Single-level lumbar fusion in chronic discogenic low-back pain: psychological and emotional status as a predictor of outcome measured using the 36-item Short Form

2005 ◽  
Vol 3 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Richard Derby ◽  
John J. Lettice ◽  
Thomas A. Kula ◽  
Sang-Heon Lee ◽  
Kwan-Sik Seo ◽  
...  
Keyword(s):  
Short Form ◽  
Lumbar Fusion ◽  
Postoperative Outcome ◽  
Low Back ◽  
Emotional Status ◽  
Content Type ◽  
Sf 36 ◽  
Discogenic Low Back Pain ◽  
Fine Print

Object. The authors examined the effect of psychological and emotional status on the outcome in patients with suspected chronic discogenic low-back pain (LBP) who have undergone lumbar fusion. Methods. The authors retrospectively analyzed the medical records, including the results of the 36-item Short Form (SF-36), of 57 consecutive patients (mean age 42.7 years) who underwent single-level lumbar reconstructive surgery between 1994 and 2000. The SF-36 physical component summary (PCS) and mental component summary (MCS) domains were evaluated. Data were sorted into the following categories: excellent, good, fair, same, and worse. Scores greater than 40 for MCS and PCS were defined as “normal” according to US general population data provided by the Medical Outcomes Trust. Of 57 patients, 47 completed postoperative SF-36 surveys at 1 year and 36 completed the 2-year follow-up surveys. Analysis showed that preoperative MCS scores exhibited a significant, direct correlation with PCS score improvements at 1 (r = 0.584, p = 0.000) and 2 (r = 0.623, p = 0.000) years after surgery. In patients in whom preoperative MCS scores reflected normal status, outcomes were excellent or good in 60% at 1-year (18 of 30 cases) and 2-year (15 of 25 cases) follow-up intervals. Patients in whom MCS scores represented abnormal status had less satisfactory outcomes, with excellent or good outcome in only two (18.2%) of all patients at the 2-year follow-up study. Conclusions. Analysis of the data suggests that psychological and emotional distress may negatively affect postoperative outcome in patients with chronic discogenic LBP. The SF-36 may be easily and effectively used to measure both preoperative psychosocial distress and postoperative outcome.

Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study

2005 ◽  
Vol 2 (3) ◽  
pp. 271-278 ◽  
Author(s):  
Claudius Thomé ◽  
Martin Barth ◽  
Johann Scharf ◽  
Peter Schmiedek
Keyword(s):  
Short Form ◽  
Randomized Study ◽  
Treated Group ◽  
Pain Patient ◽  
Recurrence Rates ◽  
Content Type ◽  
Early Outcome ◽  
Sf 36 ◽  
Fine Print

Object. Microdiscectomy currently constitutes the standard treatment for herniated lumbar discs. Although limiting surgery to excision of fragments has occasionally been suggested, prospective data are lacking. Therefore, the objective of this study was to compare early outcome and recurrence rates after sequestrectomy and microdiscectomy. Methods. Eighty-four consecutive patients 60 years of age or younger who harbored free, subligamentary, or transanular herniated lumbar discs refractory to conservative treatment were randomized to one of two treatment groups. Intraoperative parameters and findings were documented as well as pre- and postoperative symptoms such as pain, Patient Satisfaction Index (PSI), Prolo Scale score, and Short Form (SF)—36 subscale results. Follow up of at least 12 months was available in 73 patients (87%). Preoperative intergroup symptoms did not differ significantly. Surgery was significantly shorter in the sequestrectomy-treated group. Overall, low-back pain and sciatica were drastically reduced in both groups and most sensorimotor deficits improved. At 4 to 6 months, SF-36 subscales and PSI scores showed a trend in favor of sequestrectomy, leaving 3% of patients unsatisfied compared with 18% of those treated with discectomy. Outcome according to the Prolo Scale was good or excellent in 76% of discectomy-treated patients and 92% of sequestrectomy-treated patients. Reherniation occurred in four patients after discectomy (10%) and two patients after sequestrectomy (5%) within 18 months. Conclusions. Sequestrectomy does not seem to entail a higher rate of early recurrences compared with microdiscectomy. Analysis of early outcome demonstrated a trend toward superior results when sequestrectomy is performed. Although long-term follow-up data are mandatory, sequestrectomy may be an advantageous alternative to standard microdiscectomy.

Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life

2001 ◽  
Vol 94 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Helen C. Martin ◽  
Jagjit Sethi ◽  
Dorothy Lang ◽  
Glen Neil-Dwyer ◽  
Mark E. Lutman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Acoustic Neuroma ◽  
Physical Functioning ◽  
Short Form ◽  
Content Type ◽  
Sf 36 ◽  
Postoperative Symptoms ◽  
Fine Print

Object. The aim of this study was to assess whether outcomes from excision of acoustic neuroma vary among patients and have a material impact on their quality of life (QOL). Methods. A questionnaire concerning postoperative symptoms and the Short Form 36 (SF-36) QOL instrument were mailed to 97 consecutive patients who had undergone acoustic neuroma surgery via the translabyrinthine approach. The survey response rate was 78% and the symptomatology was consistent with other reports, supporting the representativeness of the sample. The respondents' QOL was rated significantly below published norms and their work capacity was reportedly reduced. Specifically, the following SF-36 dimensions were reduced: physical functioning and role-physical, together with vitality, general health, and social functioning. Greater numbers of postoperative symptoms and larger tumors were associated with a worse rating of physical functioning. More severe balance problems were associated with lower ratings of social functioning. The disparity between the patient's self-estimate and self-measurement and the clinician's assessment of the patient's facial functioning raises doubts about the validity of subjective reports and assessment. Conclusions. The present study supports the use of generic QOL measures to assess outcome and to draw comparisons between different populations.

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
Author(s):  
Eddy Garrido ◽  
P. Noel Connaughton
Keyword(s):  
Disc Herniation ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Content Type ◽  
X Ray ◽  
Flexion And Extension ◽  
Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study

2000 ◽  
Vol 93 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Shunji Matsunaga ◽  
Kosei Ijiri ◽  
Kyoji Hayashi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Symptoms ◽  
Degenerative Spondylolisthesis ◽  
Low Back ◽  
Indications For Surgery ◽  
Initial Examination ◽  
Content Type ◽  
Fine Print

Object. Controversy exists concerning the indications for surgery and choice of surgical procedure for patients with degenerative spondylolisthesis. The goals of this study were to determine the clinical course of nonsurgically managed patients with degenerative spondylolisthesis as well as the indications for surgery. Methods. A total of 145 nonsurgically managed patients with degenerative spondylolisthesis were examined annually for a minimum of 10 years follow-up evaluation. Radiographic changes, changes in clinical symptoms, and functional prognosis were surveyed. Progressive spondylolisthesis was observed in 49 patients (34%). There was no correlation between changes in clinical symptoms and progression of spondylolisthesis. The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. Low-back pain improved following a decrease in the total intervertebral space size. A total of 84 (76%) of 110 patients who had no neurological deficits at initial examination remained without neurological deficit after 10 years of follow up. Twenty-nine (83%) of the 35 patients who had neurological symptoms, such as intermittent claudication or vesicorectal disorder, at initial examination and refused surgery experienced neurological deterioration. The final prognosis for these patients was very poor. Conclusions. Low-back pain was improved by restabilization. Conservative treatment is useful for patients who have low-back pain with or without pain in the lower extremities. Surgical intervention is indicated for patients with neurological symptoms including intermittent claudication or vesicorectal disorder, provided that a good functional outcome can be achieved.

Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability

1999 ◽  
Vol 90 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Shahin Etebar ◽  
David W. Cahill
Keyword(s):  
Risk Factors ◽  
Postmenopausal Women ◽  
Calcium Supplementation ◽  
Lumbar Fusion ◽  
Adjacent Segment ◽  
Content Type ◽  
Adjacent Vertebral Body ◽  
Canal Stenosis ◽  
Fine Print

Object. The authors performed a retrospective analysis of 125 consecutive patients in whom instrumentation was placed to promote lumbar fusion for the treatment of degenerative instability. All procedures were performed by a single surgeon. The authors sought to determine the risk factors for next-segment degeneration after lumbar spinal fusion with rigid instrumentation. Methods. Thirty-one of 125 fusion procedures were performed in women who were postmenopausal. A total of 18 of 125 patients developed symptomatic next-segment degeneration at a previously asymptomatic level; 15 were postmenopausal women. Data were obtained in patients with next-segment failure based on radiographic studies, neurological assessment, demographic factors, and sequential follow-up examinations. The mean follow-up period for this group was 44.8 months. All women were postmenopausal, and 53% received biphosphonate drugs and calcium supplementation preoperatively for osteopenia. Twenty percent of all patients with next-segment failure were cigarette smokers. Next-segment diseases included spondylolisthesis (39%), spinal canal stenosis due to disc herniation and/or facet hypertrophy (33%), stress fracture of the adjacent vertebral body (28%), and scoliosis (17%). Patients frequently had more than one degenerative process at the next segment. Conclusions. The risk of adjacent-segment failure is clearly higher for patients in whom lumbar fusion with rigid instrumentation is performed to treat degenerative instability. This risk appears to be especially high in postmenopausal women.

Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis

2004 ◽  
Vol 1 (3) ◽  
pp. 267-272 ◽  
Author(s):  
Zoher Ghogawala ◽  
Edward C. Benzel ◽  
Sepideh Amin-Hanjani ◽  
Fred G. Barker ◽  
J. Fred Harrington ◽  
...  
Keyword(s):  
Short Form ◽  
Demographic Data ◽  
Degenerative Spondylolisthesis ◽  
Fusion Rate ◽  
Functional Improvement ◽  
Lumbar Stenosis ◽  
Content Type ◽  
Sf 36 ◽  
Lumbar Spinal ◽  
Fine Print

Object. There is considerable debate among spine surgeons regarding whether fusion should be used to augment decompressive surgery in patients with symptomatic lumbar spinal stenosis involving Grade I degenerative spondylolisthesis. The authors prospectively evaluated the outcomes of patients treated between 2000 and 2002 at two institutions to determine whether fusion improves functional outcome 1 year after surgery. Methods. Patients ranged in age from 50 to 81 years. They presented with degenerative Grade I (3- to 14-mm) spondylolisthesis and lumbar stenosis without gross instability (< 3 mm of motion at the level of subluxation). Those in whom previous surgery had been performed at the level of subluxation were excluded. Each patient completed Oswestry Disability Index (ODI) and Short Form—36 (SF-36) questionnaires preoperatively and at 6 to 12 months postoperatively. Some patients underwent decompression alone (20 cases), whereas others underwent decompression and posterolateral instrumentation-assisted fusion (14 cases), at the treating surgeon's discretion. Baseline demographic data, radiographic features, and ODI and SF-36 scores were similar in both groups. The 1-year fusion rate was 93%. Both forms of surgery independently improved outcome compared with baseline status, based on ODI and SF-36 physical component summary (PCS) results (p < 0.001). Decompression combined with fusion led to an improvement in ODI scores of 27.5 points, whereas decompression alone was associated with a 13.6-point increase (p = 0.02). Analysis of the SF-36 PCS data also demonstrated a significant intergroup difference (p = 0.003). Conclusions. Surgery substantially improved 1-year outcomes based on established outcomes instruments in patients with Grade I spondylolisthesis and stenosis. Fusion was associated with greater functional improvement.

Surgically treated lumbar disc disease in the pediatric population: an outcome study

2000 ◽  
Vol 92 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Susan R. Durham ◽  
Peter P. Sun ◽  
Leslie N. Sutton
Keyword(s):  
Back Pain ◽  
Pediatric Population ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Sf 36 ◽  
Study Population ◽  
Fine Print

Object. This outcome study was undertaken to investigate the long-term results obtained in surgically treated pediatric patients with lumbar disc disease by using standardized medical outcome scales and clinical follow-up examination. Methods. Twenty nine patients 17 years of age or younger underwent surgery between 1968 and 1998 for lumbar disc disease. The follow-up period ranged from 4 months to 30.5 years (mean 8.5 years). Outcome scores (health profiles) were generated using a standardized medical outcome scale, the Short Form health survey questionnaire (SF-36), and a condition-specific back pain outcome scale. Clinical follow-up data were obtained by telephone interview. The health profile of the study population closely paralleled that of the normal population and was distinctly different from the health profile of adults with low-back pain. Only physical functioning, as measured by a scale of the SF-36, was found to be impaired in a subset of the study population. The rate of reoperation was 24% over the course of the follow-up period. In contrast to similar studies in adults, there were no identifiable predictive factors for either reoperation or poor outcome. Conclusions. Lumbar disc disease in the pediatric population does not appear to lead to chronic complaints of back pain, and it does not appear to have a negative impact on overall health. This finding suggests that pediatric lumbar disc disease may be a separate entity distinct from adult lumbar disc disease, and therefore, the same conclusions regarding long-term outcome cannot be applied to the pediatric population.

Unilateral removal of pars interarticularis

2005 ◽  
Vol 2 (3) ◽  
pp. 279-288 ◽  
Author(s):  
Gabriel C. Tender ◽  
Richard V. Baratta ◽  
Rand M. Voorhies
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Short Form ◽  
Mcgill Pain Questionnaire ◽  
Foraminal Stenosis ◽  
Low Back ◽  
Content Type ◽  
Pars Interarticularis ◽  
Disc Herniations ◽  
Fine Print

Object. Lumbar radiculopathy secondary to foraminal entrapment can be treated by unilateral removal of the overlying pars interarticularis. The authors prospectively evaluated the outcome after this procedure. Methods. Thirty-six consecutive patients underwent unilateral resection of the pars interarticularis between August 1999 and July 2002. In 18 patients acute foraminal disc herniations compressed the nerve root against the superior pedicle; in the other 18 foraminal stenosis was secondary to degenerative changes. All patients, at each visit, completed the following questionnaires: visual analog scale for overall, leg, and back pain; the Prolo Functional Economic Rating scale; and the Pain Rating Index (PRI) of the Short-Form McGill Pain Questionnaire. At 1 year, leg pain improved in 33 patients (91%). Low-back pain appeared or worsened in eight patients (22%; one in the acute herniation group and seven in the chronic degenerative group). Only one patient required lumbar fusion for pain. The Prolo economic and function scores improved in 21 (58%) and 27 (75%) patients, respectively. The PRI scores improved in 30 cases (83%). No spondylolisthesis was observed at any level at which resection had been performed. Conclusions. Unilateral removal of the pars interarticularis is effective in relieving lumbar radicular symptoms in patients with intraforaminal entrapment. The incidence of low-back pain in patients with acute foraminal disc herniations does not increase as a result of this procedure. In patients with degenerative foraminal stenosis, unilateral resection of the pars interarticularis may be a better alternative to facetectomy and segmental fusion. This procedure may be a useful tool in spine surgery.

Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results

1996 ◽  
Vol 84 (2) ◽  
pp. 166-173 ◽  
Author(s):  
Charles G. diPierro ◽  
Gregory A. Helm ◽  
Christopher I. Shaffrey ◽  
James B. Chadduck ◽  
Scott L. Henson ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Neurogenic Claudication ◽  
Low Back ◽  
Content Type ◽  
Bone Fusion ◽  
Autologous Bone ◽  
Lumbar Spinal ◽  
Fine Print

✓ A new surgical technique for the treatment of lumbar spinal stenosis features extensive unilateral decompression with undercutting of the spinous process and, to preserve stability, uses contralateral autologous bone fusion of the spinous processes, laminae, and facets. The operation was performed in 29 patients over a 19-month period ending in December of 1991. All individuals had been unresponsive to conservative treatment and presented with low-back pain in addition to signs and symptoms consistent with neurogenic claudication or radiculopathy. Nine had undergone previous lumbar decompressive surgery. The minimum and mean postoperative follow-up times were 2 and 2 1/2 years, respectively. The mean patient age was 64 years; only two patients were younger than 50 years of age. Of the patients with neurogenic claudication, 69% reported complete pain relief at follow-up review. Of those with radicular symptoms, 41% had complete relief and 23% had mild residual pain that was rated 3 or less on a pain—functionality scale of 0 to 10. For the entire sample, this surgery decreased pain from 9.2 to 3.3 (p < 0.0001) on the scale. Sixty-nine percent of patients were satisfied with surgery. Low-back pain was significantly relieved in 62% of all patients (p < 0.0001). Low-back pain relief correlated negatively with number of levels decompressed (p < 0.05). To assess fusion, follow-up flexion/extension radiographs were obtained, and no motion was detected at the surgically treated levels in any patient. The results suggest that this decompression procedure safely and successfully treats not only the radicular symptoms caused by lateral stenosis but also the neurogenic claudication symptoms associated with central stenosis. In addition, the procedure, by using contralateral autologous bone fusion along the laminae and spinous processes, can preserve stability without instrumentation.

Decompressive lumbar laminectomy for spinal stenosis

1993 ◽  
Vol 78 (5) ◽  
pp. 695-701 ◽  
Author(s):  
H. Roy Silvers ◽  
P. Jeffrey Lewis ◽  
Harold L. Asch
Keyword(s):  
Pain Relief ◽  
Spinal Stenosis ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Age Groups ◽  
Normal Activity ◽  
Short Term ◽  
Content Type ◽  
Fine Print

✓ A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery. The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.

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