scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
William C. Watters ◽  
Praveen V. Mummaneni ◽  
Andrew T. Dailey ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Functional Outcome ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Minimum Clinically Important Difference ◽  
Degenerative Disease ◽  
Psychological State ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

scholarly journals Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?

2019 ◽  
Vol 10 (3) ◽  
pp. 286-293
Author(s):  
Jannat M. Khan ◽  
Joseph Michalski ◽  
Bryce A. Basques ◽  
Philip K. Louie ◽  
Oscar Chen ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Spinal Fusion ◽  
Clinical Outcomes ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Diabetic Patients ◽  
Lumbar Spinal Fusion ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objective: To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. Methods: Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. Results: A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger ( P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery ( P = .018). No differences were observed in reoperation or postoperative complication. Conclusions: While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.

scholarly journals Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion

2018 ◽  
Vol 7 (1) ◽  
pp. 28-35 ◽  
Author(s):  
H. Huang ◽  
R. W. Nightingale ◽  
A. B. C. Dang
Keyword(s):  
Finite Element ◽  
Cervical Spine ◽  
Lumbar Spine ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Fe Model ◽  
Cervical Fusion ◽  
Lumbar Spinal Fusion ◽  
Coupled Motion ◽  
Lumbar Spinal

Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1.

scholarly journals Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes

2021 ◽  
pp. 1-14
Author(s):  
James Mooney ◽  
Giorgos D. Michalopoulos ◽  
Mohammed Ali Alvi ◽  
Daniel Zeitouni ◽  
Andrew K. Chan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Operative Time ◽  
Lumbar Fusion ◽  
Leg Pain ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Lumbar Spinal ◽  
Incidental Durotomy

OBJECTIVE With the expanding indications for and increasing popularity of minimally invasive surgery (MIS) for lumbar spinal fusion, large-scale outcomes analysis to compare MIS approaches with open procedures is warranted. METHODS The authors queried the Quality Outcomes Database for patients who underwent elective lumbar fusion for degenerative spine disease. They performed optimal matching, at a 1:2 ratio between patients who underwent MIS and those who underwent open lumbar fusion, to create two highly homogeneous groups in terms of 33 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, indications, and operative details). The outcomes of interest were overall satisfaction, decrease in Oswestry Disability Index (ODI), and back and leg pain, as well as hospital length of stay (LOS), operative time, reoperations, and incidental durotomy rate. Satisfaction was defined as a score of 1 or 2 on the North American Spine Society scale. Minimal clinically important difference (MCID) in ODI was defined as ≥ 30% decrease from baseline. Outcomes were assessed at the 3- and 12-month follow-up evaluations. RESULTS After the groups were matched, the MIS and open groups consisted of 1483 and 2966 patients, respectively. Patients who underwent MIS fusion had higher odds of satisfaction at 3 months (OR 1.4, p = 0.004); no difference was demonstrated at 12 months (OR 1.04, p = 0.67). Lumbar stenosis, single-level fusion, higher American Society of Anesthesiologists Physical Status Classification System grade, and absence of spondylolisthesis were most prominently associated with higher odds of satisfaction with MIS compared with open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference 1.61, p = 0.006; MCID OR 1.14, p = 0.0495) and 12 months (mean difference 2.35, p < 0.001; MCID OR 1.29, p < 0.001). MIS was also associated with a greater decrease in leg and back pain at both follow-up time points. The two groups did not differ in operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. Revision surgery at 12 months was less likely for patients who underwent MIS (4.1% vs 5.6%, p = 0.032). CONCLUSIONS In patients who underwent lumbar fusion for degenerative spinal disease, MIS was associated with higher odds of satisfaction at 3 months postoperatively. No difference was demonstrated at the 12-month follow-up. MIS maintained a small, yet consistent, superiority in decreasing ODI and back and leg pain, and MIS was associated with a lower reoperation rate.

scholarly journals Are the Roland Morris Disability Questionnaire and Oswestry Disability Index interchangeable in patients after lumbar spinal fusion?

2021 ◽  
pp. 1-7
Author(s):  
R.F.M.R. Kersten ◽  
J. Fikkers ◽  
N. Wolterbeek ◽  
F.C. Öner ◽  
S.M. van Gaalen
Keyword(s):  
Back Pain ◽  
Spinal Fusion ◽  
Outcome Measures ◽  
Oswestry Disability Index ◽  
Roland Morris Disability Questionnaire ◽  
Leg Pain ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Disability Questionnaire ◽  
Lumbar Spinal

BACKGROUND: Low back pain is a common health problem for which there are several treatment options. For optimizing clinical decision making, evaluation of treatments and research purposes it is important that health care professionals are able to evaluate the functional status of patients. Patient reported outcome measures (PROMs) are widely accepted and recommended. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) are the two mainly used condition-specific patient reported outcomes. Concerns regarding the content and structural validity and also the different scoring systems of these outcome measures makes comparison of treatment results difficult. OBJECTIVE: Aim of this study was to determine if the RMDQ and ODI could be used exchangeable by assessing the correlation and comparing different measurement properties between the questionnaires. METHODS: Clinical data from patients who participated in a multicenter RCT with 2 year follow-up after lumbar spinal fusion were used. Outcome measures were the RMDQ, ODI, Short Form 36 – Health Survey (SF-36), leg pain and back pain measured on a 0–100 mm visual analogue scale (VAS). Cronbach’s alpha coefficients, Spearman correlation coefficients, multiple regression analysis and Bland-Altman plots were calculated. RESULTS: three hundred and seventy-six completed questionnaires filled out by 87 patients were used. The ODI and RMDQ had both a good level of internal consistency. There was a very strong correlation between the RMDQ and the ODI (r= 0.87; p< 0.001), and between the VAS and both the ODI and RMDQ. However, the Bland-Altman plot indicated bad agreement between the ODI and RMDQ. CONCLUSIONS: The RMDQ and ODI cannot be used interchangeably, nor is there a possibility of converting the score from one questionnaire to the other. However, leg pain and back pain seemed to be predictors for both the ODI and the RMDQ.

32. Does the number of patient-reported allergies impact clinical outcomes after lumbar spinal fusion?

2019 ◽  
Vol 19 (9) ◽  
pp. S16
Author(s):  
Jannat M. Khan ◽  
Bryce Basques ◽  
Dong Gue Oh ◽  
Zayd Hayani ◽  
Jennifer Hwang ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Clinical Outcomes ◽  
Lumbar Spinal Fusion ◽  
Patient Reported ◽  
Lumbar Spinal

scholarly journals MIS Fusion of the SI Joint: Does Prior Lumbar Spinal Fusion Affect Patient Outcomes?

2013 ◽  
Vol 7 (1) ◽  
pp. 163-168 ◽  
Author(s):  
Leonard Rudolf
Keyword(s):  
Lumbar Spine ◽  
Spinal Fusion ◽  
Spine Fusion ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spine Fusion ◽  
Spine Pathology ◽  
History Of ◽  
Lumbar Spinal ◽  
Si Joint

Background: Sacroiliac (SI) joint pain is a challenging condition to manage as it can mimic discogenic or radicular low back pain, and present as low back, hip, groin and/or buttock pain. Patients may present with a combination of lumbar spine and SI joint symptoms, further complicating the diagnosis and treatment algorithm [1-3]. SI joint pain after lumbar spinal fusion has been reported in the literature. Both clinical and biomechanical studies show the SI joint to be susceptible to increased motion and stress at the articular surface with up to 40-75% of patients developing significant SI joint degeneration after 5 years. In a recent case series study of 50 patients who underwent minimally invasive SI joint arthrodesis, 50% had undergone previous lumbar spinal fusion and 18% had symptomatic lumbar spine pathology treated conservatively [4]. The purpose of this study is to determine if history of previous lumbar fusion or lumbar pathology affects patient outcomes after MIS SI joint fusion surgery. Methods: We report on 40 patients with 24 month follow up treated with MIS SI joint fusion using a series of triangular porous plasma coated titanium implants (iFuse, SI-Bone, Inc. San Jose, CA). Outcomes using a numerical rating scale (NRS) for pain were obtained at 3-, 6-, 12- and 24 month follow up intervals. Additionally, patient satisfaction was collected at the latest follow up interval. Patients were separated into 3 cohorts: 1) underwent prior lumbar spine fusion (PF), 2) no history of previous lumbar spine fusion (NF), 3) no history of previous lumbar spine fusion with symptomatic lumbar spine pathology treated conservatively (LP). A repeated measures analysis of variance (rANOVA) was used to determine if the change in NRS pain scores differed across timepoints and subgroups. A decrease in NRS by 2 points was deemed clinically significant [5]. Results: Mean age was 54 (±13) years and varied slightly but not statistically between groups. All subgroups experienced a clinically and statistically significant reduction in pain at all time points (mean change >2 points, p<0.001). There was a statistically significant effect of cohort (p=0.045), with the NF cohort (no prior lumbar spinal fusion) having a somewhat greater decrease in pain (by approximately 1 point) compared to the other 2 groups (PF and LP).Patient reported satisfaction by cohort was: 89% (NF), 92% (PF) and 63% (LP).Overall satisfaction rate was 87%. Discussion and Conclusion: Patients with SI joint pain, regardless of prior lumbar spine fusion history, show significant improvement in pain after minimally invasive SI joint fusion. The presence of symptomatic lumbar spine pathology potentially confounds the treatment affect, as patients may not be able to discriminate between symptoms arising from the SI joint and the lumbar spine. These patients expressed a lower satisfaction with surgery. Patients without other confounding lumbar spine pathology and who have not undergone previous spine surgery tend to be younger and experience a greater reduction in pain.

scholarly journals Nursing care of the patient undergoing lumbar spinal fusion

2017 ◽  
Vol 8 (5) ◽  
pp. 44 ◽  
Author(s):  
Maureen P. Lall
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Cauda Equina ◽  
Research Literature ◽  
Spinal Tumors ◽  
Surgical Approaches ◽  
Lumbar Spinal Fusion ◽  
Advantages And Disadvantages ◽  
Diagnostic Modalities ◽  
Lumbar Spinal

Lumbar spinal fusion is a surgical procedure performed to join—or fuse—2 or more vertebrae in the low back. The procedure is done to stabilize the spine and prevent damage to the cauda equina and emanating nerve roots. Lumbar fusion is commonly indicated for patients with vertebral fractures, infection, or spinal tumors, and it may be appropriate for select patients with degenerative disorders and spinal stenosis. Nurses who care for patients undergoing lumbar fusion require an understanding of lumbar spinal anatomy, spinal pathology, surgical indications, and diagnostic modalities. Knowledge of the distinct surgical approaches and their respective advantages and disadvantages allows nurses to individualize patient care and be alert to postoperative complications. This article reviews clinical and research literature regarding lumbar fusion, with an emphasis on the role of the nurse in promoting a safe perioperative course.

Predicting postoperative complications in patients undergoing lumbar spinal fusion by using the modified five-item frailty index and nutritional status

2020 ◽  
Vol 102-B (12) ◽  
pp. 1717-1722
Author(s):  
TaeWook Kang ◽  
Si Young Park ◽  
Joon Suk Lee ◽  
Soon Hyuck Lee ◽  
Jong Hoon Park ◽  
...  
Keyword(s):  
Vitamin D ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Frailty Index ◽  
Lumbar Spinal Fusion ◽  
Nutritional Parameters ◽  
Posterior Surgery ◽  
Lumbar Spinal

Aims As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative complications in patients undergoing simple or complex lumbar spinal fusion. Methods We retrospectively reviewed 584 patients who had undergone lumbar spinal fusion for degenerative lumbar spinal disease. The 'simple' group (SG) consisted of patients who had undergone one- or two-level posterior lumbar fusion. The 'complex' group (CG) consisted of patients who had undergone fusion over three or more levels, or combined anterior and posterior surgery. On admission, the mFI-5 was calculated and nutritional parameters collected. Results Complications occurred in 9.3% (37/396) of patients in the SG, and 10.1% (19/167) of patients in the CG. In the SG, the important predictors of complications were age (odds ratio (OR) 1.036; p = 0.002); mFI-5 (OR 1.026 to 2.411, as score increased to 1 ≥ 2 respectively; p = 0.023); albumin (OR 11.348; p < 0.001); vitamin D (OR 2.185; p = 0.032); and total lymphocyte count (OR 1.433; p = 0.011) . In the CG, the predictors of complications were albumin (OR 9.532; p = 0.002) and vitamin D (OR 3.815; p = 0.022). Conclusion The mFI-5 and nutritional status were effective predictors of postoperative complications in the SG, but only nutritional status was successful in predicting postoperative complications in the CG. The complexity of the surgery, as well as the preoperative frailty and nutritional status of patients, should be considered when determining if it is safe to proceed with lumbar spinal fusion. Cite this article: Bone Joint J 2020;102-B(12):1717–1722.

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