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Wang S, Hebert JJ, Abraham E, Vandewint A, Bigney E, Richardson E, El-Mughayyar D, Attabib N, Wedderkopp N, Kingwell S, Soroceanu A, Weber MH, Hall H, Finkelstein J, Bailey CS, Thomas K, Nataraj A, Paquet J, Johnson MG, Fisher C, Rampersaud YR, Dea N, Small C, Manson N. Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy. Sci Rep 2022; 12:11146. [PMID: 35778472 PMCID: PMC9249755 DOI: 10.1038/s41598-022-15169-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
This retrospective study of prospectively collected data aimed to identify unique pain and disability trajectories in patients following lumbar discectomy surgery. Patients of this study population presented chiefly with lumbar radiculopathy and underwent discectomy surgery from thirteen sites enrolled in the CSORN registry. Outcome variables of interest included numeric rating scales for leg/back pain and modified Oswestry disability index scores at baseline, 3, 12, and 24 months post-operatively. Latent class growth analysis was used to identify distinct courses in each outcome. Data from 524 patients revealed three unique trajectories for leg pain (excellent = 18.4%, good = 55.4%, poor = 26.3%), disability (excellent = 59.7%, fair = 35.6%, poor = 4.7%) and back pain (excellent = 13.0%, good = 56.4%, poor = 30.6%). Construct validity was supported by statistically significant differences in the proportions of patients attaining the criteria for minimal important change (MIC; 30%) or clinical success in disability (50% or Oswestry score ≤ 22) (p < 0.001). The variable proportions of patients belonging to poor outcome trajectories shows a disconnect between improved disability and persistence of pain. It will be beneficial to incorporate this information into the realm of patient expectation setting in concert with future findings of potential factors predictive of subgroup membership.
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Affiliation(s)
- Shuaijin Wang
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Jeffrey J Hebert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.
| | - Edward Abraham
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Canada East Spine Centre, Saint John, New Brunswick, Canada.,Saint John Orthopaedics, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amanda Vandewint
- Canada East Spine Centre, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Erin Bigney
- Canada East Spine Centre, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Eden Richardson
- Canada East Spine Centre, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada.,Canadian Spine Outcomes and Research Network, Markdale, ON, Canada
| | - Dana El-Mughayyar
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Canada East Spine Centre, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Najmedden Attabib
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Canada East Spine Centre, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,The Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark
| | | | - Alex Soroceanu
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - M H Weber
- McGill University, Montreal, QC, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joel Finkelstein
- Division of Orthopedics and Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Kenneth Thomas
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Andrew Nataraj
- Department of Surgery, Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | | | - Michael G Johnson
- Departments of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Canada
| | - Charles Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Nicolas Dea
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Chris Small
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Canada East Spine Centre, Saint John, New Brunswick, Canada.,Saint John Orthopaedics, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
| | - Neil Manson
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Canada East Spine Centre, Saint John, New Brunswick, Canada.,Saint John Orthopaedics, Saint John, New Brunswick, Canada.,Horizon Health Network, Saint John, New Brunswick, Canada
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Preoperative Patient Reported Outcomes Measurement Information System Scores Assist in Predicting Early Postoperative Success in Lumbar Discectomy. Spine (Phila Pa 1976) 2019; 44:325-333. [PMID: 30074972 DOI: 10.1097/brs.0000000000002823] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospective data. OBJECTIVE Determine whether patient reported outcome (PRO) data collected prior to lumbar discectomy predicts achievement of a minimal important difference (MID) after surgery. Compare ability of PRO and clinical information to predict achievement of MID in short term follow-up after discectomy. SUMMARY OF BACKGROUND DATA We investigated the ability of patient reported outcomes measurement information system (PROMIS) and clinical factors at the preoperative time point to determine patients achieving MID after surgery. METHODS PROMIS physical function (PF), pain interference (PI), and depression (D) scores were assessed at evaluation and follow-up for consecutive visits between February, 2015 and September, 2017. Patients with preoperative scores within 30 days prior to surgery and with scores 40 days or more after surgery who completed all PROMIS domains were included yielding 78 patients. MIDs were calculated using a distribution-based method. A multivariate logistic regression model was created, and the ability to predict achieving MID for each of the PROMIS domains was assessed. Cut-off values and prognostic probabilities were determined for this model and models combining preoperative PROMIS with clinical data. RESULTS Preoperative PROMIS scores modestly predict reaching MID after discectomy (areas under the curve [AUC] of 0.62, 0.68, and 0.76 for PF, PI, and D, respectively). Preoperative cut-off scores show patients who have PF and PI scores more than 2 standard deviations, and D more than 1.5 standard deviations worse-off than population mean are likely to achieve MID. The combination of PROMIS with clinical data was the most powerful predictor of reaching MID with AUCs of 0.87, 0.84, and 0.83 for PF, PI, and D. CONCLUSION PROMIS scores before discectomy modestly predict improvement after surgery. Preoperative PROMIS combined with clinical factors was more predictive of achieving MID than either clinical factors or PROMIS alone. LEVEL OF EVIDENCE 3.
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Minami K, Tamano R, Kasai E, Oyama H, Hasegawa M, Shinohara S, Asaki T. Effects of duloxetine on pain and walking distance in neuropathic pain models via modulation of the spinal monoamine system. Eur J Pain 2017; 22:355-369. [DOI: 10.1002/ejp.1125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- K. Minami
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - R. Tamano
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - E. Kasai
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - H. Oyama
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - M. Hasegawa
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - S. Shinohara
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
| | - T. Asaki
- Pain & Neuroscience, Drug Discovery & Disease Research Laboratory; Shionogi & Co., Ltd.; Toyonaka Osaka Japan
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Tschugg A, Löscher WN, Lener S, Wildauer M, Hartmann S, Neururer S, Thomé C. Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing. 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; 26:857-864. [PMID: 28004244 DOI: 10.1007/s00586-016-4891-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/17/2016] [Accepted: 11/17/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quantitative sensory testing (QST) gained popularity to evaluate the time course of recovery in sensory dysfunction and the results of different treatment options. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders. For this purpose, we hypothesised that there are also comparable differences in pain patterns in men and women after lumbar sequestrectomy using QST. METHODS We applied the QST protocol of the German Research Network on Neuropathic Pain in 53 patients (21 women and 32 men) with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: Beck-Depression-Inventory, Oswestry Disability Index, Core Outcome Measure Index, painDETECT-Questionnaire and EQ-5D thermometer. RESULTS Our analyses showed lower heat thresholds in females preoperatively, that adjusted to that of males 1 week postoperatively. Pressure pain thresholds were lower in women as well, but differed between genders throughout the study. Vibration perception deficits resolve earlier in female than in male patients. Both, women and men, had an excellent overall improvement, postoperatively. CONCLUSION Our results clearly revealed pre- and postoperative differences in pain perception between genders. These differences have to be taken into account in the evaluation of outcome between genders. Therefore, QST seems to be a good method to evaluate the time course of recovery after surgery.
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Affiliation(s)
- Anja Tschugg
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Wolfgang N Löscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Sara Lener
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria
| | - Sebastian Hartmann
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Claudius Thomé
- Departmen of Neurosurgery, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria
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