1
|
Stephens BF, McKeithan LJ, Waddell WH, Romano J, Steinle AM, Vaughan WE, Pennings JS, Nian H, Khan I, Bydon M, Zuckerman SL, Archer KR, Abtahi AM. A clinical model to predict postoperative improvement in sub-domains of the modified Japanese Orthopedic Association score for degenerative cervical myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1265-1274. [PMID: 36877365 DOI: 10.1007/s00586-023-07607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/11/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The modified Japanese Orthopedic Association (mJOA) score consists of six sub-domains and is used to quantify the severity of cervical myelopathy. The current study aimed to assess for predictors of postoperative mJOA sub-domains scores following elective surgical management for patients with cervical myelopathy and develop the first clinical prediction model for 12-month mJOA sub-domain scores.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Byron F.] Last name [Stephens], Author 2 Given name: [Lydia J.] Last name [McKeithan], Author 3 Given name: [W. Hunter] Last name [Waddell], Author 4 Given name: [Anthony M.] Last name [Steinle], Author 5 Given name: [Wilson E.] Last name [Vaughan], Author 6 Given name: [Jacquelyn S.] Last name [Pennings], Author 7 Given name: [Jacquelyn S.] Last name [Pennings], Author 8 Given name: [Scott L.] Last name [Zuckerman], Author 9 Given name: [Kristin R.] Last name [Archer], Author 10 Given name: [Amir M.] Last name [Abtahi] Also, kindly confirm the details in the metadata are correct.Last Author listed should be Kristin R. Archer METHODS: A multivariable proportional odds ordinal regression model was developed for patients with cervical myelopathy. The model included patient demographic, clinical, and surgery covariates along with baseline sub-domain scores. The model was internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients. RESULTS The model identified mJOA baseline sub-domains to be the strongest predictors of 12-month scores, with numbness in legs and ability to walk predicting five of the six mJOA items. Additional covariates predicting three or more items included age, preoperative anxiety/depression, gender, race, employment status, duration of symptoms, smoking status, and radiographic presence of listhesis. Surgical approach, presence of motor deficits, number of surgical levels involved, history of diabetes mellitus, workers' compensation claim, and patient insurance had no impact on 12-month mJOA scores. CONCLUSION Our study developed and validated a clinical prediction model for improvement in mJOA scores at 12 months following surgery. The results highlight the importance of assessing preoperative numbness, walking ability, modifiable variables of anxiety/depression, and smoking status. This model has the potential to assist surgeons, patients, and families when considering surgery for cervical myelopathy. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA. .,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN, 37212, USA.
| | - Lydia J McKeithan
- Department of General Surgery, Vanderbilt University Medical Center, 1161 21st Ave S # D5203, Nashville, TN, 37232, USA
| | - W Hunter Waddell
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Joseph Romano
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Wilson E Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University, 2525 West End Ave ste 1100, Nashville, TN, 37203, USA
| | - Inamullah Khan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, 200 1st St SW Floor 8, Rochester, MN, 55905, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, The Village at Vanderbilt, 1500 21st Ave S Suite 1506, Nashville, TN, 37212, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, 3401 West End Ave Suite 380, Nashville, TN, 37203, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave S #3200, Nashville, TN, 37232, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| |
Collapse
|
2
|
Lin YT, Wang JS, Hsu WE, Lin YH, Wu YC, Chen KH, Pan CC, Lee CH. Correlation of Foraminal Parameters with Patient-Reported Outcomes in Patient with Degenerative Lumbar Foraminal Stenosis. J Clin Med 2023; 12:jcm12020479. [PMID: 36675407 PMCID: PMC9861602 DOI: 10.3390/jcm12020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
The relationship between quantitative anatomic parameters in MRI and patient-reported outcomes (PROs) before and after surgery in degenerative lumbar foraminal stenosis remains unknown. We included 58 patients who underwent transforaminal lumbar interbody fusion (TLIF) for single-level degenerative disc disease with foraminal stenosis between February 2013 and June 2020. PROs were evaluated using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). The foraminal parameters assessed using preoperative MRI included foraminal height, posterior intervertebral disc height, superior and inferior foraminal width, and foraminal area. The correlation between foraminal parameters and PROs before operation, at 1 year follow-up, and change from baseline were assessed. The associations between the aforementioned parameters were examined using linear regression analysis. The analysis revealed that among these parameters, superior foraminal width was found to be significantly correlated with ODI and EQ-5D at the 1 year follow-up and with change in ODI and EQ-5D from baseline. The associations remained significant after adjustment for confounding factors including age, sex, body mass index, and duration of hospital stay. The results indicated that in degenerative lumbar foraminal stenosis, decreased superior foraminal width was associated with better improvement in disability and quality of life after TLIF.
Collapse
Affiliation(s)
- Yu-Tsung Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Jun-Sing Wang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wei-En Hsu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yu-Hsien Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing, and Management, Miaoli 35664, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung 43304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 5101)
| |
Collapse
|
3
|
Jacob KC, Patel MR, Nie JW, Hartman TJ, Ribot MA, Parsons AW, Pawlowski H, Prabhu MC, Vanjani NN, Singh K. Presenting Mental Health Influences Postoperative Clinical Trajectory and Long-Term Patient Satisfaction After Lumbar Decompression. World Neurosurg 2022; 164:e649-e661. [PMID: 35577207 DOI: 10.1016/j.wneu.2022.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare patient-reported outcomes (PROMs), postoperative patient-reported satisfaction, and minimum clinically important difference (MCID) achievement after minimally invasive surgery lumbar decompression (MIS-LD) in patients stratified by their preoperative 12-Item Short-Form Mental Component Score (SF-12 MCS). METHODS Patients who underwent single-level/multilevel MIS-LD were included. PROMs were administered preoperatively and 6 weeks/12 weeks/6 months/1 year postoperatively. Patients were grouped by preoperative SF-12 MCS. Demographic/perioperative characteristics were compared among groups using a χ2 and Student t test for categorical and continuous variables, respectively. Mean PROM and postoperative satisfaction scores were compared using an unpaired Student t test. PROM improvement within cohorts was assessed with paired-samples t test. MCID achievement rates were compared using χ2 analysis. RESULTS A total of 297 patients were included: 111 patients in SF-12 MCS <48.9 and 186 patients in the SF-12 MCS ≥48.9 cohort. Cohorts showed mean postoperative differences for visual analog scale (VAS) back score at 12 weeks, VAS leg score at 6 weeks/12 weeks, Oswestry Disability Index (ODI) at 6 weeks/12 weeks, SF-12 MCS at all postoperative time points, and 12-Item Short-Form Physical Component Score at 6 weeks/12 weeks (P < 0.022, all). Of patients in the SF-12 MCS <48.9 cohort, more achieved MCID for SF-12 MCS at all postoperative time points and ODI at 1 year (P < 0.023, all). More patients in the SF-12 MCS ≥48.9 cohort achieved MCID for VAS leg score at 12 weeks and 12-Item Short-Form Physical Component Score at 6 weeks (P < 0.038). Patients in the SF-12 MCS <48.9 cohort showed inferior postoperative satisfaction for VAS leg score at 6 weeks/12 weeks/1 year, VAS back score at 12 weeks, and ODI at all postoperative time points. CONCLUSIONS Patients with inferior mental health preoperatively showed worse mean short-term postoperative clinical outcome for leg/back pain, physical function and disability, short-term and long-term postoperative satisfaction for leg pain and disability, and long-term satisfaction for sleeping/lifting/walking/standing/sex/travel.
Collapse
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
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Max A Ribot
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander W Parsons
- 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
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
| |
Collapse
|
4
|
The prevalence of depression in degenerative spine disease patients: A systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3417-3427. [PMID: 34476597 DOI: 10.1007/s00586-021-06977-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To estimate the prevalence of depression in degenerative spine disease (DSD) patients. METHODS The PubMed, EMBASE, and PsycINFO were systematically searched, the relevant studies that reported the depression prevalence of in DSD patients were identified. Data were extracted independently by 2 reviewers. Subgroup analysis and sensitivity analysis were also performed. RESULTS 24 articles met the inclusion criteria and were selected for the current study. The pooled prevalence estimate of depression in DSD patients before operative treatment was 30.8% [95% CI 24.0-38.5%]. Nine articles reported the prevalence rate in DSD patients after operative treatment, and the pooled prevalence estimate was 27.0% [95% CI 19.9-35.4%]. There were significant differences for prevalence estimates before operative treatment in types of disorders (Q = 4.56, P = 0.10), spine surgery history (Q = 5.55, P = 0.02), representativeness of sample (Q = 11.00, P = 0.00), and validity of assessment method (Q = 3.32, P = 0.07). The prevalence estimates in patients with lumbar spine stenosis, lumbar disc herniation and cervical spondylotic myelopathy were 24.0%, 40.9% and 37.3%, respectively. Studies that included patients with a history of spine surgery yielded a more extreme prevalence estimate than studies excluding those (36.9% vs 24.3%). For results of patients after operative treatment, significant differences for prevalence estimates were showed in different degrees of pain (Q = 4.72, P = 0.03), screening instruments (Q = 4.83, P = 0.09), and representativeness of sample (Q = 15.70, P = 0.00). CONCLUSION The systematic review indicated increased prevalence of depression in DSD patients. In consideration of the relationship between depression and poor surgical outcome, we should pay more attention to identifying strategies for preventing and treating depression in DSD patients.
Collapse
|
5
|
Strøm J, Bjerrum MB, Nielsen CV, Thisted CN, Nielsen TL, Laursen M, Jørgensen LB. Anxiety and depression in spine surgery-a systematic integrative review. Spine J 2018; 18:1272-1285. [PMID: 29649613 DOI: 10.1016/j.spinee.2018.03.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. PURPOSE We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. STUDY DESIGN An integrative literature review was carried out. METHODS The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings. RESULTS Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health. CONCLUSIONS Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.
Collapse
Affiliation(s)
- Janni Strøm
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark.
| | - Merete B Bjerrum
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Claus V Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark
| | - Cecilie N Thisted
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Tove L Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark; Department of Occupational Therapy, VIA University College, Hedeager 2 Aarhus N, 8200, Denmark
| | - Malene Laursen
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark
| | - Lene B Jørgensen
- Department of Clinical Medicine, Aarhus University, PalleJuul-Jensens Boulevard 82, Aarhus N, 8200, Denmark; Regional Hospitals of Central Denmark Region, Heibergsalle 1-4, 8800, Viborg, 8800, Denmark
| |
Collapse
|
6
|
Fritsch CG, Ferreira ML, Maher CG, Herbert RD, Pinto RZ, Koes B, Ferreira PH. The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies. 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 2016; 26:324-335. [DOI: 10.1007/s00586-016-4668-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
|