An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgical decompression to prevent bladder, bowel, and sexual dysfunction that can have significant impact on quality of life. There is a paucity of data relating to the prevalence of these long-term complications. Objective: The aim of this observational study was to evaluate the long-term prevalence of CES-related bladder, bowel, and sexual dysfunction and impact on quality of life to inform service provision. Methods: Participants were selected through coding of operative records of patients who underwent lumbar decompression for CES secondary to a herniated intervertebral disc at two large UK neurosurgical departments between 2011 and 2015 inclusive. A telephone-based survey including both validated and modified tools was used to collect data pertaining to bladder, bowel, and sexual function and impact on quality of life both before development of CES and at the time of the survey, at least 1 year postoperatively. Results: Of 135 patients contacted, 71 (42 male, 29 female) responded. Post-CES compared to pre-CES, there was higher prevalence and significant intrarespondent deterioration of bowel dysfunction, bladder dysfunction, perception of bladder function, sexual function, effect of back pain on sex life, and activities of daily living/quality of life (p < .0001 for all). Significant differences in individual questions pre-CES versus post-CES were also found. Conclusion: We show high prevalence of long-term bowel, bladder, and sexual dysfunction post-CES, with functional and psychosocial consequences. Our results demonstrate the need for preoperative information and subsequent screening and long-term multidisciplinary support for these complications.

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P84 Cauda equina syndrome – an assessment of long-term outcomes following surgery

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.141 ◽

2019 ◽

Vol 90 (3) ◽

pp. e43.4-e44

Author(s):

JE Hazelwood ◽

I Hoeritzauer ◽

A Demetriades

Keyword(s):

Physical Function ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Bowel Dysfunction ◽

Long Term Outcomes ◽

Symptom Profile ◽

Post Operative Pain ◽

Current Symptom ◽

Physical Dysfunction

ObjectivesData regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce, especially concerning bowel and sexual function. This study aimed to assess long-term bladder, bowel, sexual and physical function in a CES cohort.DesignDescriptive.SubjectsA pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013-November 2014.MethodsPatients were contacted over a one month period and completed validated questionnaires via telephone. These assessed bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual (Arizona Sexual Experiences Scale) and physical function (SF-12). Patients were also asked which of their current symptoms they would most value treatment for and which NHS services they had accessed post-operatively.ResultsForty-six of 77 patients (response rate 72%, inclusion rate 59%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 41% with the majority (87%) reporting very minor symptoms, sexual dysfunction 39% and physical dysfunction 48%. Pain was the most deleterious current symptom in 57% but only 7% reported post-operative pain-management referral.ConclusionsThese findings confirm the high prevalence of long-term bladder, bowel, sexual and physical dysfunction in CES patients and provide useful data to guide the expectations of patients and clinicians.

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Long-term rates of bladder dysfunction after decompression in patients with cauda equina syndrome

The Spine Journal ◽

10.1016/j.spinee.2021.01.002 ◽

2021 ◽

Author(s):

Henry Seidel ◽

Sarah Bhattacharjee ◽

Sean Pirkle ◽

Lewis Shi ◽

Jason Strelzow ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Bladder Dysfunction ◽

Cauda Equina

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Association of Patient-Reported Narcotic Use With Short- and Long-Term Outcomes After Adult Spinal Deformity Surgery

Spine ◽

10.1097/brs.0000000000002631 ◽

2018 ◽

Vol 43 (19) ◽

pp. 1340-1346 ◽

Cited By ~ 3

Author(s):

Micheal Raad ◽

Amit Jain ◽

Brian J. Neuman ◽

Hamid Hassanzadeh ◽

Munish C. Gupta ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Long Term Outcomes ◽

Patient Reported ◽

Spinal Deformity Surgery ◽

Short And Long Term

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The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity

Journal of Neurosurgery Spine ◽

10.3171/2017.10.spine17830 ◽

2018 ◽

Vol 29 (1) ◽

pp. 68-74 ◽

Cited By ~ 2

Author(s):

Micheal Raad ◽

Brian J. Neuman ◽

Amit Jain ◽

Hamid Hassanzadeh ◽

Peter G. Passias ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Activity Levels ◽

Long Term Outcomes ◽

Short Term ◽

Level Of Activity ◽

Patient Reported ◽

Active Patients ◽

Inactive Group

OBJECTIVEGiven the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity.METHODSThis is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively.RESULTSA total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001).CONCLUSIONSThe authors’ results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients’ preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.

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Total Hip Arthroplasty in Young Patients with Post-Traumatic Arthritis of the Hip

Hip International ◽

10.5301/hipint.5000499 ◽

2017 ◽

Vol 27 (6) ◽

pp. 546-550 ◽

Cited By ~ 4

Author(s):

Ishaan Swarup ◽

Ryan Sutherland ◽

Jayme C. Burket ◽

Mark P. Figgie

Keyword(s):

Patient Reported Outcomes ◽

Young Patients ◽

Implant Survival ◽

Long Term Outcomes ◽

Patient Reported ◽

Revision Tha ◽

Post Traumatic ◽

Traumatic Arthritis

Background Post-traumatic arthritis of the hip is a degenerative condition that commonly affects young patients. In this study, we evaluate long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients aged 35 or younger with post-traumatic arthritis of the hip. Methods We conducted a retrospective study with follow-up. A chart review was performed to identify young patients with post-traumatic arthritis of the hip treated with primary THA. Follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Implant survival was assessed using Kaplan-Meier survival analysis, and patient outcomes were determined using the hip disability and osteoarthritis outcome score (HOOS). Results We studied 42 patient s (44 THAs) with a mean time to follow-up of 14 years. The 10-year implant survival rate was 87% and 20-year implant survival rate was 41%. Implant survival did not differ based on patient age, gender, implant type, bearing surface, or use of cement for implant fixation (p>0.05). The mean HOOS scores at follow-up were 87 for pain, 85 for symptoms, 89 for ADLs, and 76 for sports. HOOS scores were significantly worse in patients that had undergone revision THA (p<0.05). Conclusions Young patients with post-traumatic arthritis of the hip have good long-term outcomes after THA. However, revision THA is predictive of worse long-term outcomes.

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Evaluation of Long-term Outcomes Following Plantar Fasciotomy

Foot & Ankle International ◽

10.1177/1071100718788546 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1312-1319 ◽

Cited By ~ 3

Author(s):

Rebekah Gibbons ◽

Katherine E. Mackie ◽

Todd Beveridge ◽

Dana Hince ◽

Peter Ammon

Keyword(s):

Patient Satisfaction ◽

Plantar Fasciitis ◽

Satisfaction Score ◽

Satisfaction Survey ◽

Long Term Outcomes ◽

Short Term ◽

Patient Reported ◽

Plantar Fasciotomy

Background: Plantar fasciitis is a common condition prevalent in both athletic and nonathletic populations. Approximately 10% of patients do not respond to conservative treatment and suffer chronic recalcitrant plantar fasciitis. Outcomes following plantar fasciotomy vary but short-term studies have reported excellent early pain relief and return to activity, and significant improvements in symptoms. Previous study limitations include small patient cohorts, short-term duration of follow-up or lack of validated outcome measures. We therefore aimed to investigate the long-term outcomes following complete plantar fasciotomy. Methods: Patients who underwent complete plantar fasciotomy surgery from a single surgeon within the past 10 years (minimum 7 months) were invited to participate in this retrospective survey study. To evaluate patient-reported function, participants were asked to complete the Foot and Ankle Outcome Score (FAOS). To assess subjective outcome, the participants were provided a satisfaction survey. The satisfaction survey was designed to include the 3 key factors for assessing postoperative patient satisfaction, which are preoperative expectations, symptom relief, and hospital experience. A total of 74 questionnaires were returned. Results: The median global satisfaction score was 85.4 (IQR=37.5) points out of 100. Significant correlations between the global patient satisfaction score and all FAOS subscale scores were identified. Only 3 participants (4%) reported a complication following surgery; however, 32 participants (44.4%) indicated that they still experienced swelling and/or tenderness in their foot at the time of the survey (mean follow-up time 4.8 ± 2.8 years) but for the majority of patients this was improved from before surgery. Conclusion: Long-term patient satisfaction was experienced by the majority of patients following plantar fasciotomy. Although 44% of patients continue to have postoperative complaints, 73% indicated that they were satisfied with their symptoms postoperatively, and 74% would undergo a similar procedure again. Level of Evidence: Level IV, case series.

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Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population

Hand ◽

10.1177/1558944719901319 ◽

2020 ◽

pp. 155894471990131

Author(s):

Erin F. Ransom ◽

Heather L. Minton ◽

Bradley L. Young ◽

Jun Kit He ◽

Brent A. Ponce ◽

...

Keyword(s):

Thoracic Outlet Syndrome ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Patient Reported Outcome ◽

Long Term Outcomes ◽

Neurogenic Thoracic Outlet Syndrome ◽

Patient Reported ◽

Data Points

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

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Infographic: Long-term core outcomes in cauda equina syndrome

The Bone & Joint Journal ◽

10.1302/0301-620x.103b9.bjj-2021-1152 ◽

2021 ◽

Vol 103-B (9) ◽

pp. 1462-1463

Author(s):

T. P. Barker ◽

N. Steele ◽

G. Swamy ◽

A. Cook ◽

A. Rai ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Core Outcomes

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Outcomes associated with secondary implant removal and arthrolysis in patients with a painful stiff shoulder after proximal humeral fracture fixation

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0675.r1 ◽

2022 ◽

Vol 104-B (1) ◽

pp. 157-167

Author(s):

Navnit S. Makaram ◽

Ewan B. Goudie ◽

C. Michael Robinson

Keyword(s):

Proximal Humerus ◽

Plate Fixation ◽

Multivariable Analysis ◽

Long Term Results ◽

Long Term Outcomes ◽

Patient Reported ◽

Long Term Follow Up ◽

Manual Occupation

Aims Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. Methods Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM), Oxford Shoulder Score (OSS), and EuroQol five-dimension three-level questionnaire (EQ-5D-3L) were recorded preoperatively and postoperatively. Results A total of 138 patients underwent ADROM; 111 patients were available for long-term follow-up at a mean of 10.9 years (range 1 to 20). Mean age was 50.8 years (18 to 75);79 (57.2%) were female. Mean time from primary ORPF to ADROM was 11.9 months (6 to 19). Five patients developed superficial wound infection; ten developed symptomatic osteonecrosis/post-traumatic arthrosis (ON/PTA); four underwent revision arthrolysis. Median OSS improved from 17 (interquartile range (IQR) 12.0 to 22.0) preoperatively to 40.0 (IQR 31.5 to 48.0) postoperatively, and 39.0 (IQR 31.5 to 46.5) at long-term follow-up (p < 0.001). Median EQ-5D-3L improved from 0.079 (IQR -0.057 to 0.215) to 0.691 (IQR 0.441 to 0.941) postoperatively, and 0.701 (IQR 0.570 to 0.832) at long-term follow-up (p < 0.001). We found that aROM improved in all planes (p < 0.001). Among the variables assessed on multivariable analysis, a manual occupation, worsening Charlson Comorbidity Index and increasing socioeconomic deprivation were most consistently predictive of worse patient-reported outcome scores. Patients who subsequently developed ON/PTA reported significantly worse one-year and late OSS. Conclusion ADROM in patients with persistent symptomatic stiffness following ORPF can achieve excellent short- and long-term outcomes. More deprived patients, those in a manual occupation, and those with worsening comorbidities have worse outcomes following ADROM. Cite this article: Bone Joint J 2022;104-B(1):157–167.

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