Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare?

2021 ◽  
pp. 155633162110104
Author(s):  
Christopher M. Brusalis ◽  
Roland Duculan ◽  
Frank P. Cammisa ◽  
Andrew A. Sama ◽  
Alexander P. Hughes ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Expectations ◽  
Leg Pain ◽  
Pain Patient ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Preoperative Expectations

Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a “Back > Leg” group that consisted of patients with back pain that was isolated or greater than leg pain, and a “Leg ≥ Back” group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0–100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain.

scholarly journals Profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in Kwa-Zulu Natal

2018 ◽  
Author(s):  
◽  
Jens Hillermann
Keyword(s):  
South Africa ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Surgical Management ◽  
Public Hospital ◽  
Surgical Intervention ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Orthopaedic Department

Purpose: Low Back Pain (LBP) is a leading cause of activity limitation and absence from work globally, and the treatment is often complicated and multifactorial. There is little documentation about the types of conditions requiring lumbar spine surgery in the public health care sector in South Africa (SA). The aim of this study was to develop a profile of lumbar spine conditions requiring surgical intervention in the Orthopaedic Department at a specialist public hospital in KwaZulu-Natal (KZN). Methods: This study utilised a descriptive, retrospective, clinical audit design. A total of 112 patient files meeting the study inclusion criteria were analysed and data was extracted and recorded on a data template. Permission to conduct the study was obtained from the KZN Department of Health, the Manager of the King Dinizulu Hospital and ethical approval was obtained from the Institutional Research Ethics committee. The data was analysed using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation). The data was described using means, standard deviations, percentages and count. Inferential statistical analysis was utilised to draw conclusions about populations from sample data. Chi-square and Fischer’s Exact test were used to compare categorical data with a statistical significance of p value ≤0.05. Results: The mean age of the patients was 41.7 years of age (range 3-76 years of age), with more females (55.4%, n = 62) than males (44.6%, n = 50) requiring surgery. More than half of the patients were Black Africans (55.4%, n = 62), with the majority (58%, n = 65) of all the patients being unemployed. Mechanical low back pain (MLBP) was the condition most often requiring surgical intervention (41.1%, n = 46) with lumbar stenosis being the most common diagnosis (17%, n = 19). This was followed by infective spondylitis (33.9%, n = 38). Frankel grading for neurological deficit was most often reported in patients with non-mechanical or infective causes of low back pain. Infective co-morbidity was (39.3%, n = 44) with 19.6% (n = 22) patients suffering from both tuberculosis (TB) and human immunodeficiency virus (HIV), 14.3% (n = 16) from TB alone and 5.4% (n = 6) with HIV/Acquired immunodeficiency syndrome alone. Most patients (91.1%, n = 102) received pre-surgical management consisting of medication either alone or in combination with other therapies such as physiotherapy, back braces, crutches and dietary intervention. The most common surgical procedure utilised was posterior spinal fusion (PSF) (43.8%, n = 49) either alone or in combination with other surgical procedures such as: decompression, biopsy and abscess drainage. This procedure alone was the favoured for non-mechanical LBP (NMLBP) (12.5%, n = 14), while PSF in combination with decompression was favoured the treatment for LBP of infective origin (15.2%, n = 17). Post-surgical management included medication (96.4%, n = 108) and physiotherapy (17%, n = 19); these were administered either individually or in combination. There were only six post- surgical complications; two were metal ware failure and four were infections. Of the four post- surgical infections, all of the patients had HIV/AIDS as a co-morbid condition. The trends suggest that the MLBP patients were predominantly older i.e. 40-69 years (82.6%, n = 38) and from the Indian race group (25.9%, n = 29). This was in contrast to the other types of LBP which predominately affected younger populations (i.e. 10-39 years) and Blacks. There were no differences in gender distribution for both MLBP and NMLBP. However, with LBP of infective origin, females were twice as much affected than males. Conclusion: The profile of lumbar spine conditions requiring surgical intervention at a public hospital is varied and there is a high prevalence of surgery for mechanical and infective cases of lumbar spine pain. Effective management of these conditions may reduce morbidity. Future studies should investigate the economic impact of lumbar spine surgery on health expenditure in South Africa.

scholarly journals Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

2016 ◽  
Vol 24 (3) ◽  
pp. 398-401 ◽  
Author(s):  
Sang-Hyun Han ◽  
Seung-Jae Hyun ◽  
Tae-Ahn Jahng ◽  
Ki-Jeong Kim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Surgical Treatment ◽  
Lumbar Spine ◽  
Pedicle Screws ◽  
Leg Pain ◽  
Low Back ◽  
Pedicle Fracture ◽  
Effective Option ◽  
Radiological Studies

Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.

scholarly journals Functional outcomes of intensive rehabilitation versus fusion surgery among patients with low back pain from lumbar spine degenerative disease: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Tito Guillermo D. Rejante ◽  
Kevin Paul Ferraris ◽  
Jose Carlos Alcazaren ◽  
Joseph Erroll Navarro ◽  
Kenny Seng
Keyword(s):  
Patient Outcome ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Leg Pain ◽  
Low Back ◽  
Fusion Surgery ◽  
Intensive Rehabilitation

Abstract Objective: The aim of this study is to compare the functional outcomes of intensive rehabilitation and lumbar spine fusion surgery among patients with chronic low back pain from lumbar spine degenerative disease.Methods: We did a systematic search of clinical trials on the topic followed by a meta-analysis using random effects model. The functional outcomes that were compared include Oswestry Disability Index score, improvement in low back pain and leg pain, as well as overall patient outcome.Results: Five randomized controlled trials were included in the meta-analysis. There was a 7.25 improvement in change in Oswestry Disability Index (95% CI 1.22-13.17; p=0.02; I2=98%) favoring fusion surgery. All studies showed improvement in low back pain with a VAS score change of 11.49 favoring fusion surgery (95% CI 4.48-18.50; p=0.001; I2=96%). There was a VAS score change of 7.2 improvement in leg pain (95% CI -8.58-22.97; p=0.37; I2=98%) however the effect was not significant. There was no significant difference in terms of overall patient outcome (95% CI 0.23-1.08; p=0.08; I2=78%).Conclusion: Among patients with chronic low back pain, lumbar spine fusion surgery showed improvement in functional outcomes of change in disability and low back pain when compared with intensive rehabilitation. However, the two treatment options showed no differences in terms of improvement of leg pain and overall patient outcome.

Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1037-1045 ◽  
Author(s):  
Clinton J Devin ◽  
Anthony L Asher ◽  
Kristin R Archer ◽  
Anshit Goyal ◽  
Inamullah Khan ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Return To Work ◽  
Spine Surgery ◽  
Important Determinant ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Predominant Symptom ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND The impact of symptom characteristics on outcomes of spine surgery remains elusive. OBJECTIVE To determine the impact of symptom location, severity, and duration on outcomes following lumbar spine surgery. METHODS We queried the Quality Outcomes Database (QOD) for patients undergoing elective lumbar spine surgery for lumbar degenerative spine disease. Multivariable regression was utilized to determine the impact of preoperative symptom characteristics (location, severity, and duration) on improvement in disability, quality of life, return to work, and patient satisfaction at 1 yr. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom. RESULTS A total of 22 022 subjects were analyzed. On adjusted analysis, we found patients with predominant leg pain were more likely to be satisfied (P < .0001), achieve minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to work (P = .03) at 1 yr following surgery without significant difference in Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal leg and back pain were more likely to be satisfied (P < .0001), but showed no significant difference in achieving MCID (P = .22) or return to work (P = .07). Baseline numeric rating scale-leg pain and symptom duration were most important predictors of achieving MCID and change in EQ-5D. Predominant symptom was not found to be an important determinant of return to work. Worker's compensation was found to be most important determinant of satisfaction and return to work. CONCLUSION Predominant symptom location is a significant determinant of functional outcomes following spine surgery. However, pain severity and duration have higher predictive importance. Return to work is more dependent on sociodemographic features as compared to symptom characteristics.

scholarly journals Evaluation of Dram Score as a Predictor of Poor Postoperative Outcome in Spine Surgery

2020 ◽  
Vol 9 (12) ◽  
pp. 3825
Author(s):  
Antonio Serrano-García ◽  
Manuel Fernández-González ◽  
Jesús Betegón-Nicolás ◽  
Julio Villar-Pérez ◽  
Ana Lozano-Muñoz ◽  
...  
Keyword(s):  
Mental Health ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Health ◽  
Spine Surgery ◽  
Short Form ◽  
Postoperative Outcome ◽  
Assessment Method ◽  
Leg Pain ◽  
Low Back

The Distress Risk Assessment Method (DRAM) was presented by Main, Wood and Hillis in 1992 as a simple means of assessing the risk of failure due to psychosocial factors in spine surgery. To our knowledge, it has not been used in our setting. The aim of this study was to analyse the usefulness of the Spanish translation of this instrument to predict poor outcomes. Methods: A prospective blind study was conducted including 65 patients undergoing spine surgery. We created two groups of patients based on DRAM score: not distressed (NDRAM) or distressed (DDRAM). A visual analogue scale for pain and the 12-Item Short Form Health Survey (SF-12) were used at baseline, 6 weeks and 6 months. Results: 24 patients were classified as DDRAM and 38 as NDRAM, with 3 patients not completing the questionnaires. The analysis found no significant differences in the demographic or clinical variables at baseline. At 6 weeks and 6 months, the NDRAM group showed improvements in low back pain (p < 0.001; p = 0.005), leg pain (p < 0.001; p = 0.017), physical health (p = 0.031; p = 0.003) and mental health (p = 0.137; p = 0.049). In contrast, in the DDRAM group, though leg pain score improved (p < 0.001; p = 0.002), there was no improvement at 6 weeks or 6 months in low back pain (p = 0.108; p = 0.287), physical health (p = 0.620; p = 0.263) or mental health (p = 0.185; p = 0.329). Conclusions: In our setting, the DRAM is a useful screening tool, and it has allowed the creation of a program between psychiatry and spine surgery.

scholarly journals Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies

2016 ◽  
Vol 59 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Clémence Palazzo ◽  
Evelyne Klinger ◽  
Véronique Dorner ◽  
Abdelmajid Kadri ◽  
Olivier Thierry ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
New Technologies ◽  
Exercise Program ◽  
Patient Expectations ◽  
Pain Patient ◽  
Low Back ◽  
Home Based ◽  
Program Adherence

scholarly journals Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

2016 ◽  
Vol 25 (6) ◽  
pp. 689-696 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Jing L. Han ◽  
Joseph Cheng ◽  
Isaac Karikari ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Lumbar Interbody Fusion ◽  
Longitudinal Assessment ◽  
Sf 36

OBJECTIVE With the recent passage of the Patient Protection and Affordable Care Act, there has been a dramatic shift toward critical analyses of quality and longitudinal assessment of subjective and objective outcomes after lumbar spine surgery. Accordingly, the emergence and routine use of real-world institutional registries have been vital to the longitudinal assessment of quality. However, prospectively obtaining longitudinal outcomes for patients at 24 months after spine surgery remains a challenge. The aim of this study was to assess if 12-month measures of treatment effectiveness accurately predict long-term outcomes (24 months). METHODS A nationwide, multiinstitutional, prospective spine outcomes registry was used for this study. Enrollment criteria included available demographic, surgical, and clinical outcomes data. All patients had prospectively collected outcomes measures and a minimum 2-year follow-up. Patient-reported outcomes instruments (Oswestry Disability Index [ODI], SF-36, and visual analog scale [VAS]-back pain/leg pain) were completed before surgery and then at 3, 6, 12, and 24 months after surgery. The Health Transition Index of the SF-36 was used to determine the 1- and 2-year minimum clinically important difference (MCID), and logistic regression modeling was performed to determine if achieving MCID at 1 year adequately predicted improvement and achievement of MCID at 24 months. RESULTS The study group included 969 patients: 300 patients underwent anterior lumbar interbody fusion (ALIF), 606 patients underwent transforaminal lumbar interbody fusion (TLIF), and 63 patients underwent lateral interbody fusion (LLIF). There was a significant correlation between the 12- and 24-month ODI (r = 0.82; p < 0.0001), SF-36 Physical Component Summary score (r = 0.89; p < 0.0001), VAS-back pain (r = 0.90; p < 0.0001), and VAS-leg pain (r = 0.85; p < 0.0001). For the ALIF cohort, patients achieving MCID thresholds for ODI at 12 months were 13-fold (p < 0.0001) more likely to achieve MCID at 24 months. Similarly, for the TLIF and LLIF cohorts, patients achieving MCID thresholds for ODI at 12 months were 13-fold and 14-fold (p < 0.0001) more likely to achieve MCID at 24 months. Outcome measures obtained at 12 months postoperatively are highly predictive of 24-month outcomes, independent of the surgical procedure. CONCLUSIONS In a multiinstitutional prospective study, patient-centered measures of surgical effectiveness obtained at 12 months adequately predict long-term (24-month) outcomes after lumbar spine surgery. Patients achieving MCID at 1 year were more likely to report meaningful and durable improvement at 24 months, suggesting that the 12-month time point is sufficient to identify effective versus ineffective patient care.

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