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Jiang G, Song J, Xu L, Guan J, Li Z, Feng N, Qiu Z, Ma Y, Qu Y, Xiong Y, Yang Y, Yu X. Mid-Term Outcomes of Screw Loosening in Lumbar Dynamic Stabilization with Polyetheretherketone Rods versus Titanium Rods: A Minimum 4-Year Follow-Up. World Neurosurg 2025; 196:123630. [PMID: 39938744 DOI: 10.1016/j.wneu.2024.123630] [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: 11/18/2024] [Revised: 12/20/2024] [Accepted: 12/21/2024] [Indexed: 02/14/2025]
Abstract
OBJECTIVE To retrospectively analyze screw loosening rates following dynamic fixation with polyetheretherketone (PEEK) rods and rigid fixation with titanium rods and assess mid-term outcomes of loosened screws. METHODS This retrospective analysis included 203 patients who underwent lumbar pedicle screw fixation between March 2017 and June 2020 (57 with PEEK rods, 146 with titanium rods). Patients were followed for at least 48 months to evaluate screw loosening postoperatively and investigate outcomes of loosened screws. Multivariate logistic regression identified factors influencing screw restabilization. RESULTS Both PEEK rod and titanium rod groups exhibited peak screw loosening rates approximately 1 year after surgery, decreasing with longer follow-up. At 48 months, screw loosening rates were 5.3% and 15.8% for PEEK and titanium rods, respectively (P < 0.05). Among patients experiencing early loosening (within 12 months), the proportion of stabilized screws was significantly higher with PEEK rods (84% vs. 34%, P < 0.001). Regression analysis revealed dynamic fixation (odds ratio 4.579; 95% confidence interval 1.611-12.519), lowest fixed vertebra S1 (odds ratio 3.151; 95% confidence interval 1.352-9.233), and L1-L4 average computed tomography value (odds ratio 1.132; 95% confidence interval 1.015-1.263) as independent risk factors for screw restabilization. The area under the receiver operating characteristic curve for L1-L4 average computed tomography value predicting restabilization was 0.713 (P < 0.05), with an optimal threshold of 106 Hounsfield units (sensitivity 0.771, specificity 0.803). CONCLUSIONS Following PEEK rod dynamic fixation surgery, a certain proportion of screw loosening may occur in the short term. With prolonged follow-up, screws gradually restabilize at the bone interface, with most loosened screws returning to a stable state.
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Affiliation(s)
- Guozheng Jiang
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Jiawei Song
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Luchun Xu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Jianbin Guan
- Department of Honghui-hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zeyu Li
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ningning Feng
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ziye Qiu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yukun Ma
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yi Qu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yang Xiong
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yongdong Yang
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xing Yu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China.
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Shahi P, Subramanian T, Maayan O, Singh N, Araghi K, Singh S, Asada T, Korsun M, Tuma O, Pajak A, Sheha E, Dowdell J, Qureshi SA, Iyer S. Outcomes of Minimally Invasive Decompression Alone Versus Fusion for Predominant Back Pain. HSS J 2025; 21:42-48. [PMID: 39564421 PMCID: PMC11572594 DOI: 10.1177/15563316231223503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/30/2023] [Indexed: 11/21/2024]
Abstract
Background Although a few recent studies showed good outcomes in back pain-predominant patients following decompression alone, none of the studies had a comparative fusion group. Purpose We sought to compare outcomes of minimally invasive decompression alone versus fusion in patients with predominant back pain. Methods This retrospective cohort study included patients who underwent minimally invasive decompression alone or fusion and had preoperative back pain > leg pain. Outcome measures were (1) patient-reported outcome measures (PROMs), (2) minimal clinically important difference (MCID) achievement, (3) patient acceptable symptom state (PASS) achievement, and (4) global rating change (GRC). As a subgroup analysis, MCID, PASS, and GRC rates were also compared between the decompression and fusion groups for patients with preoperative back pain < leg pain. Results Of 510 patients included, there were statistically significant improvements in all PROMs in both groups at <6 and >6 months with no significant difference in the magnitude of improvement. The fusion group showed significantly higher MCID achievement rates for Visual Analog Scale (VAS) back at <6 months (85% vs 70%) and Oswestry Disability Index (ODI) at >6 months (67% vs 51%). Proportion of patients achieving PASS and feeling better after surgery based on response to GRC showed no difference between the groups. The subgroup analysis for decompression versus fusion in patients with preoperative back pain < leg pain showed no differences in MCID, PASS, or GRC rates. Conclusions This retrospective cohort study found that in patients with predominant back pain, minimally invasive decompression alone had significantly less MCID achievement rates in VAS back at <6 months and ODI at >6 months. However, it did lead to an overall significant improvement in PROMs, similar PASS achievement rates, and similar responses on the GRC scale.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | | | - Olivia Tuma
- Hospital for Special Surgery, New York, NY, USA
| | | | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
| | | | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Jung CW, Soh J, Park JS, Park SJ, Lee CS, Kim HJ. Clinical and Radiologic Comparisons Between Oblique Lumbar Interbody Fusion Combined with Percutaneous Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for Adult Isthmic Spondylolisthesis: A 2-year Follow-Up Study. World Neurosurg 2025; 193:605-612. [PMID: 39426722 DOI: 10.1016/j.wneu.2024.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 10/09/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Adult isthmic spondylolisthesis (AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion (OLIF) is minimally invasive technique that uses a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion (TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiologic outcomes of these 2 surgical techniques for AIS. METHODS We analyzed the details of 62 patients with AIS who were treated with either OLIF (n = 26) or TLIF (n = 36) between 2019 and 2022, with a minimum 2-year follow-up. The 2 surgical techniques were compared in terms of perioperative surgical, radiologic, and clinical outcomes. The correlation between the severity of foraminal stenosis and clinical outcomes was evaluated. RESULTS The OLIF group experienced significantly less blood loss, shorter operative times, and shorter hospital stay than the TLIF group. Radiologic assessments showed no significant preoperative differences in disc height or slippage ratios, but postoperative slippage correction was significantly greater in the OLIF group than in the TLIF group (13.5 ± 8.0 vs. 5.0 ± 8.9; P < 0.001). The clinical outcome improvement ratios did not differ significantly between the 2 groups. The correlation between preoperative severity of foraminal stenosis and clinical outcomes in the OLIF group was not significant. CONCLUSIONS OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay, and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.
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Affiliation(s)
- Choong-Won Jung
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jaewan Soh
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri-si, South Korea
| | - Jin-Sung Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Se-Jun Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, South Korea
| | - Hyun-Jun Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri-si, South Korea
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Madrid-García A, Freites-Núñez D, Merino-Barbancho B, Pérez Sancristobal I, Rodríguez-Rodríguez L. Mapping two decades of research in rheumatology-specific journals: a topic modeling analysis with BERTopic. Ther Adv Musculoskelet Dis 2024; 16:1759720X241308037. [PMID: 39734395 PMCID: PMC11672599 DOI: 10.1177/1759720x241308037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 12/03/2024] [Indexed: 12/31/2024] Open
Abstract
Background Rheumatology has experienced notable changes in the last decades. New drugs, including biologic agents and Janus kinase (JAK) inhibitors, have blossomed. Concepts such as window of opportunity, arthralgia suspicious for progression, or difficult-to-treat rheumatoid arthritis (RA) have appeared; and new management approaches and strategies such as treat-to-target have become popular. Statistical learning methods, gene therapy, telemedicine, or precision medicine are other advancements that have gained relevance in the field. To better characterize the research landscape and advances in rheumatology, automatic and efficient approaches based on natural language processing (NLP) should be used. Objectives The objective of this study is to use topic modeling (TM) techniques to uncover key topics and trends in rheumatology research conducted in the last 23 years. Design Retrospective study. Methods This study analyzed 96,004 abstracts published between 2000 and December 31, 2023, drawn from 34 specialized rheumatology journals obtained from PubMed. BERTopic, a novel TM approach that considers semantic relationships among words and their context, was used to uncover topics. Up to 30 different models were trained. Based on the number of topics, outliers, and topic coherence score, two of them were finally selected, and the topics were manually labeled by two rheumatologists. Word clouds and hierarchical clustering visualizations were computed. Finally, hot and cold trends were identified using linear regression models. Results Abstracts were classified into 45 and 47 topics. The most frequent topics were RA, systemic lupus erythematosus, and osteoarthritis. Expected topics such as COVID-19 or JAK inhibitors were identified after conducting dynamic TM. Topics such as spinal surgery or bone fractures have gained relevance in recent years; however, antiphospholipid syndrome or septic arthritis have lost momentum. Conclusion Our study utilized advanced NLP techniques to analyze the rheumatology research landscape and identify key themes and emerging trends. The results highlight the dynamic and varied nature of rheumatology research, illustrating how interest in certain topics has shifted over time.
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Affiliation(s)
- Alfredo Madrid-García
- Grupo de Patología Musculoesquelética, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Prof. Martin Lagos s/n, Madrid 28040, Spain
| | - Dalifer Freites-Núñez
- Grupo de Patología Musculoesquelética, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Beatriz Merino-Barbancho
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Inés Pérez Sancristobal
- Grupo de Patología Musculoesquelética, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Luis Rodríguez-Rodríguez
- Grupo de Patología Musculoesquelética, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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Eriksson T, Tropp H, Wiréhn AB, Levin LÅ. A cost-reducing reimbursement programme? Effects of value-based reimbursement on healthcare costs. Front Public Health 2024; 12:1326067. [PMID: 39722715 PMCID: PMC11668751 DOI: 10.3389/fpubh.2024.1326067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/07/2024] [Indexed: 12/28/2024] Open
Abstract
Value-based reimbursement programmes have become increasingly common in attempts to bend the cost curve of healthcare without negative effects on quality. The aim of this study was to analyse the effect of introducing a value-based reimbursement programme on the cost to third-party payer. We performed a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement programme in Sweden. We analysed patient level cost data from inpatient and outpatient care of patients undergoing lumbar spine surgery, 2006-2015. The average 1-year episode cost decreased 11 percent during the first 2 years with the value-based reimbursement. The number of patients increased 22 percent during the same period, causing the total cost to increase by 8 percent. The value to third-party payer increased after the introduction of the value-based reimbursement since more patients were treated and attained a positive outcome. The decreased episode cost may be a result of better coordinated post-discharge care. Another explanation could be that costs previously borne by the third-party payer are shifted onto the healthcare providers. Thus, it is crucial that providers find a sustainable way of delivering care in the long term to retain value. Interlinking patient records facilitates a holistic perspective among healthcare providers raising awareness of health care utilization through the whole care chain.
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Affiliation(s)
- Thérèse Eriksson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Hans Tropp
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Ann-Britt Wiréhn
- Unit for strategic healthcare in Region Östergötland, Linköping, Sweden
| | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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Schnapp W, Schnapp M, Gottlieb J, Alexandre LC, Martiatu K, Delcroix GJR. Prospective cohort study of basivertebral nerve ablation for chronic low back pain in a real-world setting: 12 months follow-up. INTERVENTIONAL PAIN MEDICINE 2024; 3:100446. [PMID: 39655088 PMCID: PMC11626723 DOI: 10.1016/j.inpm.2024.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/30/2024] [Accepted: 11/02/2024] [Indexed: 12/12/2024]
Abstract
Background The basivertebral nerve, which densely supplies the vertebral endplates, is a potential source of chronic low back pain transmission in patients with Modic changes. Basivertebral nerve ablation (BVNA), a minimally invasive procedure, aims to disrupt this pain signaling. Objectives In this study, we investigated BVNA's effectiveness in treatment of vertebrogenic low back pain and we followed patients for 12 months to assess long-term effectiveness. Study design Single group prospective cohort study (ClinicalTrials.gov NCT05692440). Setting Single-center, community private practice. Methods Thirty-five patients were treated with the INTRACEPT® device (Boston Scientific, MA, USA). Thirty-one patients completed Oswestry Disability Index (ODI), Visual Analog Scale (VAS), SF-36 Physical Component Summary (PCS), and SF-36 Mental Component Summary (MCS) at baseline and follow-up visits up to 12 months. Results The average age of the 31 patients was 73.0 ± 6.34 years and 71.0 % of the population was male (N=22)) at baseline. All four self-reported outcomes (ODI, VAS, SF-36 PCS, and MCS) showed statistically and clinically significant improvements from baseline through 12 months (all p < 0.001, with the exception of the SF-36 MCS at 1 month, p = 0.165). Overall, 67.7 % of patients demonstrated ODI improvements above the minimal clinically important difference (decrease of at least 15 points) and 77.4 % of patients demonstrated a decrease on the VAS above the minimal clinically important difference (≥2 cm reduction) at 12 months. Limitations Limitations of the study include the lack of a control group and potentially unintentional bias in patient selection. Conclusions BVNA demonstrates potential as an effective and minimally invasive treatment for chronic low back pain in a real-world patient cohort where substantial improvements were observed. These results align with those seen in previous randomized controlled trials (RCTs) and industry-funded studies of BVNA.
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Affiliation(s)
| | | | - Jonathan Gottlieb
- NeuroSpine & Pain Center, Key West, FL, USA
- Minimally Invasive Spine Center of South Florida, Miami, FL, USA
| | - Lucien C. Alexandre
- NeuroSpine & Pain Center, Key West, FL, USA
- Minimally Invasive Spine Center of South Florida, Miami, FL, USA
| | | | - Gaëtan J.-R. Delcroix
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Neuroscience Associates, Key West, FL, USA
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Tarawneh OH, Narayanan R, Trenchfield D, Lee Y, Issa TZ, Dulitzki Y, Pashaee B, Maddy K, Bash H, Karthikeyan G, Kaye LD, Mangan JJ, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Lee JK. Impact of Preoperative Intervertebral Disc Degeneration on Patient-Reported Outcome Measures After Lumbar Fusion. World Neurosurg 2024; 189:e787-e793. [PMID: 38977129 DOI: 10.1016/j.wneu.2024.07.006] [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: 06/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE The Pfirrmann scoring system classifies lumbosacral disc degeneration based on magnetic resonance imaging signal intensity. The relationship between pre-existing disc degeneration and patient-reported outcome measures (PROMs) after one-level lumbar fusion is not well documented. The purpose of this study was to investigate the relationship between the severity of preoperative intervertebral disc degeneration and preoperative and postoperative PROMs in patients undergoing one-level lumbar fusion. METHODS All adult patients who underwent posterior lumbar decompression and fusion or transforaminal lumbar interbody fusion between 2014 and 2022 were included. Patient demographics and comorbidities were extracted from medical records. Lumbar intervertebral discs on sagittal magnetic resonance imaging T2-weighted images were assessed by 2 independent graders utilizing Pfirrmann criteria. Grades I-III were categorized as low-grade disc degeneration, while IV-V were considered high grade. Multivariable linear regression assessed the impact of disc degeneration on PROMs. RESULTS A total of 150 patients were included, of which 69 (46%) had low-grade disc degeneration, while 81 (54%) had high-grade degeneration. Patients with high-grade degeneration had increased preoperative visual analog scale (VAS)-Leg scores (6.10 vs. 4.54, P = 0.005) and displayed greater 1-year postoperative improvements in VAS-Back scores (-2.11 vs. -0.66, P = 0.002). Multivariable regression demonstrated Pfirrmann scores as independent predictors for both preoperative VAS-Leg scores (P = 0.004) and postoperative VAS-Back improvement (P = 0.005). CONCLUSIONS In patients undergoing one-level lumbar fusion, higher Pfirmann scores were associated with increased preoperative leg pain and greater 1-year postoperative improvement in back pain. Further studies into the relationship of preoperative disc degeneration and their impact on postoperative outcomes may help guide clinical decision-making and patient expectations.
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Affiliation(s)
- Omar H Tarawneh
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Delano Trenchfield
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoni Dulitzki
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bahram Pashaee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Krisna Maddy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hannah Bash
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gokul Karthikeyan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lan David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John J Mangan
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph K Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wu Y, Wulf Hanson S, Culbreth G, Purcell C, Brooks P, Kopec J, March L, Woolf AD, Pasovic M, Hamilton E, Santomauro D, Vos T. Assessing the impact of health-care access on the severity of low back pain by country: a case study within the GBD framework. THE LANCET. RHEUMATOLOGY 2024; 6:e598-e606. [PMID: 39029487 PMCID: PMC11333387 DOI: 10.1016/s2665-9913(24)00151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. Low back pain is the leading cause of disability in terms of years lived with disability (YLDs). Due to sparse data, a current limitation of GDB is that a uniform severity distribution is presumed based on 12-Item Short Form Health Survey scores derived from US Medical Expenditure Panel Surveys (MEPS). We present a novel approach to estimate the effect of exposure to health interventions on the severity of low back pain by country and over time. METHODS We extracted treatment effects for ten low back pain interventions from the Cochrane Database, combining these with coverage data from the MEPS to estimate the hypothetical severity in the absence of treatment in the USA. Severity across countries was then graded using the Health Access and Quality Index, allowing estimates of averted and avoidable burden under various treatment scenarios. FINDINGS We included 210 trials from 36 Cochrane systematic reviews in the network analysis. The pooled effect sizes (measured as a standardised mean difference) for the most effective intervention classes were -0·460 (95% uncertainty interval -0·606 to -0·309) for a combination of psychological and physical interventions and -0·366 (-0·525 to -0·207) for surgery. Globally, access to treatment averted an estimated 17·6% (14·8 to 23·8) of the low back pain burden in 2020. If all countries had provided access to treatment at a level estimated for Iceland with the highest Health Access and Quality Index score, an extra 9·1% (6·4 to 11·2) of the burden of low back pain could be avoided. Even with full coverage of optimal treatment, a large proportion (65·9% [56·9 to 70·4]) of the low back pain burden is unavoidable. INTERPRETATION This methodology fills an important shortcoming in the GBD by accounting for low back pain severity variations over time and between countries. Assumptions of unequal treatment access increased YLD estimates in resource-poor settings, with a modest decrease in countries with higher Health Access and Quality Index scores. Nonetheless, the large proportion of unavoidable burden indicates poor intervention efficacy. This method, applicable to other GBD conditions, provides policy makers with insights into health gains from improved treatment and underscores the importance of investing in research for new interventions. FUNDING Bill and Melinda Gates Foundation and Queensland Health.
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Affiliation(s)
- YiFan Wu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Garland Culbreth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Purcell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, VIC, Australia; College of Health and Medicine, University of Tasmania, Hobart, TAS Australia
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lyn March
- Rheumatology and Musculosketal Epidemiology Medicine, Northern Clinical School, Sydney, NSW, Australia
| | | | - Maja Pasovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian Santomauro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Kowalski KL, Mistry J, Beilin A, Goodman M, Lukacs MJ, Rushton A. Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures. PLoS One 2024; 19:e0307004. [PMID: 39208263 PMCID: PMC11361614 DOI: 10.1371/journal.pone.0307004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND International agreement supports physical functioning as a key domain to measure interventions effectiveness for low back pain. Patient reported outcome measures (PROMs) are commonly used in the lumbar spinal surgery population but physical functioning is multidimensional and necessitates evaluation also with physical measures. OBJECTIVE 1) To identify outcome measures (PROMs and physical) used to evaluate physical functioning in the lumbar spinal surgery population. 2) To assess measurement properties and describe the feasibility and interpretability of physical measures of physical functioning in this population. STUDY DESIGN Two-staged systematic review and narrative synthesis. METHODS This systematic review was conducted according to a registered and published protocol. Two stages of searching were conducted in MEDLINE, EMBASE, Health & Psychosocial Instruments, CINAHL, Web of Science, PEDro and ProQuest Dissertations & Theses. Stage one included studies to identify physical functioning outcome measures (PROMs and physical) in the lumbar spinal surgery population. Stage two (inception to 10 July 2023) included studies assessing measurement properties of stage one physical measures. Two independent reviewers determined study eligibility, extracted data and assessed risk of bias (RoB) according to COSMIN guidelines. Measurement properties were rated according to COSMIN criteria. Level of evidence was determined using a modified GRADE approach. RESULTS Stage one included 1,101 reports using PROMs (n = 70 established in literature, n = 67 developed by study authors) and physical measures (n = 134). Stage two included 43 articles assessing measurement properties of 34 physical measures. Moderate-level evidence supported sufficient responsiveness of 1-minute stair climb and 50-foot walk tests, insufficient responsiveness of 5-minute walk and sufficient reliability of distance walked during the 6-minute walk. Very low/low-level evidence limits further understanding. CONCLUSIONS Many physical measures of physical functioning are used in lumbar spinal surgery populations. Few have investigations of measurement properties. Strongest evidence supports responsiveness of 1-minute stair climb and 50-foot walk tests and reliability of distance walked during the 6-minute walk. Further recommendations cannot be made because of very low/low-level evidence. Results highlight promise for a range of measures, but prospective, low RoB studies are required.
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Affiliation(s)
- Katie L. Kowalski
- School of Physical Therapy, Western University, London, Ontario, Canada
- Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Jai Mistry
- School of Physical Therapy, Western University, London, Ontario, Canada
- Physiotherapy, St George’s Hospital, London, United Kingdom
| | - Anthony Beilin
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Maren Goodman
- Western Libraries, Western University, London, Ontario, Canada
| | - Michael J. Lukacs
- School of Physical Therapy, Western University, London, Ontario, Canada
- Physiotherapy Department, London Health Sciences Centre, London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
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10
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Wu CY, Chou LW, Huang SW, Liao WL, Chang SM, Lee HC, Chiu CD, Tang CH, Hsieh CL. Effects of Fu's Subcutaneous Needling on Postoperative Pain in Patients Receiving Surgery for Degenerative Lumbar Spinal Disorders: A Single-Blind, Randomized Controlled Trial. J Pain Res 2024; 17:2325-2339. [PMID: 38974828 PMCID: PMC11227350 DOI: 10.2147/jpr.s465417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Background Fu's subcutaneous needling (FSN) is a novel acupuncture technique for pain treatment. This study investigated the effects of postsurgical FSN on postoperative pain in patients receiving surgery for degenerative spinal disorders. Methods This single-center, single-blind, randomized-controlled study involved patients undergoing surgery for degenerative spinal disorders. Participants were randomized into either an FSN group or a control group that received sham FSN. The primary outcomes were scores on the Brief Pain Inventory Taiwan version (BPI-T) and Oswestry Disability Index before and at 1, 24, and 48 hours after surgery. Secondary outcomes were muscle hardness, pethidine use, and inflammatory biomarker presence. Results Initially, 51 patients met the inclusion criteria and were allocated (26 in the FSN group and 25 in the control group). Two patients were lost to follow-up, and finally, 49 patients (25 in the FSN group and 24 in the control group) who completed the study were analyzed. The FSN group had significantly lower pain intensity measured on the BPI-T compared with the control group at 1, 24, 48, and 72 hours after surgical treatment (all p < 0.001). Additionally, pain interference as measured on the BPI-T was lower in the FSN group than in the control group 1 hour (p = 0.001), 24 hours (p = 0.018), 48 hours (p = 0.001), and 72 hours (p = 0.017) after surgical treatment. Finally, the FSN group exhibited less muscle hardness in the latissimus dorsi and gluteus maximus 24, 48, and 72 hours (all p < 0.05) after surgery compared with the control group; patients in the FSN group also exhibited less muscle hardness in the L3 paraspinal muscle 48 hours (p = 0.001) and 72 hours (p < 0.001) after surgery compared with the control group. There were no significant differences in serum CRP, IL-1β, IL-2, IL-6, and TNF-α levels between the FSN and control groups at 24 hours, 72 hours, and 1-month post-surgery (all p > 0.05). Conclusion FSN treatment can reduce postoperative pain in patients receiving surgery for degenerative spinal disorders. However, larger sample sizes and multicenter clinical trials are required to verify these findings.
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Affiliation(s)
- Chih-Ying Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Shih-Wei Huang
- Department of Traditional Chinese Medicine, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shiaw-Meng Chang
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Han-Chung Lee
- Neuroscience center, Everan Hospital, Taichung, Taiwan
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Spine Center, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Ching-Liang Hsieh
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
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11
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Mizoguchi Y, Akasaka K, Suzuki K, Kimura F, Hall T, Ogihara S. Construct validation of the Japanese Core Outcome Measures Index and the impact of diseases on patient-reported outcome measures in preoperative patients with lumbar spinal stenosis and disk herniation: a single-center observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2198-2205. [PMID: 38679673 DOI: 10.1007/s00586-024-08148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The primary objective was to validate the construct validity of the Japanese Core Outcome Measures Index (COMI) in preoperative patients aged 60 years or older undergoing lumbar spine surgery for lumbar spinal stenosis (LSS) and lumbar disk herniation (LDH). Additionally, as a secondary aim, we explored the impact of these diseases on quality of life (QOL). METHODS The analysis included 199 preoperative patients aged 60 and above who were scheduled for lumbar spine surgery. To assess QOL, Japanese versions of the COMI, Oswestry Disability Index (ODI), EuroQol-5 Dimension-3 Level (EQ-5D-3L), and SF-12v2 were employed. The study assessed the validity of the COMI and compared demographic and clinical characteristics between the LSS (147 cases) and LDH (52 cases) groups. It used multivariate covariance analysis (MANCOVA) to examine the impact of diseases (LSS and LDH) on each patient-reported outcome measure while considering covariates. RESULTS Compared to the LSS group, the LDH group showed more difficulty with the COMI summary score (LSS/LDH [mean]: 6.9/8.1, p < 0.001), ODI score (46.8/57.4, p < 0.001), and EQ-5D utility (0.53/0.43, p < 0.001). The LDH group also reported more difficulties in the COMI-function, COMI-symptom-specific well-being, COMI-disability, ODI-personal care, ODI-social life, and SF-12v2-bodily pain subscales. MANCOVA demonstrated that these results were not influenced by covariates such as gender and medical history. CONCLUSIONS This study highlights the distinct impact of LSS and LDH on preoperative QOL in older patients undergoing lumbar spinal surgery. Tailored interventions are essential to address the specific challenges posed by these conditions and improve patient-centered outcomes and postoperative recovery.
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Affiliation(s)
- Yasuaki Mizoguchi
- Saitama Medical University Graduate School of Medicine, 981 Kawakado, Moroyama, Iruma, Saitama, 3500496, Japan
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Kiyokazu Akasaka
- Saitama Medical University Graduate School of Medicine, 981 Kawakado, Moroyama, Iruma, Saitama, 3500496, Japan.
| | - Kenta Suzuki
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Fumihiko Kimura
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 3508550, Japan
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12
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Papoli AF, Hosseini SM, Mirkarimpour SH. Effects of different treatments on pain, functional disability, position sense and range of motion in elite bodybuilders with chronic low back pain. Sci Rep 2024; 14:9176. [PMID: 38649771 PMCID: PMC11035542 DOI: 10.1038/s41598-024-59684-2] [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: 01/05/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
Back pain is one of the major global challenges and is one of the most prevalent musculoskeletal disorders occurring in 80% of people at least once in their lifetime. Therefore, the need to find appropriate treatment methods for this issue is very important. The objective is to examine the short-term and acute effects of a treatment session with dry needling, massage therapy, stretching exercises and Kinesio tape on pain, functional disability, position sense and range of motion in elite bodybuilders with non-specific chronic low back pain. The sample of this quasi-experimental study consisted of 48 bodybuilders with non-specific chronic low back pain (all male, mean age = 25.96 ± 2.18 years; mean weight = 74.45 ± 4.51 kg; mean height = 173.88 ± 3.74 cm; mean BMI = 24.60 ± 0.74 kg/m2) who randomly were placed in 4 dry needling, massage therapy, stretching exercises and Kinesio tape groups. The duration of each intervention was 30 min. The dependent variables in this study included the massage range of motion, position sense tests and visual pain scale that were taken separately from each subject in pretest, posttest (acute effect) and follow-up test (72 h after posttest; short-term effect). The results of a 4 (groups) × 3 (time) the mixed ANOVAs showed that pain in the short-term phase was significantly lower in the dry needling group than in the stretching and massage groups (P < 0.05). Also in the acute effect phase, the flexion range of motion was significantly lower in the dry needling group than in the massage group (P < 0.05). Furthermore, the two groups of stretching and massage exercises showed significantly greater range of motion (P < 0.05). Other comparisons were not significant (P > 0.05). The findings of the study showed that both massage and stretching treatment have higher acute effects, while dry needling treatment was more effective in follow up. On the other hand, these findings show that these treatment methods can have immediate and lasting positive effects in improving the performance in elite bodybuilders with non-specific chronic low back pain.
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Affiliation(s)
- Amirmohammad Faal Papoli
- Department of Physical Education and Sport Sciences, Faculty of Literature, Humanities and Social Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mohammad Hosseini
- Department of Sport Rehabilitation and Health, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran.
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13
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Schubiner H, Lowry WJ, Heule M, Ashar YK, Lim M, Mekaru S, Kitts T, Lumley MA. Application of a Clinical Approach to Diagnosing Primary Pain: Prevalence and Correlates of Primary Back and Neck Pain in a Community Physiatry Clinic. THE JOURNAL OF PAIN 2024; 25:672-681. [PMID: 37777033 DOI: 10.1016/j.jpain.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/17/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
Chronic back or neck pain (CBNP) can be primary (nociplastic or neuroplastic; without clear peripheral etiology) or secondary (to nociceptive or neuropathic causes). Expanding on available models of nociplastic pain, we developed a clinic-ready approach to diagnose primary/nociplastic pain: first, a standard physical exam and review of imaging to rule out secondary pain; and second, a detailed history of symptom presentation to rule in primary pain. We trained a physician who evaluated 222 patients (73.9% female, age M = 59.6) with CBNP; patients separately completed pain and psychosocial questionnaires. We estimated the prevalence of primary CBNP and explored biomedical, imaging, and psychological correlates of primary CBNP. Although almost all patients (97.7%) had at least 1 spinal anomaly on imaging, the diagnostic approach estimated that 88.3% of patients had primary pain, 5.0% had secondary pain, and 6.8% had mixed pain. Patients with primary pain were more likely than the other 2 groups of patients (combined as "non-primary pain") to report certain functional conditions, central sensitization, and features such as sensitivity to light touch, spreading pain, and pain worsening with stress; however, no difference was detected in depression, anxiety, and pain catastrophizing between those with primary and nonprimary pain. These findings are consistent with prior estimates that 85 to 90% of CBNP is "nonspecific." Further research is needed to validate and perhaps refine this diagnostic approach, which holds the potential for better outcomes if patients are offered treatments targeted to primary pain, such as pain neuroscience education and several emerging psychological therapies. PERSPECTIVE: We developed an approach to diagnose chronic primary pain, which was applied in a physiatry clinic to 222 patients with CBNP. Most patients (88.3%) had primary pain, despite almost universal anomalies on spinal imaging. This diagnostic approach can guide educational and psychological treatments tailored for primary pain.
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Affiliation(s)
- Howard Schubiner
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
| | | | - Marjorie Heule
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Yoni K Ashar
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Lim
- Department of Psychiatry, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Steven Mekaru
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Torran Kitts
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
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14
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Abu-Zahra MS, Mayfield CK, Thompson AA, Garcia O, Bashrum B, Hwang NM, Liu JN, Petrigliano FA, Alluri RK. Evaluation of Spin in Systematic Reviews and Meta-Analyses of Minimally Invasive Surgical Techniques and Standard Microdiscectomies for Treating Lumbar Disc Herniation. Global Spine J 2024; 14:731-739. [PMID: 37268297 PMCID: PMC10802545 DOI: 10.1177/21925682231181873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Spin in scientific literature is defined as bias that overstates efficacy and/or underestimates harms of procedures undergoing review. While lumbar microdiscectomies (MD) are considered the gold standard for treating lumbar disc herniations (LDH), outcomes of novel procedures are being weighed against open MD. This study identifies the quantity and type of spin in systematic reviews and meta-analyses of LDH interventions. METHODS A search was conducted on the PubMed, Scopus, and SPORTDiscus databases for systematic reviews and meta-analyses evaluating the outcomes of MD against other LDH interventions. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS All 34 included studies were observed to have at least 1 form of spin, in either the abstract or full text. The most common type of spin identified was type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies"), which was observed in ten studies (10/34, 29.4%). There was a statistically significant association between studies not registered with PROSPERO and the failure to satisfy AMSTAR type 2 (P < .0001). CONCLUSION Misleading reporting is the most common category of spin in literature related to LDH. Spin overwhelmingly tends to go in the positive direction, with results inappropriately favoring the efficacy or safety of an experimental intervention.
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Affiliation(s)
- Maya S. Abu-Zahra
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Cory K. Mayfield
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ashley A. Thompson
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Oswaldo Garcia
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Bryan Bashrum
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - N. Mina Hwang
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Joseph N. Liu
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
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15
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Zhang W, Wang G, Xie R, Zhan J, Zhu L, Wan C, Xie H, Cai C, Du Y. Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1265040. [PMID: 38020108 PMCID: PMC10663407 DOI: 10.3389/fmed.2023.1265040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Traditional Chinese exercises (TCEs) have played a significant role in treating various diseases. However, there is limited research assessing the efficacy of TCEs in treating Lumbar disc herniation (LDH). This study aimed to systematically evaluate the effects of four commonly used TCEs (Baduanjin, Yijinjing, Taichi, and Wuqinxi) on pain and disability in elderly patients with LDH. Objectives To assess the quality of relevant randomized controlled trials (RCTs) to provide evidence support for the treatment of LDH. Methods RCTs were identified through eight databases. Meta-analysis and trial sequence analysis (TSA) were conducted using RevMan 5.4, Stata 17.0, and TSA 0.9. Results A total of 22 RCTs, involving 1931 patients, were included in the analysis. TCEs exhibited a superior effectiveness in treating LDH compared to the control group. However, the TSA analysis suggested the possibility of false positives, indicating the need for more high-quality RCT evidence. Nevertheless, TCEs showed reliable results in significantly improving the VAS score and JOA score of LDH patients. Conclusion Current evidence indicates that the four TCEs have advantages in treating LDH in middle-aged and elderly individuals. However, considering the limitations of this study, we need to exercise caution in drawing conclusions, and further research is required to validate these findings. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023431633].
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Affiliation(s)
- Weiye Zhang
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gewen Wang
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rong Xie
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiawen Zhan
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Beijing, China
| | - Liguo Zhu
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Beijing, China
- Second Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunyou Wan
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Hualong Xie
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chuhao Cai
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuxuan Du
- Third Department of Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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16
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Shahzad H, Lee M, Munjal V, Veliky C, Yu E. Unlocking the Healing Potential: Cannabinoids in Spine Surgery for Pain Relief and Recovery. JBJS Rev 2023; 11:01874474-202311000-00004. [PMID: 37972215 DOI: 10.2106/jbjs.rvw.23.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
» Cannabinoids, such as D9-tetrahydrocannabinol and cannabidiol, interact with endocannabinoid receptors in the central nervous system and immune system, potentially offering pain relief. The entourage effect, resulting from the interaction of multiple cannabis components, may enhance therapeutic impact and efficacy, making them promising candidates for exploring pain relief in spine operations, known to be among the most painful operative procedures.» The use of cannabinoids in pain management requires careful consideration of safety, including their cognitive and psychomotor effects, potential cardiovascular risks, risk of dependence, mental health implications, and drug interactions.» Few studies have analyzed cannabinoid use in relation to spine surgery, with variable results reported, indicating possible effects on reoperation rates, mortality, complications, postoperative opioid use, and length of hospital stay.» Current knowledge gaps exist in the understanding of cannabinoid effects on spine surgery, including the exploration of different administration routes, timing, dosage, and specific outcomes. In addition, mechanistic explanations for the observed results are lacking.» Ethical considerations related to informed consent, medical expertise, societal impact, and legal compliance must also be thoroughly addressed when considering the utilization of cannabinoids in spinal pathologies and back pain treatment.
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Affiliation(s)
- Hania Shahzad
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Schonfeld E, Johnstone TM, Haider G, Shah A, Marianayagam NJ, Biswal S, Veeravagu A. Sigma-1 receptor expression in a subpopulation of lumbar spinal cord microglia in response to peripheral nerve injury. Sci Rep 2023; 13:14762. [PMID: 37679500 PMCID: PMC10484902 DOI: 10.1038/s41598-023-42063-8] [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: 05/27/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023] Open
Abstract
Sigma-1 Receptor has been shown to localize to sites of peripheral nerve injury and back pain. Radioligand probes have been developed to localize Sigma-1 Receptor and thus image pain source. However, in non-pain conditions, Sigma-1 Receptor expression has also been demonstrated in the central nervous system and dorsal root ganglion. This work aimed to study Sigma-1 Receptor expression in a microglial cell population in the lumbar spine following peripheral nerve injury. A publicly available transcriptomic dataset of 102,691 L4/5 mouse microglial cells from a sciatic-sural nerve spared nerve injury model and 93,027 age and sex matched cells from a sham model was used. At each of three time points-postoperative day 3, postoperative day 14, and postoperative month 5-gene expression data was recorded for both spared nerve injury and Sham cell groups. For all cells, 27,998 genes were sequenced. All cells were clustered into 12 distinct subclusters and gene set enrichment pathway analysis was performed. For both the spared nerve injury and Sham groups, Sigma-1 Receptor expression significantly decreased at each time point following surgery. At the 5-month postoperative time point, only one of twelve subclusters showed significantly increased Sigma-1 Receptor expression in spared nerve injury cells as compared to Sham cells (p = 0.0064). Pathway analysis of this cluster showed a significantly increased expression of the inflammatory response pathway in the spared nerve injury cells relative to Sham cells at the 5-month time point (p = 6.74e-05). A distinct subcluster of L4/5 microglia was identified which overexpress Sigma-1 Receptor following peripheral nerve injury consistent with neuropathic pain inflammatory response functioning. This indicates that upregulated Sigma-1 Receptor in the central nervous system characterizes post-acute peripheral nerve injury and may be further developed for clinical use in the differentiation between low back pain secondary to peripheral nerve injury and low back pain not associated with peripheral nerve injury in cases where the pain cannot be localized.
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Affiliation(s)
- Ethan Schonfeld
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA.
| | - Thomas Michael Johnstone
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA
| | - Ghani Haider
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA
| | - Aaryan Shah
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA
| | - Neelan Joseph Marianayagam
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Veeravagu
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
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Mishra S, Regmi S, Garg K. Effect of Lumbar Discectomy or Lumbar Decompression on Axial Back Pain: Results of a Meta-Analysis. World Neurosurg 2023; 177:109-121. [PMID: 37355169 DOI: 10.1016/j.wneu.2023.06.064] [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: 03/26/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE This meta-analysis evaluated the impact of lumbar disk herniation and lumbar spinal stenosis (LSS) on axial back pain and the extent of improvement of axial and radicular pain following lumbar decompression and discectomy surgery in patients with low back pain (LBP). METHODS A systematic search for published literature between January 2012 and January 2023 was made on PubMed, Google Scholar, and Cochrane library database on 31st January 2023. Original articles that included patients with lumbar disc herniation or LSS who underwent lumbar discectomy or lumbar decompression respectively were included in the study. RESULTS A total of 71 studies including 16,770 patients with LBP undergoing lumbar discectomy or decompression surgery were included in the meta-analysis. The pooled standard mean difference between postoperative and preoperative: Visual Analog Scale scores for leg pain was -5.14 with 95% confidence interval (CI): -6.59 to -3.69 (P-value = 0) and for back pain was -2.90 with 95% CI: -3.79 to -2.01 (P value = 0), Numerical pain Rating Scale for leg pain was -1.64 with 95% CI: -1.97 to -1.30 (P-value<0.01) and for back pain was -1.58 with 95% CI: -1.84 to -1.32 (P-value <0.01), Oswerty Disability Index score was -4.76 with 95% CI: -6.22 to -3.29 (P-value = 0) and the Japanese Orthopaedic Association score was 3.45 with 95% CI: 0.02 to 6.88 (P value 0) at follow-up. CONCLUSIONS This meta-analysis provides evidence that lumbar discectomy and decompression are effective in improving axial LBP in patients with lumbar disk herniation and LSS.
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Affiliation(s)
- Sandeep Mishra
- Department of Neurosurgery, Lok Nayak Hospital, New Delhi, India
| | - Sabina Regmi
- Department of Neuroanaesthesia and Critical Care, Lok Nayak Hospital, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Bansal P, Vatkar AJ, Baburaj V, Kumar V, Dhatt SS. Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5589-5601. [PMID: 37041263 DOI: 10.1007/s00402-023-04870-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Lumbar disc herniation in obese individuals poses unique surgical challenges which can influence outcomes in such patients. Limited studies are available evaluating the results of discectomy in obese persons. The aim of this review was to compare outcomes in obese and non-obese individuals; and to analyse whether approach to surgery had a bearing on these outcomes. METHODS The literature search was conducted on four databases (PubMed, Medline, EMBASE, and CINAHL) and PRISMA guidelines were followed. After screening by the authors, eight studies were shortlisted from which data were extracted and analysed. Comparative analysis was done for lumbar discectomy (microdiscectomy or minimally invasive vs. endoscopic technique) between obese and non-obese groups from the six comparative studies in our review. Pooled estimates and subgroup analysis was done to ascertain the effect of surgical approach on outcomes. RESULTS Eight studies published between 2007 and 2021 were included. Mean age of study cohort was 39.05 years. Mean operative time was significantly shorter in the non-obese group mean difference of 15.1 min (95% CI - 0.24 to 30.5). On subgroup analysis, obese individuals operated via endoscopic approach had significantly decreased operative time as compared to open approach. Blood loss and complication rates were also lower in the non-obese groups, but not statistically significant. CONCLUSION Significantly less mean operative time was seen in non-obese individuals and when obese patients were operated via endoscopic approach. This difference between obese and non-obese groups was significantly more in the open subgroup as compared to the endoscopic subgroup. No significant differences in blood loss, mean improvement in VAS score, recurrence rate, complication rate and length of hospital stay was found between obese and non-obese patients as well as between endoscopic versus open lumbar discectomy within the obese subgroup. The learning curve associated with endoscopy makes it a challenging procedure.
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Affiliation(s)
- Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | - Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India.
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20
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Garreta-Catala I, Planas-Balagué R, Abouzari R, Carnaval T, Nolla JM, Videla S, Agulló-Ferré JL. Feasibility of a multidisciplinary group videoconferencing approach for chronic low back pain: a randomized, open-label, controlled, pilot clinical trial (EN-FORMA). BMC Musculoskelet Disord 2023; 24:642. [PMID: 37558990 PMCID: PMC10410913 DOI: 10.1186/s12891-023-06763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Low back pain is a common condition that becomes even more prevalent with aging. A non-pharmacological multidisciplinary approach for chronic non-specific low back pain (CNSLBP) has been recommended, but integrating different healthcare professionals is challenging. A multidisciplinary group videoconferencing approach (MGVA) can be helpful. Our aim was to provide evidence on MGVA's feasibility in managing CNSLBP and its impact on clinical practice. METHODS We conducted an open-label, randomized, controlled, parallel-group pilot clinical trial with CNSLBP patients irresponsive to conservative treatment. Patients between 18 and 67 years of age were randomly assigned (1:1) to either Standard-of-Care + MGVA (experimental group) or Standard-of-Care alone (control group). MGVA consisted of integrated sessions for physical rehabilitation/physiotherapy, psychology, and social work treatments. The control group received standard clinical practice treatment. The feasibility was assessed by the number of study procedures completed to at least 80% as planned. The impact on clinical practice was evaluated by the number of patients who changed their status from "candidate" to "non-candidate" to low back surgery as the treatment of choice for CNSLBP. The SF-36, Oswestry Disability Index, and TMMS-24 questionnaires were used. We performed a whole population-based descriptive analysis. RESULTS We included 20 patients, but only 18 were randomized (2 withdrew consent before randomization). The mean (SD) age was 53.1 (5.9) years, and mostly women (13/18); 7 were actively employed. In the experimental group, 6/9 (67%, 95%CI:35-88%) patients attended at least 80% of the scheduled procedures, while in the control group, 8/9 (89%, 95%CI:57-98%) did. Additionally, 1 out of 4 (25%) patients in the experimental group changed their status from "candidate" for low back surgery to "non-candidate". None of the 2 patients in the control group did so. We found differences between groups in the SF-36 mental health component (p-value:0.061), Oswestry Disability Index (p-value:0.032), and TMMS-24 Repair component (p-value:0.014) at the end of the trial favoring MGVA. CONCLUSIONS The multidisciplinary group videoconferencing approach to managing chronic non-specific low back pain was feasible, suggesting overall beneficial effects on patients' health and could play a role in changing a patient's status from "candidate" to "non-candidate" for surgery. TRIAL REGISTRATION NCT05093543 (ClinicalTrials.gov), first registered in 26/10/2021.
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Affiliation(s)
- Iago Garreta-Catala
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rosa Planas-Balagué
- Rehabilitation and Physical Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Reza Abouzari
- Rehabilitation and Physical Medicine Department, Delta del Llobregat Primary Care Center, Barcelona, El Prat de Llobregat, Spain
| | - Thiago Carnaval
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José-Luis Agulló-Ferré
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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21
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Mishra S, Garg K, Chaurasia B, Budihal BR, Deora H, Tandon V, Phalak M, Mishra S, Kumar A, Umana GE, Lafuente J, Demetriades AK, Ha Y, Singh M, Chandra PS, Kale SS, Zileli M. An assessment of the variation in the practice of lumbar discectomy and its role in axial back pain. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:259-267. [PMID: 37860028 PMCID: PMC10583805 DOI: 10.4103/jcvjs.jcvjs_46_23] [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: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 10/21/2023] Open
Abstract
Background Lumbar discectomy is performed for symptomatic lumbar disc herniation and is one of the most widely performed spinal surgical procedures worldwide in a variety of ways. This survey aimed at providing an overview/perspective of different practice patterns and the impact of lumbar discectomy on axial back pain with or without sciatica. Methods An online survey was performed using the application "Google Forms." The link to the questionnaire was distributed to neurosurgeons through personal E-mail and social media platforms. Results We received 333 responses. The largest percentage of responses across five continents was from Asia (66.97%, n = 223). The mean age of the respondents was 40.08 ± 10.5 years. A total of 66 respondents (20%) had a spine practice of 7%-90%, and 28 respondents had a spine practice of 90%-100% (8.4%). The number of respondents who practiced microscopic discectomy using a tubular retractor (n = 143 respondents, 42.9%) was nearly equal to the number of respondents who practiced open discectomy (n = 142 respondents, 42.6%). An almost equal proportion of respondents believed discectomy does not help in relieving axial back pain. Only 20.4% (n = 68) of respondents recommend bed rest for a longer duration postoperatively. Conclusions Our survey revealed that only 22.2% of spine surgeons recommended discectomy in patients with radiological disc herniation with axial back pain alone and preferred a minimally invasive method of discectomy. Almost half of them believed discectomy to be ineffective for axial low back pain and only a few recommended prolonged bed rest postoperatively.
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Affiliation(s)
- Sandeep Mishra
- Department of Neurosurgery, Lok Nayak Hospital, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Bhargavi R Budihal
- MBBS Student, BGS Global Institute of Medical Sciences, Bengaluru, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - GE Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Jesus Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain
| | | | - Yoon Ha
- Department of Neurosurgery, Yonsei University, Seoul, South Korea
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - PS Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - SS Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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22
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ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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23
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Sultan KA, Ashraf M, Chaudhary A, Al Salloum L, Ghulam N, Ahmed N, Ismahel H, Farooq M, Iqbal J, Ashraf N. Negative Chronotropic Cardiovascular Changes in Lumbar Spine Surgery: A Potential Spinal-Cardiac Reflex? Asian J Neurosurg 2023; 18:404-409. [PMID: 37397037 PMCID: PMC10313433 DOI: 10.1055/s-0043-1769894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Cardiovascular changes following lumbar spine surgery in a prone position are exceedingly rare. Over the past 20 years, a total of six cases have been published where patients experienced varying degrees of bradycardia, hypotension, and asystole, which could be attributed to intraoperative dural manipulation. As such, there is emerging evidence for a potential neural-mediated spinal-cardiac reflex. The authors report their experience of negative chronotropy during an elective lumbar spine surgery that coincided with dural manipulation and review the available literature. A 34-year-old male presented with a long-standing history of lower back pain recently deteriorating to bilaterally radiating leg pain, with restricted left leg raise, and numbness at the left L5 dermatomal territory. The patient was an athletic police officer with no comorbidities or past medical history. Magnetic resonance imaging lumbosacral spine revealed spinal stenosis most pronounced at L4/L5 and disc bulges at L3/L4 and L5/S1. The patient opted for lumbar decompression surgery. After an unremarkable comprehensive preoperative workup, including cardiac evaluation (electrocardiogram, echocardiogram), the patient was induced general anesthesia in a prone position. A lumbar incision was made from L2 to S1. When the left L4 nerve root was retracted while removing the prolapsed disc at L4/L5, the anesthetist cautioned the surgeon of bradycardia (34 beats per minute [bpm]), and the surgery was immediately stopped. The heart rate improved to 60 bpm within 30 seconds. When the root was later retracted again, a second episode of bradycardia occurred for 4 minutes with heart rate declining to 48 bpm. The surgery was stopped, and after 4 minutes, the anesthetist administered 600 µg of atropine. The heart rate then rose to 73 bpm within 1 minute. Other potential causes for bradycardia were excluded. The total blood loss was estimated to be 100 mL. He remains well at his 6-month follow-up and has returned to work as normal. Akin to previously published cases, each episode of bradycardia coincided with dural manipulation, which may indicate a possible reflex between the spinal dura mater and the cardiovascular system. Such a rare adverse event may occur even in seemingly healthy, young individuals, and anesthetists should caution the operating surgeon of bradycardias to exclude operative manipulation of the dura as the cause. While this phenomenon is only reported in a handful of lumbar spine surgery cases, it provides evidence for a potential spinal-cardiac physiological reflex in the lumbar spine that may be neural mediated and should be investigated further.
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Affiliation(s)
- Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Attika Chaudhary
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Laulwa Al Salloum
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Naseeruddin Ghulam
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Nazir Ahmed
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Hassan Ismahel
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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24
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Farooque M. Specific and Nonspecific Low Back Pain-Mind the Gap and its Impact in Clinical Practice: Opinion of a Recovering Interventional Spine Physiatrist. Spine J 2023:S1529-9430(23)00170-5. [PMID: 37116719 DOI: 10.1016/j.spinee.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Mustafa Farooque
- Department of Medicine at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Suite 310, Milwaukee, WI.
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25
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Lombardo S, Hilde G, Småstuen MC, Grotle M. Effect of Godelieve Denys-Struyf (GDS) muscle and articulation chain treatment on clinical variables of patients with chronic low back pain and lumbar disc degeneration: a pilot feasibility randomized controlled trial. Pilot Feasibility Stud 2023; 9:44. [PMID: 36932432 PMCID: PMC10022086 DOI: 10.1186/s40814-023-01268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Patients with chronic low back pain (LBP) and lumbar disc degeneration are recommended to try out nonsurgical treatment options before surgery. There is need for good nonsurgical alternatives that can be adapted to the patient's needs and level of function. The aim of this pilot trial was to test study feasibility of a future full randomized controlled trial (RCT) evaluating the feasibility and benefit of the physiotherapy-based Godelieve Denys-Struyf (GDS) muscle and articulation chain treatment for patients with chronic LBP and lumbar disc degeneration referred to surgical assessment in a hospital outpatient clinic. METHODS This study is a single-center, two-arm, single-blinded, pilot RCT conducted in a regional hospital in Norway. Patients of age 35-75 years with chronic (> 3 months) LBP and degenerative lumbar disc(s) verified by imaging were included. They filled in a baseline questionnaire prior to randomization, including the Oswestry Disability Index (ODI), numerical rating scale for pain in back and pain in leg, and the EuroQoL 5L. Patients in the control group were free to use treatment as usual. Patients in the intervention group received 8 sessions over a period of 10 to 14 weeks of GDS muscle and articulation chain treatment. RESULTS The recruitment rate was slow, approximately 3/4th of the referred patients met the inclusion criteria, but majority of eligible participants (94%) were willing to participate. A total of 30 patients were randomized into the two groups. The randomization led to skewed distribution of radiating leg pain in the two groups. All participants except one (97%) completed 4 months follow-up. No serious adverse events attributable to the trial treatments were reported. The Oswestry Disability Index (ODI) and leg pain intensity scale were both suitable as primary outcomes in a full trial. The mean change in the ODI score was 8.7 (SD 16.1) points in the GDS arm, whereas there was a minor deterioration in the ODI scores of -3.7 (7.5) points in the control arm. A sample size calculation based on the ODI scores resulted in a number needed to treat of 3. CONCLUSIONS A future full RCT is feasible and would provide evidence about the effectiveness of a GDS treatment for patients with chronic LBP and lumbar disc degeneration. TRIAL REGISTRATION ClinicalTrials.gov ID: 910193.
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Affiliation(s)
- Sidsel Lombardo
- Physiotherapy Department at Vestfold Hospital Trust (VHT), P.O. Box 2168, 3103, Tønsberg, Norway
| | - Gunvor Hilde
- Center for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Center for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Margreth Grotle
- Center for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway. .,Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
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26
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Shaygan M, Zamani M, Jaberi A, Eghbal K, Dehghani A. The impact of physical and psychological pain management training on pain intensity, anxiety and disability in patients undergoing lumbar surgeries. Spine J 2023; 23:656-664. [PMID: 36736739 DOI: 10.1016/j.spinee.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND/CONTEXT Lumbar surgery is one of the interventions performed for patients with degenerative conditions. PURPOSE This study aimed to investigate the effect of pain management education on pain intensity, anxiety, and disability after the lumbar surgery. STUDY DESIGN/SETTING This randomized controlled trial was performed on seventy 30 to 65-year-old patients with lumbar canal stenosis and lumbar disc herniation from 2018 to 2019. PATIENT SAMPLE Seventy participants were randomly divided into a control and an intervention group by a randomized block design. Participants in the intervention group received in-person pain management training twice a week for seven 60 to 90-minute sessions. OUTCOME MEASURES All participants in the two groups completed the study instruments (numeric rating scale [NRS], Oswestery disability index [ODI], and pain anxiety symptoms scale [PASS]) before, immediately after, and 3 months after the study. METHODS Participants in the intervention group received in-person pain management training twice a week for seven 60 to 90-minute sessions. To analyze the treatment effects, repeated-measures multivariate analysis of variance (MANOVA) and effect sizes were used where appropriate and calculated by Partial ɳ2. Clinical outcome (MDC) for pain intensity and PASS was also reported. For participants lost to follow-up, we also used an "intention-to-treat" (ITT) approach. RESULTS The results of MANOVA indicated that there were significant differences between the two groups on ratings of pain intensity, anxiety, and disability. According to the MDC, the mean differences of pain intensity for the intervention group was also clinically improved. Meanwhile, the mean differences in pain anxiety between three different times in the two groups were not above the MDC (20.14), suggesting that the clinical improvements were not significant. The results were confirmed for all outcome measures; a statistically significant difference was found between the groups in ITT analyses (p<.001). CONCLUSIONS Physical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability. This strategy may be beneficial for such patients. Variables such as smoking behavior, past history of psychological disorders, and previous surgeries should be considered in future studies.
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Affiliation(s)
- Maryam Shaygan
- Maryam Shaygan, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahsa Zamani
- Mahsa Zamani, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Keyvan Eghbal
- Keyvan Eghbal, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Azime Dehghani
- Azime Dehghani, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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27
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Evans L, O'Donohoe T, Morokoff A, Drummond K. The role of spinal surgery in the treatment of low back pain. Med J Aust 2023; 218:40-45. [PMID: 36502448 PMCID: PMC10107811 DOI: 10.5694/mja2.51788] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
Low back pain (LBP) is common and a leading cause of disability and lost productivity worldwide. Acute LBP is frequently self-resolving, but recurrence is common, and a significant proportion of patients will develop chronic pain. This transition is perpetuated by anatomical, biological, psychological and social factors. Chronic LBP should be managed with a holistic biopsychosocial approach of generally non-surgical measures. Spinal surgery has a role in alleviating radicular pain and disability resulting from neural compression, or where back pain relates to cancer, infection, or gross instability. Spinal surgery for all other forms of back pain is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and suggests it is ineffective. Emerging areas of interest include selection of a minority of patients who may benefit from surgery based on spinal sagittal alignment and/or nuclear medicine scans, but an evidence base is absent. Spinal surgery for back pain has increased substantially over recent decades, and disproportionately among privately insured patients, thus the contribution of industry and third-party payers to this increase, and their involvement in published research, requires careful consideration.
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Affiliation(s)
| | | | - Andrew Morokoff
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Katharine Drummond
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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28
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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Jacob KC, Patel MR, Vanjani NN, Pawlowski H, Prabhu MC, Singh K. Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Isthmic Spondylolisthesis with Predominant Back Pain versus Predominant Leg Pain Symptoms. World Neurosurg 2022; 166:e672-e680. [PMID: 35933097 DOI: 10.1016/j.wneu.2022.07.074] [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: 04/29/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement following anterior or transforaminal lumbar interbody fusion for isthmic spondylolisthesis in patients presenting with predominant back pain versus predominant leg pain symptoms. METHODS A single-surgeon database was reviewed for anterior or transforaminal lumbar interbody fusion procedures for isthmic spondylolisthesis. Patient demographics, perioperative characteristics, postoperative complications, and PROMs were collected. Demographic/perioperative characteristics were compared among groups using χ2 and Student t tests for categorical and continuous variables, respectively. Mean PROM scores were compared using an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired-samples t test. MCID achievement rates were compared with χ2 analysis. RESULTS In total, 143 patients were included with 65 patients in the predominant back pain and 78 patients in the predominant leg pain cohort. Preoperative visual analog scale (VAS) leg was noted to be significantly greater in predominant leg pain cohort (P < 0.001). Cohorts demonstrated significant mean postoperative differences for the following PROMs at the following postoperative time points: significant differences were noted between cohorts for rate of achievement of MCID for the following PROMs at the following time points: VAS back at 2 years and VAS leg at 6 weeks/12 weeks/6 months/overall (P < 0.036, all). CONCLUSIONS Compared with patients presenting for surgery with predominant leg pain symptoms, patients undergoing lumbar fusion at L4-L5 and L5-S1 for isthmic spondylolisthesis with predominant back pain symptoms may demonstrate improved long-term clinical outcomes for reported back pain, leg pain, and disability and reduced postoperative length of stay and narcotic consumption.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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30
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Alnaghmoosh N, Urquhart J, Raj R, Abraham E, Jacobs B, Phan P, Johnson M, Paquet J, Nataraj A, McIntosh G, Fisher CG, Rampersaud YR, Manson N, Hall H, Rasoulinejad P, Bailey CS. Back Dominant Pain Has Equal Outcomes to Radicular Dominant Pain Following Posterior Lumbar Fusion in Adult Isthmic Spondylolisthesis: A CSORN Study. Global Spine J 2022; 12:1667-1675. [PMID: 33406898 PMCID: PMC9609517 DOI: 10.1177/2192568220985471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES This study aimed to determine how the surgeon-determined and patient-rated location of predominant pain influences patient-rated outcomes at 1-year after posterior lumbar fusion in adult isthmic spondylolisthesis. METHODS We retrospectively reviewed consecutive patients prospectively enrolled in the Canadian Spine Outcomes and Research Network national registry between 2009 and 2017 that underwent posterior lumbar fusion for isthmic spondylolisthesis. Using longitudinal mixed-model repeated-measures analysis the change from baseline in patient-reported outcome measures (PROMs) at 1 year after surgery was compared between surgeon-determined groups (back vs. radicular) and between patient-rated pain groups (back, leg, and equal) derived from preoperative pain scores on the numerical rating scale (NRS). RESULTS 83/252 (33%) patients had a surgeon-determined chief complaint of back pain, while 103 (41%) patients rated their back pain as the predominant pain location, and 78 (31%) rated their back and leg pain to be equal. At baseline patients in the surgeon-determined radicular group had worse NRS-leg pain than those in the back-pain group but equal NRS-back pain. At baseline patients in the patient-rated equal pain group had similar back pain compared to the patient-rated back pain group and similar leg pain compared to the patient-rated leg pain group. All PROMs improved post-operatively and were not different between the 2 groups at 1 year. CONCLUSIONS Our study found no difference in outcome, irrespective of whether a surgeon determines the patient's primary pain complaint back or radicular dominant, or the patient rates pain in one location greater than another.
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Affiliation(s)
- Nabeel Alnaghmoosh
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada
| | - Jennifer Urquhart
- Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada,Jennifer Urquhart, London Health Sciences
Center, E2-619B, 800 Commissioners Road, East, London, Ontario, Canada N6A 5W9.
| | - Ruheksh Raj
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada
| | - Edward Abraham
- Department of Surgery, Canada East Spine
Centre, Saint John, New Brunswick, Canada
| | - Bradley Jacobs
- Department of Surgery, University of
Calgary, Calgary, Alberta, Canada
| | - Philippe Phan
- Department of Surgery, University of
Ottawa, Ottawa, Ontario, Canada
| | - Michael Johnson
- Departments of Orthopedics and
Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Paquet
- Department of Surgery, Laval University,
Quebec City, Quebec, Canada
| | - Andrew Nataraj
- Department of Surgery, University of
Alberta, Edmonton, Alberta, Canada
| | | | - Charles G. Fisher
- Department of Surgery, Vancouver
General Hospital/University of British Columbia, Vancouver, British Columbia,
Canada
| | | | - Neil Manson
- Department of Surgery, Canada East Spine
Centre, Saint John, New Brunswick, Canada
| | - Hamilton Hall
- Department of Surgery, University of
Toronto, Toronto, Ontario, Canada
| | - Parham Rasoulinejad
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada,Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of
Surgery, Western University /London Health Sciences Centre, London, Ontario,
Canada,Lawson Health Research Institute /London
Health Sciences Centre, London, Ontario, Canada
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31
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Back Pain. Neurol Clin 2022; 41:61-76. [DOI: 10.1016/j.ncl.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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32
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Lazaridou A, Paschali M, Vilsmark ES, Edwards RR. Biofeedback EMG alternative therapy for chronic low back pain: Study protocol of a pilot randomized controlled trial. Contemp Clin Trials 2022; 121:106888. [PMID: 35988661 DOI: 10.1016/j.cct.2022.106888] [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: 05/17/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Although there is evidence that non-pharmacological therapies seem to be effective for treating low back pain, there is limited evidence of the effectiveness of EMG biofeedback with non-specific chronic low back pain (NCLBP). The purpose of this study is, therefore, to determine the efficacy of a portable EMG biofeedback device on pain in individuals with CLBP. METHODS/DESIGN This study is a prospective, single-center, assessor-blind, two-arm, parallel randomized controlled trial to be conducted at Brigham and Women's Hospital, Boston, MA. Eighty patients with CLBP will be randomized in a 2:1 ratio to receive sEMG-BF (surface EMG biofeedback) or continued care (no intervention). All participants will receive treatment virtually weekly for 8 weeks. The primary outcome will be pain intensity (Brief Pain Inventory). The secondary outcomes will include pain interference (Brief Pain Inventory), disability (The Oswestry Disability Index (ODI)), anxiety and depression (Hospital Anxiety and Depression Scale). All outcomes will be assessed at baseline, immediately post-intervention, and 3 months follow-up. CONCLUSION To our knowledge, this study will be the first powered randomized controlled trial to compare the effectiveness of a virtual sEMG-BF protocol specifically designed for CLBP. The outcome of the study may provide evidence for the effectiveness of biofeedback using digital therapeutics to relieve pain in individuals with CLBP. TRIAL REGISTRATION Clinical Trials Registry (http://ClinicalTrials.gov Identifier: NCT04607460). Registered on October 29, 2020.
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Affiliation(s)
- Asimina Lazaridou
- Harvard Medical School, Brigham & Women's Hospital, Department of Anesthesiology, Perioperative & Pain Medicine, USA
| | - Myrella Paschali
- Harvard Medical School, Brigham & Women's Hospital, Department of Anesthesiology, Perioperative & Pain Medicine, USA.
| | - Eric S Vilsmark
- Harvard Medical School, Brigham & Women's Hospital, Department of Anesthesiology, Perioperative & Pain Medicine, USA
| | - Robert R Edwards
- Harvard Medical School, Brigham & Women's Hospital, Department of Anesthesiology, Perioperative & Pain Medicine, USA
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33
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Costa F, Janela D, Molinos M, Moulder RG, Lains J, Bento V, Scheer J, Yanamadala V, Correia FD, Cohen SP. Digital Rehabilitation for Acute Low Back Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:1873-1887. [PMID: 35813029 PMCID: PMC9261956 DOI: 10.2147/jpr.s369926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) has a lifetime prevalence of 70–80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs. Purpose We aim to report the results of a fully remote digital care program (DCP) for acute LBP. Patients and Methods This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4). Conclusion This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.
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Affiliation(s)
- Fabíola Costa
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Dora Janela
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Maria Molinos
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Vijay Yanamadala
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- SWORD Health, Inc, Clinical Research, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Correspondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Farooque M. The State of Spine Care in the United States: Opinion of a Recovering Interventional Spine Physiatrist. Spine (Phila Pa 1976) 2022; 47:961-964. [PMID: 35135979 DOI: 10.1097/brs.0000000000004343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Mustafa Farooque
- Medical Director, Back & Spine Program at Aurora St. Luke's Medical Center, Milwaukee, WI, 2901 W Kinnickinnic River Pkwy, Milwaukee, WI
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35
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What Constitutes "Appropriate Care" for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project). Spine (Phila Pa 1976) 2022; 47:879-891. [PMID: 34798647 DOI: 10.1097/brs.0000000000004274] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multiround wiki-based Delphi expert panel survey. OBJECTIVE To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP). SUMMARY OF BACKGROUND DATA The provision of inappropri ate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recom mendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care." METHODS Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators. RESULTS From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators compris ing screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided. CONCLUSION These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/ funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.
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36
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Melcher C, Paulus AC, Roßbach BP, Gülecyüz MF, Birkenmaier C, Schulze-Pellengahr CV, Teske W, Wegener B. Lumbar spinal stenosis - surgical outcome and the odds of revision-surgery: Is it all due to the surgeon? Technol Health Care 2022; 30:1423-1434. [PMID: 35754243 DOI: 10.3233/thc-223389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren't obious within the intial index group of late revisions.
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Affiliation(s)
- Carolin Melcher
- Department of Spine Surgery and Scoliosis Center, Schön Klinik Neustadt, Neustadt, Germany
- Department of Orthopedic Surgery, Rehabilitation and Regenerative Medicine, LMU Munich, Munich, Germany
| | - Alexander C Paulus
- Department of Orthopedic Surgery, Rehabilitation and Regenerative Medicine, LMU Munich, Munich, Germany
| | - Bjömrn P Roßbach
- Department of Orthopaedic Surgery, Klinik St. Georg, Hamburg, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopedic Surgery, Rehabilitation and Regenerative Medicine, LMU Munich, Munich, Germany
| | - Christof Birkenmaier
- Department of Orthopedic Surgery, Rehabilitation and Regenerative Medicine, LMU Munich, Munich, Germany
| | | | - Wolfram Teske
- Department of Orthopedic Surgery, Katholisches Krankenhaus Hagen - St.-Josefs-Hospital, Hagen, Germany
| | - Bernd Wegener
- Department of Orthopedic Surgery, Rehabilitation and Regenerative Medicine, LMU Munich, Munich, Germany
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Ferreira GE, Zadro J, Liu C, Harris IA, Maher CG. Second opinions for spinal surgery: a scoping review. BMC Health Serv Res 2022; 22:358. [PMID: 35300677 PMCID: PMC8932184 DOI: 10.1186/s12913-022-07771-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain. METHODS We conducted a scoping review. Two independent researchers screened PubMed, EMBASE, Cochrane CENTRAL and CINAHL from inception to May 6th, 2021. Studies of any design published in any language were eligible provided they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) whether they reduce surgery and improve patient outcomes; and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively. RESULTS We screened 6341 records, read 27 full-texts, and included 12 studies (all observational; 11 had poor methodological quality; one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53 to 96%. Agreement for need for surgery between first and second opinions ranged from 0 to 83%. Second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and healthcare use (e.g. imaging), but might increase others (e.g. injections). CONCLUSIONS Second opinion services typically recommend less surgical treatments compared to first opinions and may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. There is a need for high-quality randomised trials to determine the value of second opinion services for reducing spinal surgery.
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Affiliation(s)
- Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, PO Box M179, Missenden Road, Camperdown | NSW|, Sydney, New South Wales, 2050, Australia.
| | - Joshua Zadro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, PO Box M179, Missenden Road, Camperdown | NSW|, Sydney, New South Wales, 2050, Australia
| | - Chang Liu
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, PO Box M179, Missenden Road, Camperdown | NSW|, Sydney, New South Wales, 2050, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, PO Box M179, Missenden Road, Camperdown | NSW|, Sydney, New South Wales, 2050, Australia
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38
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Hickman TT, Rathan-Kumar S, Peck SH. Development, Pathogenesis, and Regeneration of the Intervertebral Disc: Current and Future Insights Spanning Traditional to Omics Methods. Front Cell Dev Biol 2022; 10:841831. [PMID: 35359439 PMCID: PMC8963184 DOI: 10.3389/fcell.2022.841831] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
The intervertebral disc (IVD) is the fibrocartilaginous joint located between each vertebral body that confers flexibility and weight bearing capabilities to the spine. The IVD plays an important role in absorbing shock and stress applied to the spine, which helps to protect not only the vertebral bones, but also the brain and the rest of the central nervous system. Degeneration of the IVD is correlated with back pain, which can be debilitating and severely affects quality of life. Indeed, back pain results in substantial socioeconomic losses and healthcare costs globally each year, with about 85% of the world population experiencing back pain at some point in their lifetimes. Currently, therapeutic strategies for treating IVD degeneration are limited, and as such, there is great interest in advancing treatments for back pain. Ideally, treatments for back pain would restore native structure and thereby function to the degenerated IVD. However, the complex developmental origin and tissue composition of the IVD along with the avascular nature of the mature disc makes regeneration of the IVD a uniquely challenging task. Investigators across the field of IVD research have been working to elucidate the mechanisms behind the formation of this multifaceted structure, which may identify new therapeutic targets and inform development of novel regenerative strategies. This review summarizes current knowledge base on IVD development, degeneration, and regenerative strategies taken from traditional genetic approaches and omics studies and discusses the future landscape of investigations in IVD research and advancement of clinical therapies.
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Affiliation(s)
- Tara T. Hickman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sudiksha Rathan-Kumar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sun H. Peck
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Sun H. Peck,
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A potential target gene CD63 for different degrees of intervertebral disc degeneration. Sci Rep 2022; 12:957. [PMID: 35046480 PMCID: PMC8770635 DOI: 10.1038/s41598-022-05021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Understanding molecular mechanisms of intervertebral disc degeneration (IDD) and providing a novel target for the treatment of IDD have important implications. We sought to explore a new promising gene target for the treatment of IDD. This study integrated 19,678 genes of 38 IDD patients from two gene datasets. Differentially Expressed Genes (DEGs) of annulus fibrosus were analyzed in groups with mild disc degeneration (MDD) and severe disc degeneration (SDD). We screened the hub gene through biological information technology (bioinformatic) methods. Then, we further validated the hub gene using annulus fibrosus and nucleus pulposus tissues from 12 patients with qRT-PCR. In addition, we explored its underlying molecular mechanism with GO, KEGG and GSEA. Through multiple screening bioinformatics methods, the hub gene CD63 was identified. The qRT-PCR explored that CD63 decreased significantly in SDD group compared to that in MDD group (P < 0.001). The GO, KEGG and GSEA of CD63 explored significant enrichment of the molecular features (P < 0.001), including the cellular component (Extracellular matrix, P < 0.001), the molecular function (collagen binding, P < 0.001), the biological processes (protein targeting, collagen fibril organization and platelet degranulation, P < 0.001) and the signaling pathways. Our research explored and validated a new regulatory gene, CD63 for different degrees of IDD. A new novel form of therapeutic target for IDD may be developed.
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Ammendolia C, Hofkirchner C, Plener J, Bussières A, Schneider MJ, Young JJ, Furlan AD, Stuber K, Ahmed A, Cancelliere C, Adeboyejo A, Ornelas J. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ Open 2022; 12:e057724. [PMID: 35046008 PMCID: PMC8772406 DOI: 10.1136/bmjopen-2021-057724] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication. DESIGN A systematic review. DATA SOURCES CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020. ELIGIBILITY CRITERIA We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis. RESULTS Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review. CONCLUSIONS There is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness. PROSPERO REGISTRATION NUMBER CRD42020191860.
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Affiliation(s)
- Carlo Ammendolia
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Corey Hofkirchner
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joshua Plener
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculy of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, boulevard des Forges, Trois-Rivières Québec, Canada
| | | | - James J Young
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Sports Medicine and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Kent Stuber
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Aksa Ahmed
- Rheumatology, Sinai Health System, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Aleisha Adeboyejo
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Joseph Ornelas
- Health Systems Management, Rush University, Chicago, Illinois, USA
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Ultrasonographic Changes of Abdominal Muscles in Subjects with and without Chronic Low Back Pain. Healthcare (Basel) 2022; 10:healthcare10010123. [PMID: 35052287 PMCID: PMC8775819 DOI: 10.3390/healthcare10010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Chronic low back pain (CLBP) is a prevalent disfunction in the spine, affecting both women and men. The implication of the abdominal muscles in this disfunction has been studied, including wrong breathing patterns or inactivity of this area. However, there is a lack of studies examining changes in thickness of abdominal with ultrasonography. Thus, the aim of this study is to analyze the differences in the thickness of abdominal muscles at rest and during breathing between subjects with and without CLBP. A total of 72 subjects were divided in two groups: participants with CLBP (n = 36) and participants without CLBP (n = 36). In both groups, the thickness of the four abdominal muscles was measured and compared at rest and during breathing with ultrasonography. In TrA and IO there were no significant differences between groups, but those subjects with CLBP increased the muscle thickness more than participants without pain during breathing. In EO there were no differences in muscle thickness between groups and between rest and breathing. In RA, subjects with CLBP showed less muscle thickness than subjects without pain during breathing, but no changes were found at rest. In conclusion, the deepest abdominal muscles, TrA and IO, appear to increase their thickness and RA appear to decrease more in subjects with CLBP, in comparison with healthy participants.
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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Association between temporal summation and conditioned pain modulation in chronic low back pain: baseline results from 2 clinical trials. Pain Rep 2021; 6:e975. [PMID: 34901679 PMCID: PMC8660006 DOI: 10.1097/pr9.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Temporal summation (TS) and conditioned pain modulation (CPM) represent different aspects of central pain processing. Their relationship and differential performance within distinct body locations are not well understood. Objectives To examine the association between TS and CPM in chronic low back pain and the influence of testing location on this relationship. Methods We analyzed baseline data from 2 clinical trials on participants with chronic low back pain (n = 264; 47.3% female; mean age = 41 years, SD = 12; mean pain = 5.3/10, SD = 1.4). Measures used included questionnaires assessing pain and negative affect, phasic thermal TS at the hand (thenar) and the lower back (lumbar), followed by CPM that included a thermal testing stimulus (Heat-6, the temperature where pain rating is 6/10) and a cold-pressor conditioning stimulus. Nonparametric, proportional odds logistic regression was used to model thenar, and separately, lumbar TS, using CPM, Heat-6, negative affect, and demographics. Results Our models revealed a small association (βs = 0.17, P = 0.01) between reduced CPM and heightened TS at both testing sites, regardless of demographics or negative affect. Conclusion Results suggest a modest association between TS and CPM, irrespective of anatomical testing location, demographics, and negative affect. These findings will help improve the methodology and interpretation of TS and CPM measurement in clinical pain populations.
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Alvi MA, Wahood W, Kurian SJ, Zreik J, Jeffery MM, Naessens JM, Spinner RJ, Bydon M. Do all outpatient spine surgeries cost the same? Comparison of economic outcomes data from a state-level database for outpatient lumbar decompression performed in an ambulatory surgery center or hospital outpatient setting. J Neurosurg Spine 2021; 35:787-795. [PMID: 34416720 DOI: 10.3171/2021.2.spine201820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal procedures are increasingly conducted as outpatient procedures, with a growing proportion conducted in ambulatory surgery centers (ASCs). To date, studies reporting outcomes and cost analyses for outpatient spinal procedures in the US have not distinguished the various outpatient settings from each other. In this study, the authors used a state-level administrative database to compare rates of overnight stays and nonroutine discharges as well as index admission charges and cumulative 7-, 30-, and 90-day charges for patients undergoing outpatient lumbar decompression in freestanding ASCs and hospital outpatient (HO) settings. METHODS For this project, the authors used the Florida State Ambulatory Surgery Database (SASD), offered by the Healthcare Cost and Utilization Project (HCUP), for the years 2013 and 2014. Patients undergoing outpatient lumbar decompression for degenerative diseases were identified using CPT (Current Procedural Terminology) and ICD-9 codes. Outcomes of interest included rates of overnight stays, rate of nonroutine discharges, index admission charges, and subsequent admission cumulative charges at 7, 30, and 90 days. Multivariable analysis was performed to assess the impact of outpatient type on index admission charges. Marginal effect analysis was employed to study the difference in predicted dollar margins between ASCs and HOs for each insurance type. RESULTS A total of 25,486 patients were identified; of these, 7067 patients (27.7%) underwent lumbar decompression in a freestanding ASC and 18,419 (72.3%) in an HO. No patient in the ASC group required an overnight stay compared to 9.2% (n = 1691) in the HO group (p < 0.001). No clinically significant difference in the rate of nonroutine discharge was observed between the two groups. The mean index admission charge for the ASC group was found to be significantly higher than that for the HO group ($35,017.28 ± $14,335.60 vs $33,881.50 ± $15,023.70; p < 0.001). Patients in ASCs were also found to have higher mean 7-day (p < 0.001), 30-day (p < 0.001), and 90-day (p = 0.001) readmission charges. ASC procedures were associated with increased charges compared to HO procedures for patients on Medicare or Medicaid (mean index admission charge increase $4049.27, 95% CI $2577.87-$5520.67, p < 0.001) and for patients on private insurance ($4775.72, 95% CI $4171.06-$5380.38, p < 0.001). For patients on self-pay or no charge, a lumbar decompression procedure at an ASC was associated with a decrease in index admission charge of -$10,995.38 (95% CI -$12124.76 to -$9866.01, p < 0.001) compared to a lumbar decompression procedure at an HO. CONCLUSIONS These "real-world" results from an all-payer statewide database indicate that for outpatient spine surgery, ASCs may be associated with higher index admission and subsequent 7-, 30-, and 90-day charges. Given that ASCs are touted to have lower overall costs for patients and better profit margins for physicians, these analyses warrant further investigation into whether this cost benefit is applicable to outpatient spine procedures.
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Affiliation(s)
- Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Waseem Wahood
- 3Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Jad Zreik
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Molly M Jeffery
- 5Division of Health Care Policy and Research, Department of Health Sciences Research, and
| | - James M Naessens
- 5Division of Health Care Policy and Research, Department of Health Sciences Research, and
- 6Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Mustafa R, Kissoon NR. Approach to Radiculopathy. Semin Neurol 2021; 41:760-770. [PMID: 34826877 DOI: 10.1055/s-0041-1726363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Low back pain and neck pain, often with associated radiculopathy, are two of the most common reasons for referral to the outpatient neurology clinic. A thorough clinical evaluation remains paramount in establishing an accurate diagnosis and subsequently an appropriate treatment plan. In this article, we review anatomic considerations for spondylotic radiculopathy; outline the clinical approach for the evaluation of these patients, including discussion of electrodiagnostic and imaging modalities; and address treatment options based on a stratified treatment approach.
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Affiliation(s)
- Rafid Mustafa
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Narayan R Kissoon
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Hasan MS, Yunus SN, Ng CC, Chan CYW, Chiu CK, Kwan MK. Tranexamic Acid in Pediatric Scoliosis Surgery: A Prospective Randomized Trial Comparing High-dose and Low-dose Tranexamic Acid in Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery. Spine (Phila Pa 1976) 2021; 46:E1170-E1177. [PMID: 33882541 DOI: 10.1097/brs.0000000000004076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized double-blinded trial. OBJECTIVE The objective of this study is to determine the efficacy of high-dose versus low-dose tranexamic acid (TXA) in adolescent idiopathic scoliosis (AIS) corrective surgery. SUMMARY OF BACKGROUND DATA Corrective surgery for AIS is associated with significant blood loss. Evidence on the optimum TXA dose to reduce bleeding in pediatric population is scarce. METHODS A total of 166 AIS patients aged between 10 and 21 years, of American Society of Anesthesiologists (ASA) physical status I and II, preoperative hemoglobin >10 g/dL, platelet count >150,000 cells/L and Cobb angle of >45° scheduled for elective single-stage posterior spinal fusion (PSF) surgery by two attending surgeons were included between March 2017 and November 2018. Patients were randomized into Group A (High Dose, 30 mg/kg TXA loading dose followed by 10 mg/kg/h infusion) and Group B (Low Dose, 10 mg/kg TXA loading dose followed by 1 mg/kg/h infusion). The primary outcome was total surgical blood loss between both groups. Secondary outcomes were transfusion requirement, perioperative changes in hemoglobin and coagulation profiles, adverse events, and factors that influence total blood loss. RESULTS The mean total surgical blood loss between the two groups was not significant (Group A: 928.8 ± 406.1 mL [range: 348-1857 mL]; Group B: 918.1 ± 406.2 mL [range: 271-2000 mL], P = 0.865). The median duration of surgery was 120 minutes. One patient in each group received allogenic blood transfusion during the perioperative period. There were no significant changes in hemoglobin and coagulation profile at pre-operation, post-operation 0 hour and 48 hours. Sex, number of vertebral levels fused, and duration of surgery were independently associated with total surgical blood loss. No adverse events were observed perioperatively. CONCLUSION Low-dose TXA was as efficacious as high-dose TXA in reducing blood loss and allogenic blood transfusion for AIS patients undergoing PSF surgery.Level of Evidence: 1.
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Affiliation(s)
- Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nadzrah Yunus
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Choe Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
There is an ongoing desire for the development of motion-preserving facet replacement devices as an alternative to rigid fixation in hopes of better preserving the natural kinematics of the lumbar spine. Theoretically, such a construct would simultaneously address pain associated with spinal instability and prevent abnormal load distribution and adjacent segment degeneration. Several such devices have been developed including the Anatomic Facet Replacement System, the Total Facet Arthroplasty System, and the Total Posterior Arthroplasty System. Of these devices, none have yet proven to be more efficacious than rigid fixation for lumbar spinal stenosis, and studies are ongoing.
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Donnino MW, Thompson GS, Mehta S, Paschali M, Howard P, Antonsen SB, Balaji L, Bertisch SM, Edwards R, Ngo LH, Grossestreuer AV. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Rep 2021; 6:e959. [PMID: 34589642 PMCID: PMC8476063 DOI: 10.1097/pr9.0000000000000959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic back pain is the leading cause of disability in the United States. Based on the hypothesis that nonspecific back pain may be rooted in a psychophysiologic etiology, we propose a new approach to chronic back pain. OBJECTIVES A pilot study was conducted to assess whether psychophysiologic symptom relief therapy (PSRT) can reduce disability and back pain bothersomeness for patients with chronic back pain. METHODS This was a three-armed, randomized trial for adults with nonspecific chronic back pain that compared PSRT with usual care and an active comparator (mindfulness-based stress reduction [MBSR]). Psychophysiologic symptom relief therapy-randomized participants received a 12-week (36 hours) course based on the psychophysiological model of pain. All groups were administered validated questionnaires at baseline and at 4, 8, 13, and 26 weeks. The primary outcome was the reduction in pain disability measured by the Roland-Morris Disability Questionnaire. RESULTS The mean Roland-Morris Disability Questionnaire score for the PSRT group (n = 11) decreased from 9.5 (±4.3 SDs) to 3.3 (±5.1) after 26 weeks which was statistically significant compared with both MBSR (n = 12) (P = 0.04) and usual care (n = 12) (P = 0.03). Pain bothersomeness scores and pain-related anxiety decreased significantly over 26 weeks in PSRT compared with MBSR and usual care (data in manuscript). At 26 weeks, 63.6% of the PSRT arm reported being pain free (0/10 pain) compared with 25.0% and 16.7% in MBSR and usual care arms, respectively. Psychophysiologic symptom relief therapy attendance was 76%, and there was 100% follow-up of all groups. CONCLUSION Psychophysiologic symptom relief therapy is a feasible and potentially highly beneficial treatment for patients with nonspecific back pain.
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Affiliation(s)
- Michael W. Donnino
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Garrett S. Thompson
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shivani Mehta
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Patricia Howard
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sofie B. Antonsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Lakshman Balaji
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne M. Bertisch
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Long H. Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Anne V. Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Kim SK, Park H. The Effect of Auricular Acupressure for Chronic Low Back Pain in Elders: A Randomized Controlled Study. Holist Nurs Pract 2021; 35:182-190. [PMID: 34115736 DOI: 10.1097/hnp.0000000000000457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic low back pain (CLBP) is a major problem throughout the world and getting worse because of population increase and aging. The cost of treatment increases as the population of people with CLBP increases. This study aimed to examine the effect of auricular acupressure (AA) on pain and disability in elders with chronic low back pain. The randomized, single-blinded, and placebo-controlled study was conducted on 51 elders with CLBP in South Korea from June 2019 to August 2019. The experimental group (n = 26) received AA on low back pain-related points, whereas the placebo control group (n = 25) received AA on points unrelated to low back pain. Participants received 6 weeks of AA in weekly cycles. Collected data were analyzed using IBM SPSS Statistics, version 25. Statistically significant differences between the 2 groups emerged in the visual analog scale (P < .001), pain threshold (P < .001), and Oswestry Disability Index (P < .001). This study showed that 6 weeks of AA improved CLBP and pain-related disability. Therefore, AA can be used as a noninvasive and self-managed alternative intervention for CLBP in older adults.
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Affiliation(s)
- Soo Kyoung Kim
- California Pacific Medical Center, San Francisco, California (Ms Kim); and College of Nursing, Ewha Womans University, Seoul, Republic of Korea (Ms Kim and Dr Park)
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Mummaneni PV, Bydon M, Knightly JJ, Alvi MA, Yolcu YU, Chan AK, Foley KT, Slotkin JR, Potts EA, Shaffrey ME, Shaffrey CI, Fu KM, Wang MY, Park P, Upadhyaya CD, Asher AL, Tumialan L, Bisson EF. Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database. J Neurosurg Spine 2021; 35:25-33. [PMID: 33962388 DOI: 10.3171/2020.11.spine201442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optimizing patient discharge after surgery has been shown to impact patient recovery and hospital/physician workflow and to reduce healthcare costs. In the current study, the authors sought to identify risk factors for nonroutine discharge after surgery for cervical myelopathy by using a national spine registry. METHODS The Quality Outcomes Database cervical module was queried for patients who had undergone surgery for cervical myelopathy between 2016 and 2018. Nonroutine discharge was defined as discharge to postacute care (rehabilitation), nonacute care, or another acute care hospital. A multivariable logistic regression predictive model was created using an array of demographic, clinical, operative, and patient-reported outcome characteristics. RESULTS Of the 1114 patients identified, 11.2% (n = 125) had a nonroutine discharge. On univariate analysis, patients with a nonroutine discharge were more likely to be older (age ≥ 65 years, 70.4% vs 35.8%, p < 0.001), African American (24.8% vs 13.9%, p = 0.007), and on Medicare (75.2% vs 35.1%, p < 0.001). Among the patients younger than 65 years of age, those who had a nonroutine discharge were more likely to be unemployed (70.3% vs 36.9%, p < 0.001). Overall, patients with a nonroutine discharge were more likely to present with a motor deficit (73.6% vs 58.7%, p = 0.001) and more likely to have nonindependent ambulation (50.4% vs 14.0%, p < 0.001) at presentation. On multivariable logistic regression, factors associated with higher odds of a nonroutine discharge included African American race (vs White, OR 2.76, 95% CI 1.38-5.51, p = 0.004), Medicare coverage (vs private insurance, OR 2.14, 95% CI 1.00-4.65, p = 0.04), nonindependent ambulation at presentation (OR 2.17, 95% CI 1.17-4.02, p = 0.01), baseline modified Japanese Orthopaedic Association severe myelopathy score (0-11 vs moderate 12-14, OR 2, 95% CI 1.07-3.73, p = 0.01), and posterior surgical approach (OR 11.6, 95% CI 2.12-48, p = 0.004). Factors associated with lower odds of a nonroutine discharge included fewer operated levels (1 vs 2-3 levels, OR 0.3, 95% CI 0.1-0.96, p = 0.009) and a higher quality of life at baseline (EQ-5D score, OR 0.43, 95% CI 0.25-0.73, p = 0.001). On predictor importance analysis, baseline quality of life (EQ-5D score) was identified as the most important predictor (Wald χ2 = 9.8, p = 0.001) of a nonroutine discharge; however, after grouping variables into distinct categories, socioeconomic and demographic characteristics (age, race, gender, insurance status, employment status) were identified as the most significant drivers of nonroutine discharge (28.4% of total predictor importance). CONCLUSIONS The study results indicate that socioeconomic and demographic characteristics including age, race, gender, insurance, and employment may be the most significant drivers of a nonroutine discharge after surgery for cervical myelopathy.
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Affiliation(s)
- Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohammed Ali Alvi
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yagiz U Yolcu
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Kevin T Foley
- 4Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 7Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 8Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Kai-Ming Fu
- 9Department of Neurological Surgery, Weill Cornell Medical College, New York City, New York
| | - Michael Y Wang
- 10Department of Neurologic Surgery, University of Miami, Florida
| | - Paul Park
- 11Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute's Spine Program; Saint Luke Health System, Kansas City, Missouri
| | - Anthony L Asher
- 13Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Luis Tumialan
- 14Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Erica F Bisson
- 15Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
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