Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

AbstractBackgroundPrehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery.ObjectiveThe objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease.DesignThis study was a randomized controlled trial.SettingThe study took place at 2 private spine clinics and 1 university hospital.PatientsWe prospectively enrolled 118 patients scheduled for lumbar fusion surgery.InterventionThe active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care.MeasurementsThe primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome.ResultsNo statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect (“Group × Time”) was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up.LimitationsThe participants’ preoperative level of disability was lower than normative values, which suggests selection bias.ConclusionsBoth interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.

Download Full-text

Return to Golf After Lumbar Fusion

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738116680200 ◽

2016 ◽

Vol 9 (3) ◽

pp. 280-284 ◽

Cited By ~ 3

Author(s):

Grant D. Shifflett ◽

Michael D. Hellman ◽

Philip K. Louie ◽

Christopher Mikhail ◽

Kevin U. Park ◽

...

Keyword(s):

Lumbar Fusion ◽

Case Series ◽

Return To Sport ◽

Leg Pain ◽

Level Of Evidence ◽

Fusion Surgery ◽

Telephone Contact ◽

Spinal Fusion Surgery ◽

Lumbar Fusion Surgery

Background: Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf. Hypothesis: Most golfers successfully return to sport after lumbar fusion surgery. Study Design: Case series. Level of Evidence: Level 4. Methods: All patients who underwent 1- or 2-level primary lumbar fusion surgery for degenerative pathologies performed by a single surgeon between January 2008 and October 2012 and had at least 1-year follow-up were included. Patients completed a specifically designed golf survey. Surveys were mailed, given during follow-up clinic, or answered during telephone contact. Results: A total of 353 patients met the inclusion and exclusion criteria, with 200 responses (57%) to the questionnaire producing 34 golfers. The average age of golfers was 57 years (range, 32-79 years). In 79% of golfers, preoperative back and/or leg pain significantly affected their ability to play golf. Within 1 year from surgery, 65% of patients returned to practice and 52% returned to course play. Only 29% of patients stated that continued back/leg pain limited their play. Twenty-five patients (77%) were able to play the same amount of golf or more than before fusion surgery. Of those providing handicaps, 12 (80%) reported the same or an improved handicap. Conclusion: More than 50% of golfers return to on-course play within 1 year of lumbar fusion surgery. The majority of golfers can return to preoperative levels in terms of performance (handicap) and frequency of play. Clinical Relevance: This investigation offers insight into when golfers return to sport after lumbar fusion surgery and provides surgeons with information to set realistic expectations postoperatively.

Download Full-text

RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain

European Spine Journal ◽

10.1007/s00586-011-2113-y ◽

2011 ◽

Vol 21 (7) ◽

pp. 1331-1337 ◽

Cited By ~ 16

Author(s):

Fiachra E. Rowan ◽

Natasha O’Malley ◽

Ashley Poynton

Keyword(s):

Lumbar Fusion ◽

Leg Pain ◽

Fusion Surgery ◽

Lumbar Fusion Surgery

Download Full-text

RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain. Rowan FE, O’Malley N, Poynton A. Eur Spine J 2011 Dec 14. [Epub ahead of print]

The Spine Journal ◽

10.1016/j.spinee.2012.02.024 ◽

2012 ◽

Vol 12 (2) ◽

pp. 172

Keyword(s):

Lumbar Fusion ◽

Leg Pain ◽

Fusion Surgery ◽

Lumbar Fusion Surgery

Download Full-text

Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders?

Journal of Neurosurgery Spine ◽

10.3171/2016.2.spine151472 ◽

2016 ◽

Vol 25 (3) ◽

pp. 352-356 ◽

Cited By ~ 11

Author(s):

Leah Y. Carreon ◽

Mladen Djurasovic ◽

John R. Dimar ◽

R. Kirk Owens ◽

Charles H. Crawford ◽

...

Keyword(s):

Rating Scales ◽

Short Form ◽

Lumbar Fusion ◽

Leg Pain ◽

Fusion Surgery ◽

Lumbar Fusion Surgery ◽

Sf 36 ◽

Patient Responses ◽

Linear Regression Modeling ◽

Anxiety Depression

OBJECTIVE Studies have shown that anxious or depressed patients may have poorer outcomes after lumbar fusion. These conclusions were drawn from questionnaires specifically designed to measure anxiety and depression. The objective of this study is to determine if responses to the EQ-5D anxiety/depression domain or the items used to calculate the 36-Item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) can predict outcomes after lumbar fusion surgery. METHODS Patients enrolled in the National Neurosurgery Quality and Outcomes Database from a single center with 1-year follow-up were identified. The outcomes collected include the Oswestry Disability Index (ODI), EQ-5D, SF-36, and the back- and leg-pain numeric rating scales (range 0–10). Linear regression modeling was performed to predict the 1-year ODI scores using the EQ-5D anxiety/depression domain and the 14 items used to calculate SF-36 MCS. RESULTS Complete data were available for 312 (88%) of 353 eligible patients. The mean patient age was 58.5 years, 175 (56%) patients were women, and 52 patients were smokers. After controlling for other factors, the item in the SF-36 that asks “Have you felt downhearted and depressed?” is the strongest predictor of the 1-year ODI score (r2 = 0.191; p = 0.000) and 1-year EQ-5D score (r2 = 0.205; p = 0.000). Neither the EQ-5D anxiety/depression domain nor the diagnoses of anxiety or depression were predictors of 1-year outcomes. CONCLUSIONS Patient responses to SF-36 item “Have you felt downhearted and depressed?” account for 20% of the variability of the 1-year ODI and EQ-5D scores and can be used by clinicians to screen for anxiety or depression in patients prior to lumbar fusion surgery. Clinicians may offer psychological support to these patients preoperatively in order to improve treatment outcomes.

Download Full-text

The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

European Spine Journal ◽

10.1007/s00586-021-06960-8 ◽

2021 ◽

Author(s):

Shane Shahrestani ◽

Andy Ton ◽

Xiao T. Chen ◽

Alexander M. Ballatori ◽

Jeffrey C. Wang ◽

...

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Single Level ◽

Lumbar Fusion Surgery

Download Full-text

Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network

Global Spine Journal ◽

10.1177/2192568220985470 ◽

2021 ◽

pp. 219256822098547

Author(s):

Nathan Evaniew ◽

Ganesh Swamy ◽

W. Bradley Jacobs ◽

Jacques Bouchard ◽

Roger Cho ◽

...

Keyword(s):

Back Pain ◽

Degenerative Disc Disease ◽

Short Form ◽

Lumbar Fusion ◽

Research Network ◽

Disc Disease ◽

Fusion Surgery ◽

Degenerative Disc ◽

Lumbar Fusion Surgery ◽

Related Quality

Study Design: Uncontrolled retrospective observational study. Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. Results: Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being “somewhat” or “extremely” satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. Conclusions: Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.

Download Full-text