Postoperative Outcomes After Degenerative Lumbar Spine Surgery in Rheumatoid Arthritis Patients -a Propensity Score-matched Analysis

Abstract Background. Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis.Methods. Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups.Results. Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p=0.008) and EQ-5D (0.640 vs. 0.738, p=0.03), although these differences were not significant between RA and non-RA patients not on steroids.Conclusions. RA patients showed worse postoperative outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.

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Correlation between the Oswestry Disability Index and the 4-item short forms for physical function and pain interference from PROMIS

Journal of Neurosurgery Spine ◽

10.3171/2019.5.spine19400 ◽

2019 ◽

Vol 31 (5) ◽

pp. 691-696 ◽

Cited By ~ 1

Author(s):

Timothy J. Yee ◽

Brandon W. Smith ◽

Jacob R. Joseph ◽

Yamaan S. Saadeh ◽

Jay K. Nathan ◽

...

Keyword(s):

Lumbar Spine ◽

Physical Function ◽

Spine Surgery ◽

Oswestry Disability Index ◽

Short Form ◽

Pearson Correlation ◽

Pain Interference ◽

Lumbar Spine Surgery ◽

Time Points ◽

Patient Reported

OBJECTIVEThe Oswestry Disability Index (ODI) is one of the most commonly used patient-reported outcome instruments, but completion of this 10-question survey can be cumbersome. Tools from the Patient-Reported Outcomes Measurement Information System (PROMIS) are an alternative, and potentially more efficient, means of assessing physical, mental, and social outcomes in spine surgery. Authors of this retrospective study assessed whether scores on the 4-item surveys of function and pain from the PROMIS initiative correlate with those on the ODI in lumbar spine surgery.METHODSPatients evaluated in the adult neurosurgery spine clinic at a single institution completed the ODI, PROMIS Short Form v2.0 Physical Function 4a (PROMIS PF), and PROMIS Short Form v1.0 Pain Interference 4a (PROMIS PI) at various time points in their care. Score data were retrospectively analyzed using linear regressions with calculation of the Pearson correlation coefficient.RESULTSThree hundred forty-three sets of surveys (ODI, PROMIS PF, and PROMIS PI) were obtained from patients across initial visits (n = 147), 3-month follow-ups (n = 107), 12-month follow-ups (n = 52), and 24-month follow-ups (n = 37). ODI scores strongly correlated with PROMIS PF t-scores at baseline (r = −0.72, p < 0.0001), 3 months (r = −0.79, p < 0.0001), 12 months (r = −0.85, p < 0.0001), and 24 months (r = −0.89, p < 0.0001). ODI scores also correlated strongly with PROMIS PI t-scores at baseline (r = 0.71, p < 0.0001), at 3 months (r = 0.82, p < 0.0001), at 12 months (r = 0.86, p < 0.0001), and at 24 months (r = 0.88, p < 0.0001). Changes in ODI scores moderately correlated with changes in PROMIS PF t-scores (r = −0.68, p = 0.0003) and changes in PROMIS PI t-scores (r = 0.57, p = 0.0047) at 3 months postoperatively.CONCLUSIONSA strong correlation was found between the ODI and the 4-item PROMIS PF/PI at isolated time points for patients undergoing lumbar spine surgery. Large cohort studies are needed to determine longitudinal accuracy and precision and to assess possible benefits of time savings and improved rates of survey completion.

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Is the Hospital Anxiety and Depression Scale Associated With Outcomes After Lumbar Spine Surgery?

Global Spine Journal ◽

10.1177/2192568219845662 ◽

2019 ◽

Vol 10 (3) ◽

pp. 266-271 ◽

Cited By ~ 1

Author(s):

Leah Y. Carreon ◽

Annette B. Jespersen ◽

Christian C. Støttrup ◽

Karen H. Hansen ◽

Mikkel O. Andersen

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Short Form ◽

Depression Scale ◽

Leg Pain ◽

Anxiety And Depression ◽

Lumbar Spine Surgery ◽

Consecutive Series ◽

Medical Patients ◽

Hospital Anxiety

Study Design:Longitudinal cohort.Objectives:The Hospital Anxiety and Depression Scale (HADS) was developed to provide clinicians a reliable, valid, and practical tool to identify and quantify the anxiety and depression in medical patients. Several studies have shown that patients with chronic low back pain may have subclinical depression and impairments in mental health and that these in turn may lead to less than optimal results after lumbar spine surgery. The purpose of this study is to determine if there are associations between preoperative HADS and differences in pre- and postoperative health-related quality-of-life (HRQOLs) scores after spine surgery.Methods:From a single center, a consecutive series of patients completed the HADS, Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain. Except for HADS, the patients completed the same HRQOLs 1 year after surgery.Results:Of 308 eligible cases, 208 (68%) had follow-up data available and were included in the analysis. Patients in the HADS-Anxiety (HADS-A) Abnormal category had the worst preoperative HRQOLs but had the greatest improvement in 1-year postoperative scores. Except for VAS Leg Pain, preoperative HRQOLs were better in patients in the HADS-Depressed (HADS-D) Normal category. Patients in the HADS-D Abnormal category had statistically significantly greater improvement in 1-year postoperative EQ-5D and ODI scores when compared with the other cohorts.Conclusion:Worse HADS-A and HADS-D scores are associated with worse preoperative HRQOL scores in patients with lumbar degenerative disorders scheduled for spine surgery. However, similar improvements in HRQOLs can be expected 1 year postoperative regardless of the patients’ HADS scores.

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The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: Three- and Twelve-Month Results

Neurosurgery ◽

10.1093/neuros/nyz310_115 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Juneyoung L Chavez ◽

Christina A Porucznik ◽

Lisa H Gren ◽

Jian Guan ◽

Evan Joyce ◽

...

Keyword(s):

Lumbar Spine ◽

Treatment Group ◽

Spine Surgery ◽

Stress Reduction ◽

Postoperative Outcomes ◽

Prescription Opioid ◽

Lumbar Spine Surgery ◽

Opioid Use ◽

Patient Reported ◽

Change In Mean

Abstract INTRODUCTION Prescription opioids negatively affect postoperative outcomes after lumbar spine surgery, and according to the CDC, the drug overdose epidemic has been exacerbated by the involvement of prescription medications. Thus, alternatives for pain control are imperative. Mindfulness-based stress reduction (MBSR) has been associated with improved activity, mood, walking, and work in opioid-using chronic pain patients. Prospective studies utilizing preoperative MBSR to impact postoperative outcomes in degenerative lumbar spine surgery are lacking. METHODS The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. A total of 3- and 12-mo postoperative patient-reported outcomes for pain, disability, quality of life, and prescription opioid use were compared. Univariate linear regression was used to assess if MBSR use was a significant predictor of outcomes. RESULTS At 3 mo, follow-up was 87.5% and 95.8% in the comparison and treatment groups, respectively. Mean ODI was significantly lower (P = .032), mean PROMIS-PF was significantly higher (P = .002), and mean PROMIS-PI was significantly lower (P = .025) in the treatment group. Also, change in mean PROMIS-PF and change in mean PROMIS-PI were significantly greater (P = .002, P = .038). MBSR use was a significant predictor of change in PROMIS-PF (P = .003). At 12 mo, follow-up was 58.3% and 83.3% in the comparison and treatment groups, respectively. Mean PROMIS-PI was significantly lower (P = .011) and change in mean PROMIS-PI was significantly greater (P = .003) in the treatment group. MBSR use was a significant predictor of change in PROMIS-PI (P = .004). CONCLUSION At 3 mo, the treatment group experienced significantly lower disability, higher physical function, and lower pain interference. At 12 mo, only lower pain interference persisted. Further clinical trials are needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.

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Diabetes is associated with greater leg pain and worse patient-reported outcomes at 1 year after lumbar spine surgery

Scientific Reports ◽

10.1038/s41598-021-87615-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kosei Nagata ◽

Hideki Nakamoto ◽

Masahiko Sumitani ◽

So Kato ◽

Yuichi Yoshida ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Postoperative Recovery ◽

Diabetic Group ◽

Leg Pain ◽

Lumbar Spine Surgery ◽

Patient Reported ◽

Patients With Diabetes ◽

The Impact

AbstractAlthough patients with diabetes reportedly have more back pain and worse patient-reported outcomes than those without diabetes after lumbar spine surgery, the impact of diabetes on postoperative recovery in pain or numbness in other regions is not well characterized. In this study, the authors aimed to elucidate the impact of diabetes on postoperative recovery in pain/numbness in four areas (back, buttock, leg, and sole) after lumbar spine surgery. The authors retrospectively reviewed 993 patients (152 with diabetes and 841 without) who underwent decompression and/or fixation within three levels of the lumbar spine at eight hospitals during April 2017–June 2018. Preoperative Numerical Rating Scale (NRS) scores in all four areas, Oswestry Disability Index (ODI), and Euro quality of life 5-dimension (EQ-5D) were comparable between the groups. The diabetic group showed worse ODI/EQ-5D and greater NRS scores for leg pain 1 year after surgery than the non-diabetic group. Although other postoperative NRS scores tended to be higher in the diabetic group, the between-group differences were not significant. Diabetic neuropathy caused by microvascular changes may induce irreversible nerve damage especially in leg area. Providers can use this information when counseling patients with diabetes about the expected outcomes of spine surgery.

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The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyaa427 ◽

2020 ◽

Author(s):

Oliver G S Ayling ◽

Tamir Ailon ◽

John T Street ◽

Nicolas Dea ◽

Greg McIntosh ◽

...

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Short Form ◽

Research Network ◽

Lumbar Spine Surgery ◽

Degenerative Disorders ◽

Patient Reported ◽

Euroqol 5D

Abstract BACKGROUND Perioperative adverse events (AEs) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. OBJECTIVE To examine perioperative AEs and their impact on outcome after lumbar spine surgery. METHODS A total of 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3, 12, and 24 mo postoperatively included the Owestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary scales, visual analog scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction. RESULTS AEs occurred in 767 (21.6%) patients, and 85 (2.4%) patients suffered major AEs. Patients with major AEs had worse ODI scores and did not reach minimum clinically important differences at 2 yr (no AE: 25.7 ± 19.2, major: 36.4 ± 19.1, P < .001). Major AEs were associated with worse ODI scores on multivariable linear regression (P = .011). PCS scores were lower after major AEs (43.8 ± 9.5, vs 37.7 ± 20.3, P = .002). On VAS leg and back and EQ5D, the 2-yr outcomes were significantly different between the major and no AE groups (<0.01), but these differences were small (VAS leg: 3.4 ± 3.0 vs 4.0 ± 3.3; VAS back: 3.5 ± 2.7 vs 4.5 ± 2.6; EQ5D: 0.75 ± 0.2 vs 0.64 ± 0.2). SF12 MCS scores were not different. Rates of satisfaction were lower after major AEs (no AE: 84.6%, major: 72.3%, P < .05). CONCLUSION Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing AEs.

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Current Prehabilitation Programs Do Not Improve the Postoperative Outcomes of Patients Scheduled for Lumbar Spine Surgery: A Systematic Review With Meta-analysis

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2021.9748 ◽

2020 ◽

pp. 1-47

Author(s):

Esther R.C. Janssen ◽

Ilona M. Punt ◽

Michel J. Clemens ◽

Bart J. Staal ◽

Thomas J. Hoogeboom ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Spine Surgery ◽

Meta Analysis ◽

Postoperative Outcomes ◽

Lumbar Spine Surgery

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Patient-reported outcomes in lumbar spine surgery

Nigerian Journal of Medicine ◽

10.4103/njm.njm_208_20 ◽

2021 ◽

Vol 30 (4) ◽

pp. 353

Author(s):

ObinnaHenry Obiegbu

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Patient Reported

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124. The Minimum Clinically Important Difference in Lumbar Spine Surgery Patients: A Choice of Methods Using the Oswestry Disability Index, MOS Short Form-36, and Pain Scales

The Spine Journal ◽

10.1016/j.spinee.2007.07.147 ◽

2007 ◽

Vol 7 (5) ◽

pp. 60S ◽

Cited By ~ 1

Author(s):

Anne Copay ◽

Steven Glassman ◽

Brian Subach ◽

Sigurd Berven ◽

Thomas Schuler ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Oswestry Disability Index ◽

Short Form ◽

Minimum Clinically Important Difference ◽

Lumbar Spine Surgery ◽

Short Form 36 ◽

Clinically Important Difference ◽

Pain Scales

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P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.330 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S83-S83

Author(s):

O Ayling ◽

C FIsher

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Physical Disability ◽

Research Network ◽

Lumbar Spine Surgery ◽

Degenerative Disorders ◽

Patient Reported ◽

Euroqol 5D

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

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