The Rehabilitation-Related Effects on the Fear, Pain, and Disability of Patients With Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis

Haiyan Cheng,Jing Liu,Lin Shi,Xiuxiu Hei 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Objective: The lumbar fusion is an important surgery for the orthopedic diseases. The rehabilitation might improve the outcome of patients with lumbar fusion surgery. The rehabilitation-related effects can be revealed by a systemic review and meta-analysis of randomized clinical trials (RCTs). The purpose of this study is to clarify the rehabilitation effects in the patients with lumbar fusion surgery. Methods: We performed a systematic search and a meta-analysis for the RCT of rehabilitation treatment on the patients with lumbar fusion surgery. The comparison between rehabilitation treatment (including psychological rehabilitation, exercise, and multimodal rehabilitation) and typical treatment was performed to find if the rehabilitation treatment can improve the outcome after the lumbar fusion surgery. Fifteen studies of lumbar fusion patients under rehabilitation treatment and typical treatment were enrolled in a variety of rehabilitation modalities. The focused outcome was the rehabilitation-related effects on the fear, disability, and pain of patients after the lumbar fusion surgery. Results: Five hundred twenty-eight rehabilitation subjects and 498 controls were enrolled. The psychological-related rehabilitation showed a significant decrease in pain-related fear when compared to usual treatment. The multimodal rehabilitation can improve the disability outcome to a greater extent when compared to usual treatment. The multimodal rehabilitation seemed to have a more significantly positive effect to decrease disability after lumbar fusion surgery. In addition, the exercise and multimodal rehabilitation can relieve the pain after lumbar fusion surgery. The exercise rehabilitation seemed to have a more significantly positive effect to relieve pain after lumbar fusion surgery. Conclusion: The rehabilitation might relieve the pain-related fear, disability, and pain after lumbar fusion surgery.

요추수술 후 환자의 의과 및 한의과 의료기관 이용 행태 분석: 건강보험심사평가원 표본데이터를 이용하여

예성애,김남권,송윤경 한방재활의학과학회 2019 한방재활의학과학회지 Vol.29 No.4

Objectives We are going to analyze patient‘s medical and Korean medicine use trends after lumbar surgery, and examine the percentage of use of Korean medicine after surgery and its relevance to the medical care outcome after lumbar surgery. Methods Using 3% patients’ sample data of the Health Insurance Review and Assessment Service, two groups were compared the treatment progress of the Korean Medicine treatment group and the untreated group after lumbar surgery by hierarchical logistic regression analysis. After hierarchical logistic regression analysis(including propensity scores), two groups were compared after lumbar surgery, the Korean Medicine treatment group within 50days and untreated group within 50days. Results Lumbar surgery was performed in 2750 patients in 2015. It was 3.72 that the risk(odds ratio) of finished treatment of patients treated without Korean Medicine, compared to patients with Korean Medicine. It was 0.12 that the risk of continuing treatment(odds ratio) of patients treated with Korean Medicine within 50 days, compared to patients treatment more than 50 days. Conclusions The ratio of Korean Medicine treatment after lumbar surgery was 14.8%. The group that did not have Korean Medicine showed a higher possibility of treatment termination than the group who did not. Among the groups treated with Korean Medicine, the early treatment group was more likely to end treatment than the late treatment group. Considering various situations in the medical environment, further studies such as prospective studies and long-term data analysis are considered to be necessary. (J Korean Med Rehabil 2019;29(4):89-100)

Lumbar Spinal Steroid Injections and Infection Risk after Spinal Surgery: A Systematic Review and Meta-Analysis

Patel Harshadkumar A.,Cheppalli Naga Suresh,Bhandarkar Amit Wasudeo,Patel Vidhi,Singla Anuj 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6

Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08–2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12–3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.

Comparison of Clinical and Radiologic Results of Mini-Open Transforaminal Lumbar Interbody Fusion and Extreme Lateral Interbody Fusion Indirect Decompression for Degenerative Lumbar Spondylolisthesis

Yutaka Kono,Hogaku Gen,Yoshio Sakuma,Yasuhide Koshika 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective study. Purpose: In this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis. Overview of Literature: There are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF. Methods: Forty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by miniopen TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery. Results: There was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss (p <0.001). Serious complications were not observed in either group. In clinical assessment, no significant differences were observed between the groups with regard to the JOABPEQ results. The change in DH at 12 months after surgery increased significantly in the X group (p <0.05), and the changes in DA and SL were not significantly different between the two groups. The change in CSA was significantly greater in the T group (p <0.001) Conclusions: Postoperative clinical results were equally favorable for both procedures; however, in comparison with mini-open TLIF, less blood loss and greater correction of DH were observed in XLIF.

Clinical Correlation between Muscle Damage and Oswestry Disability Index Score after Open Lumbar Surgery: Does Open Surgery Reduces Functional Ability?

Rushama Tandon,Vivek Kiyawat,Neeraj Kumar 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.3

Study Design: Single-surgeon, single-center prospective study with prospective data collection. Purpose: To clinically evaluate muscle damage after open lumbar surgery and its relationship to functional activity and to validatethe improvement in function as indicated by improved Oswestry Disability Index (ODI) score despite muscle damage. Overview of Literature: Few studies have analyzed the functional loss and recovery pattern of muscles after open lumbar surgery. Methods: The study included 30 patients who underwent open lumbar spine fusion surgery at our institution between August 2013 and May 2015. Preoperatively and at 6 months postoperatively, the patients were subjected to functional, biochemical, electrophysiological, and radiological assessments as outpatients, and the results were compared. Results: Mean preoperative and 6-month postoperative values were as follows: creatine phosphokinase levels, 133.07±17.57 and 139±17.7 U/L (p <0.001); Visual Analog Scale scores for backache, 6.73±0.88 and 3.27±0.96 (p <0.001); and ODI scores, 41.6±5.51 and 22.4±4.48 (p <0.001), respectively. Preoperatively, electrophysiological studies showed that 20% of the patients had a polyphasic configuration whereas at 6 months postoperatively, all patients had polyphasic configuration (p <0.001). The mean cross-sectional area of the multifidus observed using magnetic resonance imaging (MRI) decreased from 742.67±76.62 mm2 preoperatively to 598.27±66.38 mm2 6 months postoperatively (p <0.001), with all the patients exhibiting grade 2 atrophy. Conclusions: Open lumbar fusion surgery resulted in significant damage to the lumbar paraspinal muscles, as indicated by a reduction in the cross-sectional area of the multifidus by MRI and denervation of the multifidus demonstrated using electromyography. Nevertheless, the patients reported reduced back pain and improved quality of life, which may have been due to increased stability of the previously unstable lumbar spinal segment after the surgery.

Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

Reisener Marie-Jacqueline,Hughes Alexander P.,Schadler Paul,Forman Alexa,Sax Oliver C.,Shue Jennifer,Cammisa Frank P.,Sama Andrew A.,Girardi Federico P.,Mancuso Carol A. 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

Study Design: Matched cohort study. Purpose: To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids. Overview of Literature: Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed. Methods: A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected. Results: The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, p=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, p=0.01) and compared with higher users (70, p=0.01). In multivariable analysis, “reater expectations” was independently associated with having had chiropractic care (p=0.03), being more disabled (p=0.002), and being a lower-dose opioid user (p=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, p=0.003). Conclusions: Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.

Change in pain catastrophizing in patients with lumbar spinal surgery

Kim, Ho-Joong,Kwon, Oh Hyo,Chang, Bong-Soon,Lee, Choon-Ki,Chun, Heoung-Jae,Yeom, Jin S. Elsevier 2018 The spine journal Vol.18 No.1

<P><B>Abstract</B></P> <P><B>Background Context</B></P> <P>Even though catastrophizing can negatively moderate the outcome of surgery for lumbar spinal stenosis (LSS), it is still unclear whether pain catastrophizing is an enduring stable or a dynamic structure related to pain intensity after spine surgery.</P> <P><B>Purpose</B></P> <P>The purpose of this study was to determine whether catastrophizing would change in patients who undergo spinal surgery for LSS.</P> <P><B>Study Design</B></P> <P>A prospective observational cohort study was carried out.</P> <P><B>Study Sample</B></P> <P>Patients who underwent spine surgery for LSS comprised the study sample.</P> <P><B>Outcome Measures</B></P> <P>The Visual Analog Pain Scale (VAS) scores for back/leg pain, Oswestry Disability Index (ODI), and Pain Catastrophizing Scale (PCS) were the outcome measures.</P> <P><B>Methods</B></P> <P>The present observational cohort consisted of 138 patients between the ages of 40 and 80 years who were scheduled to undergo surgery for LSS. Among them, a total of 96 patients underwent a 3-year assessment after surgery. The PCS questionnaire was used for pain catastrophizing assessment before and 3 years after surgery. The VAS for back and leg pain, and ODI were assessed 3 and 6 months, and 1 and 3 years after surgery. The correlations between variables were analyzed before and 3 years after surgery. To clarify the causal relationship, time-series and linear mixed models were also used.</P> <P><B>Results</B></P> <P>At 3 years after surgery, ODI, VAS for back and leg pain, and PCS scores were significantly decreased. The correlation of PCS with VAS and ODI was significant both before and 3 years after surgery. The correlation between change in pain or disability and change in pain catastrophizing from preoperative to 3 years after surgery was also significant. In the causal relationship between pain and catastrophizing, overall changes in pain and disability were significant predictors of overall changes in pain catastrophizing from baseline to 3 year after surgery.</P> <P><B>Conclusion</B></P> <P>The present study shows that pain catastrophizing can change in association with the improvement in pain intensity after spine surgery. Therefore, catastrophizing may not be an enduring stable construct, but a dynamic construct.</P>

Impact of Multidisciplinary Spine Conferences on Surgical Planning and Perioperative Care in Elective Lumbar Spine Surgeries

Khodadad Namiranian,Edward John Norris,James Gregory Jolissaint,Jigar Bharat Patel,Celeste Marie Lombardi 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.5

Study Design: Pre- and post-implementation analysis. Purpose: We examined the impact of implementing multidisciplinary spine conferences—“spine board” reviews—on the general utilization of elective lumbar spine surgeries in a tertiary medical institute. Overview of Literature: A multidisciplinary approach to spine care reportedly improves the appropriate utilization of surgical spine procedures. Methods: A multidisciplinary spine board was established to review candidates selected for elective lumbar spine surgery. The board comprised representatives from orthopedic spine surgery, neurosurgery, psychology, physical therapy, radiology, pharmacy, primary care, pain management, anesthesiology, and veteran advocacy. Two similar 6-month periods were selected to study the impact of this implementation: pre-implementing (June 1, 2015 to November 30, 2015) and post-implementation (June 1, 2016 to November 30, 2016) periods. Results: Between March 1, 2016 and December 30, 2016, the spine board discussed 11 patients. All patients underwent clinical examinations and radiological assessments findings that warranted elective lumbar surgery. The board recommended non-surgical interventions before proceeding with the planned surgeries in all cases. In the pre-implementation period, a total of 101 elective lumbar spine surgeries were performed. In the post-implementation period, a total of 51 elective lumbar spine surgeries were performed (p <0.05). The surgical plan for elective lumbar spine surgery in the post-implementation period was not directly influenced by the review of spine board because none of the cases were discussed in the conferences; however, the care occurred at a hospital where the spine board was implemented. There was no significant change in the number of cervical spine surgeries performed (66 preimplementation vs. 56 post-implementation). The average surgery duration was 52 minutes shorter in the post-implementation period compared with that in the pre-implementation period (p <0.05). Conclusions: Implementation of a multidisciplinary spine board was concurrent with an overall decrease in the utilization of lumbar spine surgeries for elective cases of low back pain in a tertiary medical center.

Endoscopic Lumbar Surgery: The State of the Art in 2019

Alexander J. Butler,Milad Alam,Kevin Wiley,Alexander Ghasem,Augustus J. Rush III,Jeffrey Wang 대한척추신경외과학회 2019 Neurospine Vol.16 No.1

This study was aimed to provide a brief historical perspective to facilitate appreciation of current techniques, describe outcomes of endoscopic lumbar surgery relative to those of existing techniques, and identify topics in need of study and future directions for the field of endoscopic lumbar surgery. Using the PubMed database, a comprehensive search was conducted to identify peer-reviewed English language articles pertaining to endoscopic lumbar surgery. Lack of focus on pertinent techniques or lack of outcome measures constituted exclusion criteria. A majority of included articles were published from 2015–2019. A context with which to appreciate the application of endoscopic lumbar techniques is established. An abundance of case series and several recent comparison studies have documented the benefits and potential pitfalls of these methods in the past two decades. The advantages of endoscopic lumbar spine surgery are widely touted to include reduced perioperative morbidity, including blood loss, operative time and immediate postoperative recovery, minimal structural trauma resulting from surgery, generally positive patient report outcome scores and the potential to contain costs. Additional high-quality research assessing outcomes of endoscopic lumbar surgery are certainly needed and currently expected given the rapid expansion of the field in recent years.

Endoscopic Spine Surgery

Choi, Gun,Pophale, Chetan S,Patel, Bhupesh,Uniyal, Priyank The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.5

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.