Lumbar Spinal Stability: Decision Making

In order to improve understanding of the complex interactions between spinal sub-systems (i.e., the passive (ligaments, discs, fascia and bones), the active (muscles and tendons) and the neural control systems), it is necessary to take a dynamic approach that incorporates the measurement of multiple systems concurrently. There are currently no reviews of studies that have investigated dynamic sagittal bending movements using a combination of electromyography (EMG) and lumbar kinematic measurements. As such it is not clear how understanding of spinal stability concepts has advanced with regards to this functional movement of the spine. The primary aim of this review was therefore to evaluate how such studies have contributed to improved understanding of lumbar spinal stability mechanisms. PubMed and Cochrane databases were searched using combinations of the keywords related to spinal stability and sagittal bending tasks, using strict inclusion and exclusion criteria and adhering to PRISMA guidelines. Whilst examples of the interactions between the passive and active sub-systems were shown, typically small sample sizes meant that results were not generalizable. The majority of studies used regional kinematic measurements, and whilst this was appropriate in terms of individual study aims, the studies could not provide insight into sub-system interaction at the level of the spinal motion segment. In addition, the heterogeneity in methodologies made comparison between studies difficult. The review suggests that since Panjabi’s seminal spinal control papers, only limited advancement in the understanding of these theories has been provided by the studies under review, particularly at an inter-segmental level. This lack of progression indicates a requirement for new research approaches that incorporate multiple system measurements at a motion segment level.

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Comparison of Three Measures of Shared Decision Making: SDM Process_4, CollaboRATE, and SURE Scales

Medical Decision Making ◽

10.1177/0272989x19855951 ◽

2019 ◽

Vol 39 (6) ◽

pp. 673-680 ◽

Cited By ~ 4

Author(s):

Suzanne Brodney ◽

Floyd J. Fowler ◽

Michael J. Barry ◽

Yuchiao Chang ◽

Karen Sepucha

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Quality ◽

Herniated Disc ◽

Shared Decision ◽

Patient Centered ◽

Patient Decision ◽

Patient Reported ◽

Patient Reported Measures ◽

Lumbar Spinal

Objective. If shared decision making (SDM) is to be part of quality assessment, it is necessary to have good measures of SDM. The purpose of this study is to compare the psychometric performance of 3 short patient-reported measures of SDM. Methods. Patients who met with a specialist to discuss possible surgery for hip or knee osteoarthritis (hips/knees), lumbar herniated disc, or lumbar spinal stenosis (backs) were surveyed shortly after the visit and again 6 months later. Some of the patients saw a patient decision aid (PDA) prior to the meeting. The 3 SDM measures were the SDM Process_4 (SDMP) survey, CollaboRATE, and SURE scale. The follow-up survey included measures of decision regret, satisfaction, and decision quality. Results. Patients in the sample ( N = 649) had a mean age of 63.3 years, 51% were female, 60% were college educated, and there were more hip/knee patients than back patients (69% v. 31%). Forty-nine percent had surgery. For hips/knees, the SDMP and SURE scores were significantly associated with viewing all of the PDA compared with those who did not ( P < 0.001), but not for CollaboRATE ( P = 0.35). For backs, none of the scores were significantly associated with viewing all the PDA. All 3 scores were significantly associated with less regret and higher satisfaction ( P < 0.001) for hips/knees. For backs, only SURE and CollaboRATE were significantly associated with less regret, and only SDMP was significantly associated with higher satisfaction. For hips/knees and backs, the SDMP and SURE scales were significantly associated with an informed patient-centered decision ( P < 0.001), but this relationship was not significant for CollaboRATE (hips/knees: P = 0.24; backs: P = 0.25). Discussion. Each measure has some evidence of validity. SURE and SDMP better discriminate the use of PDAs and have higher decision quality.

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Split–spinous process laminotomy and discectomy for degenerative lumbar spinal stenosis: a preliminary report

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.3.229 ◽

2007 ◽

Vol 6 (3) ◽

pp. 229-239 ◽

Cited By ~ 37

Author(s):

Der-Yang Cho ◽

Hung-Lin Lin ◽

Wen-Yuan Lee ◽

Han-Chung Lee

Keyword(s):

Back Pain ◽

Functional Outcomes ◽

Operative Time ◽

Spinous Process ◽

Spinal Stability ◽

Cross Sectional ◽

Lateral Recess ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal

Object The authors evaluated a new minimally invasive spinal surgery technique to correct degenerative lumbar spinal stenosis involving a split–spinous process laminotomy and discectomy (also known as the “Marmot operation”). Methods This prospective study randomized 70 patients with lumbar stenosis to undergo either a Marmot operation (40 patients), or a conventional laminectomy (30 patients), with or without discectomy. Spinal anteroposteri-or diameter, cross-sectional area, lateral recess distance, spinal stability, postoperative back pain, functional outcomes, and muscular trauma were evaluated. The follow up ranged from 10 to 18 months, with a mean of 15.1 months for the Marmot operation group and 14.8 months for the conventional laminectomy group. Compared with patients in the conventional laminectomy group, patients who received a Marmot operation had a shorter mean postoperative duration until ambulation without assistance, a reduced mean duration of hospital stay, a lower mean creatine phosphokinase–muscular-type isoenzyme level, a lower visual analog scale score for back pain at 1-year follow up, and a better recovery rate. These patients also had a longer mean duration of operative time and a greater mean blood loss compared with the conventional group. Satisfactory neurological decompression and symptom relief were achieved in 93% of these patients. Most of the patients (66%) in this group needed discectomy for decompression. The postoperative mean lateral recess width, spinal anteroposterior diameter, and cross-sectional area were all significantly increased. There was no evidence of spinal instability in any patient. One patient with insufficient lateral recess decompression and recurrent disc herniation needed additional conventional laminectomy and discectomy, and one patient with mild superficial wound infection was successfully treated with antibiotics and frequent dressing changes. Conclusions A Marmot operation may provide effective spinal decompression. Although this method requires more operative time than a conventional method, it may involve only minimal muscular trauma, spinal stability maintenance, and early mobilization; shorten the duration of hospital stay; reduce postoperative back pain; and provide satisfactory neurological and functional outcomes.

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