range: 5 to 41%) and comorbid hip OA (prevalence range: 2 to 35%). Two studies provided prevalence data for index knee OA and comorbid LSS (prevalence range 17 to 54%). No studies reporting prevalence data for index hip OA and comorbid LSS were found. Few studies used comparable case definitions and all but one study were rated as high risk of bias. Conclusions There is evidence that multimorbid LSS with knee or hip OA occurs in people (0 to 54%), although results are based on studies with high risk of bias and surgical populations. Variability in LSS and OA case definitions limit the comparability of studies and prevalence estimates should therefore be interpreted with caution. Review registration PROSPERO (CRD42020177759). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05104-3.
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Affiliation(s)
- James J Young
- Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Research Division, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada. .,Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, DK-5230, Odense M, Denmark.
| | - Rikke Krüger Jensen
- Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Odense M, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Odense M, Denmark
| | - Ewa M Roos
- Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Carsten Bogh Juhl
- Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
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8
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Knutsson B, Jong M, Sayed-Noor A, Sjödén G, Augutis M. Waiting for lumbar spinal stenosis surgery: suffering and a possibility to discover coping abilities. Orthop Rev (Pavia) 2022; 14:30716. [PMID: 35106129 DOI: 10.52965/001c.30716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Objective The objective of this study was to describe aspects of suffering related to being a person with LSS and how suffering is managed before LSS surgery. Methods/design/setting A Swedish county hospital. Interviews with 18 consecutive patients on the waiting list for LSS surgery. The themes that emerged from content analysis were further interpreted using Antonovsky salutogenic model as a sensitizing concept. Results The suffering from LSS before surgery included the main theme of experiencing an impaired physical and social life and struggling to be believed and taken seriously. This had coping strategies to manage symptoms before surgery: a good physician-patient relationship alleviates the burden of long waiting times; ways to manage pain and disability; ambiguous expectations and hope for recovery, and; ways to handle concerns before surgery). Conclusion Being a person with LSS includes suffering and a possibility to discover coping abilities or having support structures for doing so. Our study emphasizes the importance of a supportive dialogue, where physicians and patients make the suffering from LSS and care before LSS surgery more comprehensible and manageable.
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Affiliation(s)
- Björn Knutsson
- Department of Surgical and Perioperative Science, Umeå University
| | - Mats Jong
- Department of Health Sciences/Public Health, Mid Sweden University
| | - Arkan Sayed-Noor
- Department of clinical science and education, Södersjukhuset, Karolinska Institutet Stockholm
| | - Göran Sjödén
- Department of clinical science and education, Södersjukhuset, Karolinska Institutet Stockholm
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society. Division Clinical Geriatrics, Karolinska Institutet, Stockholm
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Health-Related Quality of Life and Return to Work after Surgery for Spinal Meningioma: A Population-Based Cohort Study. Cancers (Basel) 2021; 13:cancers13246371. [PMID: 34944991 PMCID: PMC8699140 DOI: 10.3390/cancers13246371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Spinal meningioma is the most common primary intradural spinal tumor. Although histologically benign, the tumors often cause neurological deficits. Health-related quality of life (HRQoL) is defined as the aspects of quality of life which are most affected by ill health and is a measure of self-perceived health status. Despite many studies evaluating the neurological outcome after surgery for spinal meningiomas, no study has been concerned with the HRQoL and frequency of return to work. In this population-based cohort study, we reviewed 84 cases of surgically treated spinal meningiomas, with a mean follow-up of 8.7 years, to assess their HRQoL compared to a sample of the general population. We found that HRQoL after surgery was equal to the normal population, and the frequency of return to work was 100%, often within three months of surgery. Thus, surgical treatment of spinal meningiomas should not be considered a threat to long-term quality of life. Abstract Spinal meningiomas are the most common primary spinal intradural tumor. This study aimed to assess Health-related quality of life (HRQoL) and the frequency of return to work in patients surgically treated for spinal meningiomas, in comparison to the general population. Variables were collected from patient charts, EQ-5D-3L, and study specific questionnaires. Patients who had been operated between 2005–2017 were identified in a previous study and those alive in 2020 (104 of 129) were asked to participate. Eighty-four patients (80.8%) with a mean follow-up of 8.7 years, responded and were included. Data was compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. Analysis for potential non-response bias showed no significant differences. Women in the meningioma sample scored more problems than men with regards to mobility (p = 0.048). There were no significant differences concerning EQ-5Dindex (p = 0.325) or EQVAS (p = 0.116). The correlation between follow-up time and EQ-5Dindex was low (r = 0.167). When comparing HRQoL to the general population sample, no significant differences were found within the EQ-5D-3L dimensions, EQ-5Dindex or EQVAS. Those who postoperatively scored 3–5 on mMCs scored significantly more problems in the EQ-5D-3L dimension mobility (p = 0.023). Before surgery, 41 (48.8%) of the spinal meningioma patients were working and after surgery all returned to work, the majority within three months. Seventy-eight (96%) of the patients would accept surgery for the same diagnosis if asked today. We conclude that surgery for spinal meningiomas is associated with good long-term HRQoL and a high frequency of return to work.
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Nolte MT, Parrish JM, Jenkins NW, Cha EDK, Lynch CP, Mohan S, Geoghegan CE, Jadczak CN, Hrynewycz NM, Singh K. The Influence of Comorbidity on Postoperative Outcomes Following Lumbar Decompression. Clin Spine Surg 2021; 34:E390-E396. [PMID: 33560010 DOI: 10.1097/bsd.0000000000001133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/22/2020] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE Evaluate the association between comorbidity burden and reaching minimum clinically important difference (MCID) following lumbar decompression (LD). SUMMARY OF BACKGROUND DATA There is limited research on the influence of preoperative comorbidity burden on patient-reported outcome improvement following LD. METHODS A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries between 2015 and 2019. Inclusion criteria were primary, single, or multilevel LD. Patients were excluded for missing preoperative patient-reported outcome surveys. Stratification was based on Charlson Comorbidity Index (CCI) score: 0 points (no comorbidities), 1-2 points (low CCI), ≥3 points (high CCI). Demographics and perioperative characteristics were evaluated for differences. Linear regression assessed postoperative improvement for visual analogue scale (VAS) back, VAS leg, Oswestry disability index (ODI), Short Form-12 Physical Composite Score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) scores through 1 year. Achievement rate of MCID was compared between groups and evaluated for significant predictors. RESULTS Three hundred fourteen patients were included (123 no comorbidities, 100 low CCI, 91 high CCI). Higher CCI patients were older, more likely to smoke, and have comorbid diseases (all P<0.001). Perioperative differences included increased operative time, levels decompressed, length of stay, and discharge day in the CCI≥3 group. No differences in the rate of achieving MCID for VAS back, VAS leg, and ODI. CCI≥3 subgroup had a lower rate of reaching MCID at 6 months for SF-12 PCS, at 6 weeks for PROMIS-PF, and the overall rate for both SF-12 PCS and PROMIS-PF (all P<0.05). Multilevel procedures was a predictor for MCID achievement for ODI. CONCLUSIONS Patients with increased comorbidities undergoing LD had an equivalent MCID achievement rate for pain and disability metrics through 1 year. High CCI patients did, however, have a lower rate of achieving MCID for their physical function surveys which suggests that comorbidity burden influences improvement in physical function following LD.
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Affiliation(s)
- Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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11
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Virk S, Sandhu M, Wright-Chisem J, Vaishnav A, Albert T, Qureshi SA. The association between spondylolisthesis and decreased muscle health throughout the lumbar spine for patients with operative 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 2021; 30:2605-2612. [PMID: 33893871 DOI: 10.1007/s00586-021-06832-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/02/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE There are data underlining the relationship between muscle health and spine related pathology, but little data regarding changes in paralumbar muscle associated with lumbar spondylolisthesis. We aimed to define changes in paralumbar muscle health associated with spondylolisthesis. METHODS A retrospective review was performed on consecutive patients with lumbar spine pathology requiring an operation. A pre-operative lumbar MRI was analysed for muscle health measurements including lumbar indentation value (LIV), paralumbar cross-sectional area divided by body mass index (PL-CSA/BMI), and Goutallier classification of fatty atrophy. All measurements were taken from an axial slice of a T2-weighted image at lumbar disc spaces. Baseline health-related quality of life scores (HRQOLs), narcotic use and areas of stenosis were tracked. We performed Chi-square analyses and student's t test to determine statistically significant differences between cohorts. RESULTS There were 307 patients (average age 56.1 ± 16.7 years, 141 females) included within our analysis. 112 patients had spondylolisthesis. There were no differences in baseline HRQOLs between the spondylolisthesis cohort (SC) and non-spondylolisthesis cohort (non-SC). There were significantly worse PL-CSA/BMI at L2-L3 (p = 0.03), L3-L4 (p = 0.04) and L4-L5 (p = 0.02) for the SC. Goutallier classification of paralumbar muscle was worse for SC at L1-L2 (p = 0.04) and at L4-L5 (p < 0.001). Increased grade of spondylolisthesis was associated with worse PL-CSA at L1-L2 (p = 0.02), L2-L3 (p = 0.03) and L3-L4 (p = 0.05). Similarly, there were worse Goutallier classification scores associated with higher-grade spondylolisthesis at all levels (p < 0.05). CONCLUSION There are significant detrimental changes to paralumbar muscle health throughout the lumbar spine associated with spondylolisthesis.
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Affiliation(s)
- Sohrab Virk
- Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | - Milan Sandhu
- Weill Cornell Medical College, New York, NY, USA
| | | | - Avani Vaishnav
- Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA. .,Weill Cornell Medical College, New York, NY, USA.
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12
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Lorio D, Twetten M, Golish SR, Lorio MP. Determination of Work Relative Value Units for Management of Lumbar Spinal Stenosis by Open Decompression and Interlaminar Stabilization. Int J Spine Surg 2021; 15:1-11. [PMID: 33900951 DOI: 10.14444/8026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I Current Procedural Terminology (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved. During the survey process, CPT® 22867 was erroneously assessed with a percutaneous "sister" code (CPT® 22869), which is performed with no decompression (but within the same new "family") and primarily by nonsurgeons. However, similar CPT® code descriptors assigned to each of these new codes undermined their procedural differences during the survey process and generated confusion among physician survey responders, the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), and ultimately the Centers for Medicare and Medicaid Services (CMS) regarding the value of ILS. The resulting physician payment determination for the ILS procedure has had severe deleterious effects on this procedure being offered to lumbar spinal stenosis (LSS) patients. Our independent society-driven survey presents new data that assess the accuracy of the assigned wRVUs for CPT® 22867. METHODS An independent survey was driven by the International Society for the Advancement of Spine Surgery (ISASS) in November 2018 and sent to 58 US surgeons with experience performing open decompression with ILS (CPT® 22867) and without financial conflicts of interest as analogous to RUC survey financial disclosure requests. Respondents were asked to compare CPT® 22867 with a list of 10 other comparator CPT® codes reflective of common spine surgeries. The survey presented each comparator CPT® code with its code descriptor and corresponding wRVUs alongside the code descriptor for CPT® 22867. A patient vignette was also provided that describes a typical clinical scenario for the surveyed procedure. Respondents were then asked to indicate which comparator CPT® code on the reference list is most similar to the survey code descriptor and typical patient/service vignette provided, as well as specify estimated wRVUs for CPT® 22867 relative to their selected comparator CPT® code. The surgeons' responses were analyzed to determine comparator CPT® codes and estimated wRVUs. RESULTS Among the 28 surgeons who responded to the survey, both open decompression codes (57.1%) and fusion codes (42.9%) were chosen as most similar to the typical patient/service for CPT® 22867. Furthermore, the laminectomy procedure (CPT® 63047) was chosen as the surveyed surgeons' model response for a reference procedure in terms of similar work intensity and time for CPT® 22867. After calculating the difference between the selected comparator codes and estimated wRVUs, nearly all respondents had a positive calculated difference, indicating that surgeons selected wRVUs lower than they deemed appropriate as a result of the listed CPT® codes they were required to use. In the spirit of the Rasch analysis, the regression analysis estimated wRVUs for CPT® 22867 that are greater than its assigned wRVUs (13.5) and its most comparable procedure (CPT® 63047; reference wRVUs: 15.37). DISCUSSION AND CONCLUSIONS The survey results indicate that the wRVUs assigned to CPT® 22867 are significantly undervalued at 13.50 and have directly resulted in the underreimbursement for surgeons performing the ILS procedure. This misvaluation of the code has created a supply-and-demand anomaly in which the rate of ILS procedures has flatlined despite increasing rates of fusion procedures and an increasing older population. This anomaly is a cause of concern for policy makers and the health care community for the future of safeguarding patient welfare and procedural innovation. Therefore, understanding the clinical economic impact and appropriately addressing potential misvalued codes, such as the ILS procedure, are critical to protecting the future of patient care.
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Affiliation(s)
- Delaine Lorio
- University of Edinburgh Business School, Edinburgh, Scotland
| | - Matthew Twetten
- International Society for the Advancement of Spine Surgery, Wheaton, Illinois
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Williamson E, Sanchez Santos MT, Morris A, Garrett A, Conway O, Boniface G, Fairbank J, Lamb SE. The Prevalence of Back and Leg Pain and the Cross-sectional Association With Adverse Health Outcomes in Community Dwelling Older Adults in England. Spine (Phila Pa 1976) 2021; 46:54-61. [PMID: 33315364 DOI: 10.1097/brs.0000000000003719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional analysis of the Oxford Pain, Activity and Lifestyle (OPAL) Cohort Study. OBJECTIVE The aim of this study was to assess the prevalence of back pain (BP) and leg pain and determine their relationship with adverse health states among older adults in England. SUMMARY OF BACKGROUND DATA Epidemiological data describing the prevalence of BP and leg pain in older adults in England is lacking. METHODS A total of 5304 community-dwelling adults (aged 65-100 years) enrolled in the OPAL cohort study who provided data on BP and leg pain were included. Participants were classified into four groups based on reports of back and leg pain: no BP, BP only, BP and leg pain which was likely to be neurogenic claudication (NC), and BP and leg pain which was not NC. Adverse health states were frailty, falls, mobility decline, low walking confidence, poor sleep quality, and urinary incontinence. We collected demographic and socioeconomic information, health-related quality of life, and existing health conditions, and estimated the association between BP presentations and adverse health states using regression analysis. RESULTS Thirty-four percent of participants (1786/5304) reported BP only, 11.2% (n = 594/5304) reported BP and NC and 8.3% (n = 441/5304) reported BP and non-NC leg pain. Participants with BP had worse quality of life compared to those without BP. All BP presentations were significantly associated with adverse health states. Those with NC were most affected. In particular, there was greater relative risk (RR) of low walking confidence (RR 3.11, 95% confidence interval [CI] 2.56-3.78), frailty (RR 1.88, 95% CI 1.67-2.11), and mobility decline (RR 1.74, 95% CI 1.54-1.97) compared to no BP. CONCLUSION Back and leg pain is a common problem for older adults and associated with reduced quality of life and adverse health states. Findings suggest a need to develop more effective treatment for older adults with BP especially for those with neurogenic claudication. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Esther Williamson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria T Sanchez Santos
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Alana Morris
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Angela Garrett
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Oliver Conway
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Graham Boniface
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeremy Fairbank
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah E Lamb
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Roop SC, Battié MC, Jhangri GS, Hu RW, Jones CA. Functional Recovery after Surgery for Lumbar Spinal Stenosis in Patients with Hypertension. Healthcare (Basel) 2020; 8:E503. [PMID: 33233682 PMCID: PMC7712444 DOI: 10.3390/healthcare8040503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022] Open
Abstract
Hypertension is a prevalent condition that is associated with lower health status in patients with lumbar spinal stenosis. The study determined whether hypertension is a prognostic factor associated with functional recovery after spine surgery for lumbar spinal stenosis. This was a secondary analysis of the Alberta Lumbar Spinal Stenosis Study in which patients were identified as participants at the time of lumbosacral magnetic resonance imaging or computed tomography in Calgary, Alberta, Canada. Multivariable linear regression analyses were performed to examine hypertension as a prognostic factor of functional recovery after surgery (Oswestry Disability Index, the Swiss Spinal Stenosis (SSS)-Symptom Severity and SSS-Physical Function scales). Of the 97 surgical participants, 49 who were hypertensive were older (76.8, SD 11.4 years) than the 48 non-hypertensive participants (66.7, SD 12.4 years) (p < 0.001). No significant associations between hypertension and post-operative function in any of the three multivariable models were seen. The Oswestry Disability Index mean score improved after surgery (effect size: 1.73; 95%CI: 1.39, 2.06), with no differences seen between those with and without hypertension (p = 0.699). Large changes were seen after surgery for the SSS-Symptom Severity (effect size: 1.0, 95%CI 0.7, 1.3) and SSS-Physical Function (effect size: 0.9, 95%CI 0.6, 1.2) scales. Hypertension alone does not negatively impact functional recovery following surgery.
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Affiliation(s)
- Sanjesh C. Roop
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.C.R.); (G.S.J.)
| | - Michele C. Battié
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada;
| | - Gian S. Jhangri
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.C.R.); (G.S.J.)
| | - Richard W. Hu
- Section of Orthopaedics, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada;
| | - C. Allyson Jones
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.C.R.); (G.S.J.)
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Chuang HC, Tsai KL, Tsai KJ, Tu TY, Shyong YJ, Jou IM, Hsu CC, Shih SS, Liu YF, Lin CL. Oxidative stress mediates age-related hypertrophy of ligamentum flavum by inducing inflammation, fibrosis, and apoptosis through activating Akt and MAPK pathways. Aging (Albany NY) 2020; 12:24168-24183. [PMID: 33223505 PMCID: PMC7762458 DOI: 10.18632/aging.104105] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
The role of oxidative stress in ligamentum flavum (LF) hypertrophy has not been elucidated. We hypothesize that oxidative stress induces inflammatory responses and the subsequent fibrotic processes in LF, via activation of the Akt and MAPK pathways. Specimens of LFs were collected during surgeries for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS). Part of the LF specimens underwent analyses for ROS, fibrotic markers, and inflammatory mediators, with the remainder minced for cell cultures. The cell cultures were treated with H2O2, after which the cells were lysed and analyzed via western blotting. The specimens of the LSS patients showed increased infiltration of inflammatory cells and were stained positively for MMP-3, MMP-9, vimentin, and fibronectin. The LF of the LSS patients had increased oxidative stress and inflammation compared to that of the LDH patients. In vitro analyses demonstrated that oxidative stress rapidly activated the Akt and MAPK pathways. Inflammatory mediators, iNOS and NF-κB, and fibrotic markers, including TGF-β, β-catenin, α-SMA and vimentin, were significantly upregulated after induction of oxidative stress. Oxidative stress activated the intrinsic apoptotic pathway. These findings revealed that oxidative stress is one of the etiological factors of LF hypertrophy, which might provide new insights into treatment approaches.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Ling Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Yuan Tu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Jye Shyong
- Department of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Che-Chia Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Shien Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Fu Liu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan
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16
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Prevalence of sleep disturbance in patients with lumbar spinal stenosis and analysis of the risk factors. Spine J 2020; 20:1239-1247. [PMID: 32061837 DOI: 10.1016/j.spinee.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/18/2020] [Accepted: 02/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although sleep quality is indispensable for good quality of life, it has not been properly measured or treated in patients with lumbar spinal stenosis (LSS). Studies that investigate the prevalence of sleep disturbances and identify high-risk patients are essential to help understand mechanisms of sleep disturbance in patients with LSS, develop multimodal treatment strategies, and eventually improve the clinical outcome for LSS. PURPOSE The purpose of the study was to investigate the prevalence and status of sleep disturbance in patients with LSS and understand its mechanism by identifying the risk factors. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE Patients diagnosed with LSS. OUTCOME MEASURES Pittsburgh sleep quality index (PSQI). METHODS A study was performed on patients diagnosed with LSS. Sleep disturbance was evaluated using the PSQI. Clinical and radiologic risk factors of sleep disturbance were investigated by comparing its presence and absence in patients with LSS. Multivariate logistic regression analysis was conducted to identify significant risk factors related to sleep disturbance. RESULTS A total of 230 patients with LSS were analyzed in our study, 141 of whom (61.3%) were women, and the average age was 67.7 years. Sleep disturbance (PSQI score≥6) was identified in 66.1% of the patients (152 out of 230). After a multivariate analysis, sleep disturbance was consistently associated with the female sex, a negative score on the depression scale, and a severe foraminal-type stenosis. Oswestry disability index, visual analogue pain scale, and presence of nocturnal pain were not independently associated with sleep disturbance. CONCLUSIONS This study identified potential high-risk groups for sleep disturbance among patients with LSS. Proper caution and evaluation for these patients, along with further studies about their treatment outcomes, are required.
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Clinical outcomes of lumbar spinal surgery in patients 80 years or older with lumbar stenosis or spondylolisthesis: a systematic review and meta-analysis. 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; 29:2129-2142. [PMID: 31912292 DOI: 10.1007/s00586-019-06261-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/02/2019] [Accepted: 12/16/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic review and meta-analysis of all available evidence was performed to assess the safety and efficacy of surgery for lumbar stenosis and spondylolisthesis in patients 80 years or older versus those younger than 80 years. METHODS A search of the literature was conducted in PubMed/MEDLINE, EMBASE and the Cochrane Collaboration Library. Relevant studies comparing the clinical outcomes of lumbar surgery in octogenarians and younger patients were selected according to the eligibility criteria. The predefined endpoints were extracted and meta-analysed from the identified studies. RESULTS Data from 16 observational studies including 374,197 patients were included in the final analysis. The pooled data revealed that patients 80 years or older had a significantly higher incidence of overall complication, mortality, readmission and longer length of hospital stay than younger patients. There was a similar improvement in the clinical symptoms (Oswestry Disability Index and pain) of patients in the two groups. No significant differences in overall wound complication, reoperation rate, operative time and intraoperative blood loss were found between the groups. CONCLUSIONS Our results revealed that the clinical improvement in pain and disability did not significantly differ according to age, although the patients aged 80 years or older had increased incidences of mortality and complication than younger patients. Age alone is not a contraindication for lumbar surgery in very old patients. A careful preoperative evaluation, proper patient selection and appropriate surgical approach are important to achieve successful surgical outcomes. These slides can be retrieved under Electronic Supplementary Material.
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Coyle PC, Pugliese JM, Sions JM, Eskander MS, Schrack JA, Hicks GE. Pain Provocation and the Energy Cost of Walking: A Matched Comparison Study of Older Adults With and Without Chronic Low Back Pain With Radiculopathy. J Geriatr Phys Ther 2019; 42:E97-E104. [PMID: 30998562 DOI: 10.1519/jpt.0000000000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Chronic low back pain with radiculopathy (CLBPR) is common among older adults and can lead to walking difficulty. Energy cost of walking strongly predicts changes in walking speed, which is predictive of mortality in older adults. The purposes of this study were to examine (1) the impact of pain provocation on the energy cost of walking and (2) the relationship between pain intensity and change in energy cost of walking. METHODS Older adults (60-85 years) with (n = 20) and without (n = 20) CLBPR were matched on age, sex, and diabetes presence/absence. Energy cost of walking was measured with a portable metabolic gas analyzer, as participants walked for 20 minutes or less. Energy cost and pain measurements occurred during early and late stages of walking. Percent change in energy cost was calculated. Participants were grouped by their pain response during walking: increased pain (n = 13); consistent pain (n = 7); no pain, matched to individuals with increased pain (n = 13); and no pain, matched to individuals with consistent pain (n = 7). We examined the within-groups change in energy cost for all groups, as well as the relationship between late-stage pain intensity and percent change of energy cost for individuals whose pain increased. RESULTS AND DISCUSSION Within the increased pain group, energy cost of walking significantly increased from early to late stages (median change = 0.003 mL/kg/m, P = .006), and late-stage pain intensity explained 41.2% (p = 0.040) of the variance in percent change. Since pain appears to be linked to energy cost, effective pain management with walking may be an important factor in preventing mobility decline. CONCLUSIONS Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Delaware, Newark
| | | | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark
| | | | - Jennifer A Schrack
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark
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Ward L, Williamson E, Hansen Z, French DP, Boniface G, Rogers D, Lamb SE. Development and delivery of the BOOST (Better Outcomes for Older adults with Spinal Trouble) intervention for older adults with neurogenic claudication. Physiotherapy 2019; 105:262-274. [PMID: 30935673 DOI: 10.1016/j.physio.2019.01.019] [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: 04/09/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022]
Abstract
Neurogenic claudication due to spinal stenosis is a common cause of disability in older adults. Conservative treatments are a favourable treatment option. This paper describes the development and delivery of the BOOST (Better Outcomes for Older adults with Spinal Trouble) intervention, a physiotherapist-delivered physical and psychological intervention for the management of neurogenic claudication in older adults. The BOOST intervention is being tested in a multi-centre, randomised controlled trial in UK National Health Service Trusts; delivered by physiotherapists registered with the Health and Care Professionals Council. Participants are aged 65 years or older, registered with a primary care practice, and report symptoms consistent with neurogenic claudication. Intervention content and delivery was initially informed by clinical and patient experts, research evidence, and behaviour change guidelines; and refined following an intervention development day attended by researchers, health professionals, and Patient and Public Involvement representatives. The BOOST intervention comprises 12 group sessions, promoting sustained adherence with a long term home and physical activity programme. Each session includes education and group discussion, individually tailored exercises, and walking. Initial exercise levels are set at a one-to-one assessment. Continued home exercise adherence and increased physical activity following completion of the sessions is facilitated through support telephone calls. Trial registration ISRCTN12698674.
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Affiliation(s)
- Lesley Ward
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - Esther Williamson
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - Zara Hansen
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester M13 9PL, UK.
| | - Graham Boniface
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - David Rogers
- Centre for Musculoskeletal Medicine, Royal Orthopaedic Hospital NHS Foundation Trust Birmingham, Bristol Road South, Birmingham B31 2AP, UK.
| | - Sarah E Lamb
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
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Verde ECL, Risso Neto MI, Mistro Neto S, Veiga IG, Zuiani GR, Pasqualini W, Tebet MA, Cavali PTM. CORRELATION BETWEEN LUMBAR SPINAL STENOSIS BASED ON MORPHOLOGY OF THE DURAL SAC AND THE QUALITY OF LIFE. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191801178961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the possible existence of a significant correlation between quality of life and severity classification of lumbar stenosis based on dural sac morphology in outpatients. Methods: Forty patients with a diagnosis of lumbar stenosis followed at a university hospital were submitted to magnetic resonance imaging (MRI) and quality of life questionnaires: Oswestry Disability Index (ODI), SF-36, Swiss Spinal Stenosis Questionnaire (SSS) and EQ-5D. They were classified as type A, B, C or D based on MRI. For the statistical analysis, the Spearman correlation was used. Results: Seventeen female patients and 23 male patients with mean age of 56.5 years constituted the sample. ODI had a mean dysfunction of 44.9%, the PCS score averaged 29.9, the MCS score was 41.3. The general symptoms of SSS presented a mean of 3.2 and the EQ-5D presented an average of 0.491. The patients with the highest severity in the classification were not necessarily those who presented worse scores in the quality of life questionnaires. Conclusion: The classification of severity of the lumbar spinal stenosis based on dural sac morphology does not correlate with the applied quality of life questionnaires. Level of Evidence III; Cross-sectional observational study.
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Affiliation(s)
| | | | - Sylvio Mistro Neto
- Universidade Estadual de Campinas, Brazil; Hospital Alemão Oswaldo Cruz, Brazil
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Filippiadis DK, Marcia S, Ryan A, Beall DP, Masala S, Deschamps F, Kelekis A. New Implant-Based Technologies in the Spine. Cardiovasc Intervent Radiol 2018; 41:1463-1473. [DOI: 10.1007/s00270-018-1987-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
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Coyle PC, Pugliese JM, Sions JM, Eskander MS, Schrack JA, Hicks GE. Energy Impairments in Older Adults With Low Back Pain and Radiculopathy: A Matched Case-Control Study. Arch Phys Med Rehabil 2018; 99:2251-2256. [PMID: 29698638 DOI: 10.1016/j.apmr.2018.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on (1) energy efficiency and (2) energy capacity among community-dwelling older adults. DESIGN Matched case-control study. SETTING Clinical research laboratory. PARTICIPANTS Included in the analysis were community-dwelling older adults (N=38, 60-85 years) with and without CLBPR. Participants were matched between-groups on age (±5 years), sex, and diabetic status. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Energy cost of walking at self-selected speed (ie, energy efficiency) and peak volume of oxygen consumed (ie, energy capacity). RESULTS Older adults with CLBPR had a higher energy cost of walking at self-selected speed (P=.009) and lower peak volume of oxygen consumed while walking (P=.050), compared to those without pain. CONCLUSIONS Older adults with CLBPR may benefit from specific rehabilitative interventions that target these potentially modifiable energetic outcomes, thereby reducing the risk of mobility decline. Future studies should identify which mechanisms specifically contribute to diminished energy efficiency and capacity among older adults with CLBPR.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | | | - Jennifer A Schrack
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware.
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Abstract
UNLABELLED MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone. STUDY DESIGN A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care. OBJECTIVE The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors. SUMMARY OF BACKGROUND DATA LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes. METHODS Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model. RESULTS N = 970; mean age: 50 years (range: 18-93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03). CONCLUSION Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP. LEVEL OF EVIDENCE 3.
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RISSO NETO MARCELOITALO, MISTRO NETO SYLVIO, ROSSANEZ ROBERTO, ZUIANI GUILHERMEREBECHI, VEIGA IVANGUIDOLIN, PASQUALINI WAGNER, TEBET MARCOSANTÔNIO, AMATO FILHO AUGUSTOCELSOSCARPARO, LANDIM ELCIO, CAVALI PAULOTADEUMAIA. CORRELATION BETWEEN QUALITY OF LIFE AND OSTEOLYSIS AROUND LUMBAR PEDICLE SCREWS. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161504147749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate whether the presence of osteolysis around the pedicle screws affects the quality of life of patients who underwent posterolateral arthrodesis of the lumbosacral spine. Methods: A retrospective study of patients undergoing lumbar posterolateral or lumbosacral arthrodesis due to spinal degenerative disease. CT scans of the operated segments were performed at intervals of 45, 90, 180, and 360 postoperatively. In these tests, the presence of a peri-implant radiolucent halo was investigated, which was considered present when greater than 1mm in the coronal section. Concurrently with the completion of CT scans, the participants completed the questionnaire Oswestry Disability Index (ODI) to assess the degree of disability of the patients. Results: A total of 38 patients were evaluated, and 14 (36.84%) of them showed some degree of osteolysis around at least one pedicle screw at the end of follow-up. Of the 242 analyzed screws, 27 (11.15%) had osteolysis in the CT coronal section, with the majority of these occurrences located at the most distal level segment of the arthrodesis. There was no correlation between the presence of the osteolysis to the quality of life of patients. The quality of life has significantly improved when comparing the preoperative results with the postoperative results at different times of application of ODI. This improvement in ODI maintains linearity over time. Conclusion: There is no correlation between the presence of peri-implant osteolysis to the quality of life of patients undergoing lumbar or posterolateral lumbosacral arthrodesis in the follow-up period up to 360 days. The quality of life in postoperative has significantly improvement when compared to the preoperative period.
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Kesänen J, Leino-Kilpi H, Lund T, Montin L, Puukka P, Valkeapää K. The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial. PATIENT EDUCATION AND COUNSELING 2016; 99:1984-1991. [PMID: 27448838 DOI: 10.1016/j.pec.2016.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/29/2016] [Accepted: 07/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis. METHODS One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n=50) or a control group (CG, n=50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up. RESULTS At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable. CONCLUSION A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge. PRACTICE IMPLICATION KTFI is an effective method of preoperative education in patients with spinal stenosis.
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Affiliation(s)
- Jukka Kesänen
- Department of Nursing Science, University of Turku, Turku, Finland; Orton Orthopaedic Hospital, Helsinki, Finland; Metropolia University of Applied Sciences, Helsinki, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Teija Lund
- Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | | | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Kirsi Valkeapää
- Department of Nursing Science, University of Turku, Turku, Finland; Lahti University of Applied Sciences, Lahti, Finland
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The Number of Patients and Therapeutic Profile of Spinal Stenosis Using Health Insurance Claims in Japan. Spine (Phila Pa 1976) 2016; 41:1146-1152. [PMID: 26882506 DOI: 10.1097/brs.0000000000001498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Population-based retrospective descriptive study. OBJECTIVE To describe the number and therapeutic profile of patients with spinal stenosis at a large-scale community level using health insurance claims data. SUMMARY OF BACKGROUND DATA A few reports have documented the prevalence of spinal stenosis, and no report has described the therapeutic profile for spinal stenosis in a population base. METHODS We studied the claims data of National Health Insurance and Late-stage Elderly Health Insurance in a prefecture in Japan from April 2010 to March 2011. We considered patients to have spinal stenosis if their claims included at least one diagnosis coded as spinal stenosis for at least 1 month during the study period. Disease criteria were based on the International Classification of Diseases, 10th version. We then described the number and the therapeutic profile of the patients with spinal stenosis by age and sex. RESULTS Of 699,723 beneficiaries, 52,889 patients with spinal stenosis were identified. The number of patients with spinal stenosis per 1000 beneficiaries was 76, and those for the subgroups of age ≥ 65 years, ≥ 75 years, and ≥ 85 years were 128, 155, and 152, respectively. The number of patients per 1000 beneficiaries showed unimodal distribution, and the peak for males was 191 between the ages 95 to 99 years and that for females was 160 between the ages 80 to 84 years. Analgesics, prostaglandin E1, or both were prescribed to 40%, 2%, or 20% of patients with spinal stenosis, respectively. Physical therapy, nerve blocks, and surgery were done for 19%, 8%, and 0.4% of the patients, respectively. Approximately, 33% of patients did not receive any treatment. CONCLUSION There were a large number of patients with spinal stenosis in elderly people. Most of them received nonsurgical treatments. Health insurance claims data could be a useful source of surveillance for such common diseases as spinal stenosis. LEVEL OF EVIDENCE 4.
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McKillop AB, Carroll LJ, Jones CA, Battié MC. The relation of social support and depression in patients with chronic low back pain. Disabil Rehabil 2016; 39:1482-1488. [PMID: 27415131 DOI: 10.1080/09638288.2016.1202335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP. METHOD Patients with LBP (n = 483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression. RESULTS More social support (overall functional social support) at baseline was associated with recovery from depression (OR = 0.24; 95% CI 0.10, 0.55) and less depressive symptoms (β = 1.68; 95% CI = 0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes. CONCLUSIONS Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation. Implications for Rehabilitation Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems. Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.
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Affiliation(s)
- Ashley B McKillop
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Linda J Carroll
- b Department of Public Health Sciences , School of Public Health, University of Alberta , Edmonton , Alberta , Canada
| | - C Allyson Jones
- c Department of Physical Therapy, Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
| | - Michele C Battié
- c Department of Physical Therapy, Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Alberta , Canada
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Bailey CS, Gurr KR, Bailey SI, Taylor D, Rosas-Arellano MP, Tallon C, Bureau Y, Urquhart JC. Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study. CMAJ Open 2016; 4:E185-93. [PMID: 27398362 PMCID: PMC4933598 DOI: 10.9778/cmajo.20150001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Waits for elective spine surgery are common in Canada. We examined whether a prolonged wait for surgery for lumbar degenerative spinal stenosis was detrimental to outcome. METHODS In this prospective observational study, we enrolled 166 consecutive patients referred to our centre for treatment of lumbar degenerative spinal stenosis between 2006 and 2010. Outcome measures were assessed at referral, preoperatively and until 24 months postoperatively. Primary outcome measures were the physical and mental component summary scores of the 36-Item Short-Form Health Survey and the Oswestry Disability Index. Secondary outcome measures included the symptom severity scale of the Zurich Claudication Questionnaire, a numeric rating scale for back and leg pain, and patient satisfaction with treatment. Wait time was defined as the time from referral to surgery. RESULTS The follow-up rate at 2 years was 85%. The median wait time was 349 days. All health-related quality of life measures deteriorated during the waiting period, but there was no significant correlation between wait time and magnitude of the change in outcome measure. At 6 months postoperatively, the Pearson correlation was significantly positive between wait time and change in disability (r = 0.223), Zurich Claudication Questionnaire score (r = 0.2) and leg pain score (r = 0.221). At 12 months, the correlation remained significant for change in disability (r = 0.205) and was significant for change in mental well-being (r = -0.224). At 12 months, patients with a shorter wait (≤ 12 months) showed greater improvement in mental well-being (mean difference in change [and 95% confidence interval (CI)] 5.7 [1.4-9.9]) and decrease in disability (-9.3 [95% CI -15.1 to -3.6]) and leg pain (-1.6 [95% CI -3.0 to -0.3]). There were no statistically significant differences in outcome or patient satisfaction with treatment between those with shorter and longer waits at 24 months. INTERPRETATION Patients awaiting spinal surgery experienced deterioration in health-related quality of life irrespective of the length of wait time. However, longer waits were associated with a delay in recovery during the first year after surgery.
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Affiliation(s)
- Christopher S Bailey
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - Kevin R Gurr
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - Stewart I Bailey
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - David Taylor
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - M Patricia Rosas-Arellano
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - Corinne Tallon
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - Yves Bureau
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
| | - Jennifer C Urquhart
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry (Bailey CS, Gurr, Bailey SI, Taylor), Western University; London Health Sciences Centre (Bailey CS, Gurr, Bailey SI, Taylor, Rosas-Arellano, Tallon, Urquhart); and Lawson Health Research Institute (Bailey CS, Rosas-Arellano, Tallon, Bureau, Urquhart), London, Ont
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Schmidt CT, Ward RE, Suri P, Kurlinski L, Anderson DE, Kiely DK, Bean JF. Health Characteristics, Neuromuscular Attributes, and Mobility Among Primary Care Patients With Symptomatic Lumbar Spinal Stenosis: A Secondary Analysis. J Geriatr Phys Ther 2016; 40:135-142. [PMID: 27007991 DOI: 10.1519/jpt.0000000000000085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE Mobility problems are common among older adults. Symptomatic lumbar spinal stenosis (SLSS) is a major contributor to mobility limitations among older primary care patients. In comparison with older primary care patients with mobility problems but without SLSS, it is unclear how mobility problems differ in older primary care patients with SLSS. The purpose of this study was to compare health characteristics, neuromuscular attributes, and mobility status in a sample of older primary care patients with and without SLSS who were at risk for mobility decline. We hypothesized that patients with SLSS will manifest poorer health and greater severity of neuromuscular impairments and mobility limitations. METHODS This is a secondary analysis of the Boston Rehabilitative Study of the Elderly (Boston RISE). Fifty community-dwelling primary care patients aged 65 years or older at risk for mobility decline met inclusion criteria. SLSS was determined on the basis of computerized tomography (CT) scan and self-reported symptoms characteristic of neurogenic claudication. Outcome measures included health characteristics, neuromuscular attributes (trunk endurance, limb strength, limb speed, limb strength asymmetry, ankle range of motion [ROM], knee ROM, kyphosis, sensory loss), and mobility (Late-Life Function and Disability Instrument: basic and advanced lower extremity function subscales, 400-meter walk test, habitual gait speed, and Short Physical Performance Battery score). Health characteristics were collected at a baseline assessment. Neuromuscular attributes and mobility status were measured at the annual visit closest to conducting the CT scan. RESULTS AND DISCUSSION Five participants met criteria for having SLSS. Differences are reported in medians and interquartile ranges. Participants with SLSS reported more global pain, a greater number of comorbid conditions [SLSS: 7.0 (2.0) vs no-SLSS: 4.0 (2.0), P < .001], and experienced greater limitation in knee ROM [SLSS: 115.0° (8.0°) vs no-SLSS: 126.0° (10.0°), P = .04] and advanced lower extremity function than those without SLSS.A limitation of this study was its small sample size and therefore inability to detect potential differences across additional measures of neuromuscular attributes and mobility. Despite the limitation, the differences in mobility for participants with SLSS may support physical therapists in designing interventions for older adults with SLSS. Participants with SLSS manifested greater mobility limitations that exceeded meaningful thresholds across all performance-based and self-reported measures. In addition, our study identified that differences in mobility extended beyond not just walking capacity but also across a variety of tasks that make up mobility for those with and without SLSS. CONCLUSION Among older primary care patients who are at risk for mobility decline, patients with SLSS had greater pain, higher levels of comorbidity, greater limitation in knee ROM, and greater limitations in mobility that surpassed meaningful thresholds. These findings can be useful when prioritizing interventions that target mobility for patients with SLSS.
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Affiliation(s)
- Catherine T Schmidt
- 1Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, Massachusetts. 2New England Geriatric Research Education and Clinical Center, GRECC, VA Boston Healthcare System, Boston, Massachusetts. 3Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts. 4Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington. 5Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Health Care System, Seattle, Washington. 6Department of Rehabilitation Medicine, University of Washington, Seattle. 7Center for Lifelong Health & Fitness, Spaulding Cambridge Outpatient Center, Cambridge, Massachusetts. 8Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 9Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts. 10Spaulding Rehabilitation Hospital, Boston, Massachusetts. 11Department of PM&R, Harvard Medical School, Boston, Massachusetts
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Knutsson B, Sandén B, Sjödén G, Järvholm B, Michaëlsson K. Body Mass Index and Risk for Clinical Lumbar Spinal Stenosis: A Cohort Study. Spine (Phila Pa 1976) 2015; 40:1451-6. [PMID: 26165225 DOI: 10.1097/brs.0000000000001038] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study that used a Swedish nationwide occupational surveillance program for construction workers (period of registration from 1971 to 1992). In all, 364,467 participants (mean age at baseline 34 yr) were included in the study. OBJECTIVE To determine whether overweight and obesity are associated with a higher risk of lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA During recent decades, LSS has become the most common indication for spine surgery, a change that coincides with a higher prevalence of obesity. METHODS A diagnosis of LSS was collected through individual linkage to the Swedish National Patient Register through December 31, 2011. Poisson regression models were employed to estimate multivariable-adjusted incidence rate ratios (IRRs) for LSS. RESULTS At baseline, 65% had normal weight (BMI [body mass index]: 18.5-24.99 kg/m), 29% were overweight (BMI: 25-29.99 kg/m), 5% were obese (BMI ≥30 kg/m), and 2% were underweight (BMI <18.5 kg/m). During 11,190,944 person-years of follow-up, with a mean of 31 years, 2381 participants were diagnosed with LSS. Compared with normal weight individuals, obese workers had an IRR of 2.18 (95% confidence interval, 1.87-2.53) for LSS and overweight workers had an IRR of 1.68 (95% confidence interval, 1.54-1.83). Workers who were underweight halved their risk of LSS (IRR: 0.52, 95% confidence interval, 0.30-0.90). CONCLUSION Obese and overweight persons are at a higher risk of developing LSS. Furthermore, our results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Björn Knutsson
- *Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden Department of †Surgical and Perioperative Science and ‡Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Jauregui JJ, Banerjee S, Issa K, Cherian JJ, Mont MA. Does Co-Existing Lumbar Spinal Canal Stenosis Impair Functional Outcomes and Activity Levels after Primary Total Hip Arthroplasty? J Arthroplasty 2015; 30:1569-73. [PMID: 25865814 DOI: 10.1016/j.arth.2015.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/02/2015] [Accepted: 03/16/2015] [Indexed: 02/01/2023] Open
Abstract
Degenerative lumbar spinal stenosis (LSS) is a cause for substantial morbidity in the elderly population: many often undergo total hip arthroplasty for associated hip arthritis. With a matched cohort we investigated the effect of co-existing LSS on aseptic survivorship, functional outcomes, activity levels, overall subjective physical and mental health status, and satisfaction rates in patients undergoing primary THA. The aseptic-implant survivorship was similar in LSS and non-stenosis cohort. Although both cohorts significantly improved, the LSS cohort achieved lower improvements in HHS, UCLA, SF-36 physical, and satisfaction rates than the matched non-stenotic cohort. Surgeons should consider cautioning patients with LSS that although they can expect relief of their arthritic symptoms following THA, they may continue to expect limitations in function, physical-status, activity-levels, and satisfaction rates.
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Affiliation(s)
- Julio J Jauregui
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Samik Banerjee
- Albany Medical College, Department of Orthopaedic Surgery, Albany, New York
| | - Kimona Issa
- Seton Hall University, Department of Orthopaedic Surgery, South Orange, New Jersey
| | - Jeffrey J Cherian
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Sobottke R, Herren C, Siewe J, Mannion AF, Röder C, Aghayev E. Predictors of improvement in quality of life and pain relief in lumbar spinal stenosis relative to patient age: a study based on the Spine Tango registry. 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 2015; 26:462-472. [PMID: 26138216 DOI: 10.1007/s00586-015-4078-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND An open decompression is the most common treatment for lumbar spinal canal stenosis (LSS), even in the elderly. However, it is not clear whether the treatment outcome is age dependent. The main purpose of this study was to evaluate the improvement in quality of life (QoL) and pain relief, after open decompression for LSS in relation to patient age. METHODS The study was performed on the basis of Spine Tango registry data. The database query resulted in 4768 patients from 40 international Spine Tango centres. The patients were subdivided into three age groups: (1) 20-64, (2) 65-74, and (3) ≥75 years. In multivariate logistic regression models, predictors for improvement in QoL and achievement of the minimum clinically relevant change in pain of two points were analysed. RESULTS All groups benefited from significant improvement in QoL and back and leg pain relief. Age group had no significant influence on the outcomes. The preoperative status of each outcome was a predictor for its own postoperative outcome. Fewer previous surgeries, rigid or dynamic stabilization, and lower patient comorbidity also had a partially predictive influence for one or the other outcome. CONCLUSIONS Our results confirm that all age groups significantly benefit from the open decompressive treatment of LSS. Age group had no significant influence on any outcome.
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Affiliation(s)
- Rolf Sobottke
- Department of Orthopaedic Surgery, Medizinisches Zentrum StädteRegion Aachen GmbH, Mauerfeldchen 25, 52146, Würselen, Germany.,Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924, Cologne, Germany
| | - Christian Herren
- Department for Trauma and Reconstructive Surgery, University Clinic RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jan Siewe
- Department of Orthopaedic and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Straße 9, 50924, Cologne, Germany
| | - Anne F Mannion
- Spine Centre Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Christoph Röder
- Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
| | - Emin Aghayev
- Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
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Marcia S, Hirsch JA, Chandra RV, Marras M, Piras E, Anselmetti GC, Muto M, Saba L. Midterm Clinical and Radiologic Outcomes after Percutaneous Interspinous Spacer Treatment for Neurogenic Intermittent Claudication. J Vasc Interv Radiol 2015; 26:1687-93.e1-2. [PMID: 26119203 DOI: 10.1016/j.jvir.2015.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 04/22/2015] [Accepted: 05/07/2015] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the midterm clinical and radiologic outcome of percutaneous interspinous process spacer (IPS) treatment for neurogenic intermittent claudication (NIC) in patients who fail conservative treatment. METHODS Consecutive patients with NIC, lumbar spinal stenosis confirmed on magnetic resonance imaging, failure of conservative management for at least 6 months, and treatment with percutaneous IPS were included. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at baseline, 1 month, 1 year and 3 years after treatment. Spinal canal and foraminal cross-sectional areas were calculated from multidetector computed tomography at baseline and 1 year. RESULTS There were 80 patients treated with 94 IPS devices; 83% of patients received a single IPS; 78% of IPS devices were placed at L4-L5. An IPS dislocation was the single periprocedural major complication. VAS score of 8.1 ± 2 before treatment was reduced to 4.4 ± 2 at 1 month after treatment (P = .0001); ODI score of 23.3 ± 10 before treatment was reduced to 11.7 ± 8.5 at 1 month after treatment (P = .0001). These significant reductions were durable at 1-year and 3-year follow-up evaluations (P < .01). Spinal canal and foraminal cross-sectional area increased by 15% at 1 year (P = .0001). CONCLUSIONS Patients with NIC who failed conservative treatment and were treated with percutaneous IPS achieved significant gains in pain relief and reduced disability that remained durable at 3-year clinical follow-up evaluation. This outcome was accompanied by significant increases in spinal canal and foraminal cross-sectional areas at the treated level.
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Affiliation(s)
- Stefano Marcia
- Department of Radiology, SS. Trinità Hospital, Cagliari, Italy
| | - Joshua A Hirsch
- Neuroendovascular Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronil V Chandra
- Neurovascular Surgery and Neuroradiology Services, Monash Health, Monash University, Melbourne, Australia
| | | | - Emanuele Piras
- Department of Radiology, SS. Trinità Hospital, Cagliari, Italy
| | | | - Mario Muto
- Department of Neuroradiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy.
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Sekiguchi M, Yonemoto K, Kakuma T, Nikaido T, Watanabe K, Kato K, Otani K, Yabuki S, Kikuchi SI, Konno SI. Relationship between lumbar spinal stenosis and psychosocial factors: a multicenter cross-sectional study (DISTO project). 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 2015; 24:2288-94. [DOI: 10.1007/s00586-015-4002-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/28/2022]
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Abstract
STUDY DESIGN Cross sectional analysis of patient-reported spine-related disability and comorbidity. OBJECTIVE To determine if nonorthopedic physical and psychological comorbidity are independently associated with self-reported spine-related disability in patients scheduled for spine surgery. SUMMARY OF BACKGROUND DATA The association between psychological comorbidity and spine-related disability is well known; less is known about the contribution of nonorthopedic physical comorbidity to patients' ratings of spine-related disability. METHODS Several days before surgery, 175 patients with cervical problems and 538 patients with lumbar problems completed the Neck Disability Index and the Oswestry Disability Index, respectively; scores range from 0% to 100%; higher scores reflect more disability. The Charlson Comorbidity Index, a standard index of weighted major physical comorbidity, was used to dichotomize patients according to no major physical comorbidity (Charlson Comorbidity Index=0) or any major physical comorbidity (Charlson Comorbidity Index≥1). Psychological comorbidity was measured for depressive symptoms and anxiety with validated scales. RESULTS Mean age of patients with cervical problems was 54 years, 60% were males, mean Neck Disability Index score was 44%, and 25% had major physical comorbidity. In multivariate analysis controlling for younger age (P<0.0001) and female sex (P<0.0001), more depressive symptoms (P=0.0003), and having major physical comorbidity (P=0.02) were associated with worse Neck Disability Index scores. Mean age of patients with lumbar problems was 56 years, 55% were males, mean Oswestry Disability Index score was 56%, and 30% had major physical comorbidity. In multivariate analysis controlling for younger age (P=0.36) and female sex (P=0.002), more depressive symptoms (P<0.0001), and having major physical comorbidity (P=0.03) were associated with worse Oswestry Disability Index scores. CONCLUSION Psychological comorbidity and nonorthopedic physical comorbidity measured by a standard index are associated with patient-reported spine-related disability in patients undergoing cervical and lumbar spine surgery. Given that disability is a major indicator for surgery, how psychological and physical comorbidity influence patients' assessment of spine-related disability merits further investigation. LEVEL OF EVIDENCE 2.
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE To identify cost-effective treatment strategies for lumbar spine degenerative diseases. SUMMARY OF BACKGROUND DATA There is a paucity of literature assisting physicians and society regarding the cost-efficiency of management of lumbar spine conditions. Limited articles on selective operative and nonoperative therapies have been published for a variety of lumbar conditions. METHODS A systematic search of PubMed, EMBASE, the Cochrane Collaboration data base, University of York, Centre for Reviews and Dissemination (National Health Services Economic Evaluation Database and health technology assessment), and the Tufts CEA Registry was conducted through December 16, 2013. Three specific questions were addressed for adult patients: (1) What is the evidence that surgery is cost-effective compared with nonsurgical management for lumbar degenerative spondylolisthesis or stenosis? (2) What is the evidence that fusion is cost-effective compared with no fusion for degenerative spondylolisthesis or stenosis? and (3) What is the evidence that instrumentation is cost-effective compared with none for degenerative spondylolisthesis? The Quality of Health Economic Studies instrument was used to provide an initial basis for critical appraisal of included economic studies. Articles were further refined with individual review based on inclusion/exclusion criteria. RESULTS Initial search resulted in 122 potentially relevant citations, 115 of which were excluded at title and abstract levels and 3 at full-text reviews, leaving 5 for analysis. No non-English language text met inclusion/exclusion criteria. All studies illustrated a clinical benefit of surgical treatment as measured by quality-adjusted life year (0.11-8.05). Surgical treatments had a greater financial cost than nonoperative care ($5883-$26,035). Incremental cost-effectiveness ratio calculations noted operative treatment over nonoperative treatment for spondylolisthesis ($59,487-$115,600) per quality-adjusted life year. However, cost for patients without spondylolisthesis varied greatly from nonoperative treat dominating to $77,600 per quality-adjusted life year favoring surgery. Because the articles had heterogeneous methods and patient population, conclusion differed greatly on cost assessment. CONCLUSION Limited quality data exist on cost-effective treatment of degenerative lumbar spinal conditions, despite more recent interest related to this topic. It is important that future research efforts focus on constructing higher quality trials in this area to help determine the most cost-effective care. LEVEL OF EVIDENCE 3.
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Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. Spine J 2014; 14:837-46. [PMID: 24417814 DOI: 10.1016/j.spinee.2013.09.052] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 09/12/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. PURPOSE The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS. STUDY DESIGN Best-evidence synthesis. PATIENT SAMPLE Patients receiving the diagnosis of LSS and surgery. METHODS A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review. RESULTS Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable. CONCLUSIONS Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.
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Rampersaud YR, Lewis SJ, Davey JR, Gandhi R, Mahomed NN. Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee--part 1: long-term change in health-related quality of life. Spine J 2014; 14:234-43. [PMID: 24325880 DOI: 10.1016/j.spinee.2013.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It is well accepted that total hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health-related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes with THA/TKA after surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome after LSS surgery compared with THA/TKA remains uncertain. PURPOSE The primary purpose of this study is to assess whether improvements in HRQoL after surgical management of focal lumbar spinal stenosis (FLSS) with or without spondylolisthesis are sustainable over the long term compared with that of THA/TKA for OA. STUDY DESIGN Single-center, retrospective, longitudinal matched cohort study of prospectively collected outcomes, with a minimum of 5-year follow-up (FU). PATIENT SAMPLE Patients who had primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary OA. OUTCOME MEASURES Postoperative change from baseline to last FU in Short-Form 36 physical component summary (PCS) and mental component summary (MCS) scores among groups was used as the primary outcome measure. METHODS An age, sex-matched inception cohort of primary one- to two-level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared with a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was used for the primary analysis. RESULTS Mean (percent) FUs in months were 80.5+16.04 (79%), 94.6+16.62 (92%), and 80.6+16.84 (85%) for the FLSS, THA, and TKA cohorts, respectively, with a range of 5 to 10 years for all three cohorts. The number of patients who have undergone revision including those lost to FU for the FLSS, THA, and TKA cohorts were n=20 (20.2%, same site [n=7] and adjacent segment [n=13]) requiring 27 operations, n=3 (3%, same site) requiring 5 operations, and n=8 (8.1%, same site) requiring 12 operations, respectively (p<.01). The average time to first revision was 56/65/43 months, respectively. Mean postoperative PCS (p<.0001) and MCS (p<.02) scores improved significantly and were durable for all groups at the last FU. The mean changes from baseline PCS/MCS scores to last FU were 8.5/6.4, 12.3/7.0, and 8.3/4.9 for FLSS, THA, and TKA, respectively. Adjusting for baseline age, sex, body mass index, PCS score, and MCS score, there was a strong trend in favor of greater sustained change in the PCS score of THA over FLSS (p=.07) and TKA (p=.08). No difference was noted for change in PCS score between FLSS and TKA (p=.95). No differences were noted for change in MCS score among all three cohorts (p>.1). CONCLUSIONS Significant improvements in HRQoL after surgical treatment of FLSS with or without spondylolisthesis and hip and knee OA are sustained for a mean of 7 to 8 years, with a minimum of 5-year FU. Despite a higher revision rate, patients undergoing surgery for FLSS can expect a comparable long-term average improvement in HRQoL from baseline compared with their peers undergoing TKA and to a lesser extent THA.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - J Roderick Davey
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8; Arthritis Program, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Rampersaud YR, Tso P, Walker KR, Lewis SJ, Davey JR, Mahomed NN, Coyte PC. Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 2--estimated lifetime incremental cost-utility ratios. Spine J 2014; 14:244-54. [PMID: 24239803 DOI: 10.1016/j.spinee.2013.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 08/22/2013] [Accepted: 11/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been widely accepted as highly cost-effective procedures, spine surgery for the treatment of degenerative conditions does not share the same perception among stakeholders. In particular, the sustainability of the outcome and cost-effectiveness following lumbar spinal stenosis (LSS) surgery compared with THA/TKA remain uncertain. PURPOSE The purpose of the study was to estimate the lifetime incremental cost-utility ratios for decompression and decompression with fusion for focal LSS versus THA and TKA for osteoarthritis (OA) from the perspective of the provincial health insurance system (predominantly from the hospital perspective) based on long-term health status data at a median of 5 years after surgical intervention. STUDY DESIGN/SETTING An incremental cost-utility analysis from a hospital perspective was based on a single-center, retrospective longitudinal matched cohort study of prospectively collected outcomes and retrospectively collected costs. PATIENT SAMPLE Patients who had undergone primary one- to two-level spinal decompression with or without fusion for focal LSS were compared with a matched cohort of patients who had undergone elective THA or TKA for primary OA. OUTCOME MEASURES Outcome measures included incremental cost-utility ratio (ICUR) ($/quality adjusted life year [QALY]) determined using perioperative costs (direct and indirect) and Short Form-6D (SF-6D) utility scores converted from the SF-36. METHODS Patient outcomes were collected using the SF-36 survey preoperatively and annually for a minimum of 5 years. Utility was modeled over the lifetime and QALYs were determined using the median 5-year health status data. The primary outcome measure, cost per QALY gained, was calculated by estimating the mean incremental lifetime costs and QALYs for each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses adjusting for +25% primary and revision surgery cost, +25% revision rate, upper and lower confidence interval utility score, variable inpatient rehabilitation rate for THA/TKA, and discounting at 5% were conducted to determine factors affecting the value of each type of surgery. RESULTS At a median of 5 years (4-7 years), follow-up and revision surgery data was attained for 85%-FLSS, 80%-THA, and 75%-THA of the cohorts. The 5-year ICURs were $21,702/QALY for THA; $28,595/QALY for TKA; $12,271/QALY for spinal decompression; and $35,897/QALY for spinal decompression with fusion. The estimated lifetime ICURs using the median 5-year follow-up data were $5,682/QALY for THA; $6,489/QALY for TKA; $2,994/QALY for spinal decompression; and $10,806/QALY for spinal decompression with fusion. The overall spine (decompression alone and decompression and fusion) ICUR was $5,617/QALY. The estimated best- and worst-case lifetime ICURs varied from $1,126/QALY for the best-case (spinal decompression) to $39,323/QALY for the worst case (spinal decompression with fusion). CONCLUSION Surgical management of primary OA of the spine, hip, and knee results in durable cost-utility ratios that are well below accepted thresholds for cost-effectiveness. Despite a significantly higher revision rate, the overall surgical management of FLSS for those who have failed medical management results in similar median 5-year and lifetime cost-utility compared with those of THA and TKA for the treatment of OA from the limited perspective of a public health insurance system.
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Affiliation(s)
- Y Raja Rampersaud
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8.
| | - Peggy Tso
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
| | - Kevin R Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
| | - Stephen J Lewis
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - J Roderick Davey
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - Nizar N Mahomed
- Department of Surgery, Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St. East Wing, 1-441, Toronto, ON, Canada M5T-2S8
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, Canada M5T 3M7
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Abstract
BACKGROUND Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. PURPOSE The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. DATA SOURCES Studies were searched on electronic databases to January 2012. STUDY SELECTION Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. DATA EXTRACTION Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. DATA SYNTHESIS Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight-supported treadmill walking have similar effects, and that corsets are better than no corsets. LIMITATIONS The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. CONCLUSIONS No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS.
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Kim KH, Kim TH, Lee BR, Kim JK, Son DW, Lee SW, Yang GY. Acupuncture for lumbar spinal stenosis: a systematic review and meta-analysis. Complement Ther Med 2013; 21:535-56. [PMID: 24050593 DOI: 10.1016/j.ctim.2013.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/13/2013] [Accepted: 08/11/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Lumbar spinal stenosis (LSS) negatively affects patients' quality of life. No systematic review evaluating the effects and safety of acupuncture for this population is available. We aimed to evaluate evidence indicating the effectiveness and safety of acupuncture for LSS. METHODS We searched five English-language databases (EMBASE, MEDLINE, CENTRAL, CINAHL, and AMED) and one Chinese database (CAJ) for randomised controlled trials (RCTs) and non-randomised controlled clinical trials (CCTs) of needle acupuncture for LSS. CCTs were analyzed only in terms of safety and intervention-related information. RESULTS Six RCTs (n=582) and six CCTs, which were all from China and reported in Chinese, were included. High or uncertain risk of bias and clinical heterogeneity due to different acupuncture techniques were observed. All RCTs compared different combinations or techniques of acupuncture. None of the included studies mentioned safety issues. Acupuncture combined with other interventions and/or with additional stimulation increased the number of improved patients compared with acupuncture alone or relatively simpler stimulation (n=582; relative risk, 1.16; 95% confidence interval 1.08-1.25). Pain intensity, overall symptoms, and functional outcomes related to LSS and quality of life showed significantly favourable improvement in the treatment group compared with the control group, which lasted for up to 6 months post-treatment. CONCLUSIONS We found no conclusive evidence of the effectiveness and safety of acupuncture for LSS because of high or uncertain risk of bias and the limited generalisability of the included studies. Future trials using rigorous methodology, appropriate comparisons and clinically relevant outcomes should be conducted.
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Affiliation(s)
- Kun Hyung Kim
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, South Korea; Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea
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Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVE To evaluate the diagnostic value of the sedimentation sign further by assessing its performance on the differential diagnosis of patients with lumbar spinal stenosis (LSS) and other lumbar conditions with similar clinical presentations. SUMMARY OF BACKGROUND DATA Recently, a new test using MR imaging, the sedimentation sign, was introduced to aid in the diagnosis of LSS. The initial testing demonstrated that the sign was positive in 100% of patients with LSS with decreased walking ability and dural sac cross-sectional areas (CSA) less than 80 mm, and negative in 94% of patients with nonspecific low back pain, no leg pain or claudication and dural sac CSA greater than 120 mm. METHODS Fifty patients with central or combined LSS, 22 with lateral stenosis only and 43 with posterolateral disc herniation with unilateral radiculopathy were included. Using axial MR images of the lumbar spine, the sedimentation sign was assessed by 2 observers independently, without knowledge of participant clinical history or diagnosis. Frequencies of a positive sign in each patient group were calculated. RESULTS The sedimentation sign was positive in 2% of patients with disc herniation, 23% with lateral stenosis, and 54% with central or combined stenosis. When the analysis included only patients with LSS with dural sac CSA less than 80 mm and walking limitations similar to the original study introducing the sedimentation sign (n = 17), the proportion of patients presenting with a positive sign increased to 82%. CONCLUSION The sedimentation sign is more prevalent in patients with the clinical diagnosis of central or combined LSS than in patients with lateral stenosis only or posterolateral disc herniation. Yet, whether it enhances current diagnostic practices remains undetermined.
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Abbas J, Hamoud K, May H, Peled N, Sarig R, Stein D, Alperovitch-Najemson D, Hershkovitz I. Socioeconomic and physical characteristics of individuals with degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 2013; 38:E554-61. [PMID: 24477055 DOI: 10.1097/brs.0b013e31828a2846] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). OBJECTIVE To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. SUMMARY OF BACKGROUND DATA Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. METHODS Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ tests were used to determine the association between parametric and nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. RESULTS Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. CONCLUSION Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS.
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Affiliation(s)
- Janan Abbas
- *Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel †Department of Physical Therapy, Zefat Academic College, Zefat, Israel ‡Department of Orthopedic Surgery, Poria Medical Center, Tiberias, Israel; and §Department of Radiology, Carmel Medical Center, Haifa, Israel
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Wong DA. Commentary: lessons and limitations of population-based research. Spine J 2012; 12:196. [PMID: 22469302 DOI: 10.1016/j.spinee.2012.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 02/26/2012] [Indexed: 02/03/2023]
Abstract
Battié MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189-95 (in this issue).
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