Introduction

Because it typically afflicts older patients with poorer health and/or risk factors, spondylodiscitis can become life threatening. Lingering symptoms, which can be attributed to residual destruction as well as concurrent degenerative changes in the adjacent segments after inflammation has subsided, are frequently present after both conservative and operative therapies. Here, quality of life outcomes are presented for patients two years after operative and conservative treatment.

Introduction: Quoted complication rates in older patients range from 2.5–80% after surgical treatment of LSS. There is general disagreement whether operative therapy is riskier for older versus younger spines. Using comprehensive literature review and data from the international “Spine Tango” register (www.eurospine.org), this study examines the risk of surgery for LSS relative to age.

Methods: Between May 2005 and August 2009 20’794 patients with various spinal pathologies were documented. The current study applied the following inclusion criteria:

- lumbar or lumbosacral degenerative spinal stenosis

This produced 1,493 patients, who were subdivided into three age groups:

< 65 yrs (n=609, 41%),

Results: Over 80% of patient outcomes were scaled as good or excellent by the treating physician with no significant differences between the age groups.

The surgical complication rate in the complete sample was 5.7%. Multivariate logistic regression showed surgery time (p< 0.001), fusion/rigid stabilization (p=0.025) and age group (p=0.043) as a significant co-variates for surgical complications. Group 3 had a 2.1-times higher likelihood for a surgical complication as in group 1.

The general complication rate of the complete sample was 2.9%. We found ASA (p=0.002), fusion / rigid stabilization (p=0.022) and age group (p=0.008) as significant influencing factors for general complications.

The follow-up complication rate was 10.2% and did not vary significantly between age groups, but multivariate logistic regression showed fusion/rigid stabilization (p< 0.001) and previous surgery (p=0.005) to be significant co-variates for FU complications.

Clearly age-related was the duration of hospital admission and level of ASA (both p< 0.001).

Discussion: The outcomes found in the “Spine Tango” register indicate that both surgical and general (particularly cardiovascular and urinary tract infections) complication rates after decompression for LSS are negatively influenced by age. The complication rates at FU showed no age-related variation, and according literature re-operation rates after surgery of the lumbar spine appear to actually decrease with aging.

Our study and literature leaves no doubt about that aged and very aged patients benefit from surgical treatment. Therefore, although we should be aware of the increased risk for surgical and general complications in this population, high age (> 75 yrs) should not be a main influencing factor in the choice of operative indication and strategy when treating LSS.

Introduction: Posterior lumbar fusion, in many variations, is one of the frequently performed procedures in spinal surgery. High percentages of good and excellent results are indicated by physicians. On the other hand isolated patient-based outcomes are reported. However, little is known about correlation of these two assessment types. We aimed at their comparison.

Methods: The analysis included 567 patients from the international registry ‘Spine Tango’. 453 patients with degenerative disease and posterior lumbar fusion had preop and postop VAS separately indicating back- and leg-pain, surgery and follow up data. Mean age was 57y; female/male ratio was 52% to 48%. Remaining 114 patients with the same diagnoses and treatment had additional preop and postop Oswestry disability indices (ODI). Mean age was 61y; female/male ratio was 55% to 45%.

Physician administered McNab criteria “excellent, good, fair and poor” were compared to ODI, VAS back- and leg pain and to the patients answer describing the outcome of the operation with the following options: helped a lot, helped, helped only little, didn’t help and made things worse. Then the concept of minimum clinically important difference (MCID) was applied

Results: In the “excellent” group ODI-improvement was detected for all patients, the proposed MCID was reached in 90% for ODI. According to this model 85.2% of patients reached MCID for VAS leg pain and 54.1% for VAS back pain. All patient said that the treatment helped or helped a lot

In the “good” group 86% (MCID: 51.7%) of patients improved regarding ODI, 81% (MCID: 65,7%) regarding back and 93% (MCID: 89.4%) regarding leg pain. 99% of patients said that the treatment helped a lot, helped or helped only little.

65% (MCID: 40%) of patients in the “fair” group had improved ODIs. Even in this group 88% of patients perceived the treatment as helping a lot, helping or helping only little.

Moreover in the “poor” group had 60% (MCID: 40%) of patients improved ODIs, 55% (MCID: 40%) alleviated back and 36% (MCID: 30%) reduced leg pain. But only 30% of patient stated that the treatment helped or helped only little.

Spearman correlation coefficients for ODI, VAS back, VAS leg and patient’s verbal statement on overall outcome were 0.42, 0.18, 0.27 and 0.53.

Discussion: ‘Spine Tango’ registry, to date containing more than 13.000 documented surgeries and three times more outcome datasets, provides excellent opportunities for comparison of outcomes. The analysis of patient and physician-based outcomes showed good correlation with the highest correlation coefficient for patient’s verbal statement. With this study we can state that there is strong evidence that physicians evaluation of outcome is very good corresponding with the patients’ perception of success or failure of the analyzed procedure.

Introduction: To date, herniated nucleus pulposus (NP) with radiculopathy and central or lateral recess stenosis are considered as contraindications for lumbar disc arthroplasty. In the present study we used data from a unique mandatory spine register, SWISSspine to investigate associations between preoperative status of NP herniated/non herniated with presence/absence of sciatica and clinical outcome

Methods: Between 3/2005 and 8/2008, 358 mono-segmental lumbar total disc arthroplasties were documented in a prospective observational multicenter mode. The data collection included peri-operative data and clinical outcomes based on NASS, EuroQol and VAS. The patients were divided into 4 groups: group I-128 patients with herniated NP with sciatica, group II-48 patients with herniated NP without sciatica, group III-74 patients without herniated NP but with sciatica and group IV-108 patients without herniated NP and no sciatica (classic indication). The groups were pair wise compared regarding 1-year postoperative VAS, EuroQol and NASS scores using ANOVA-test with Boferroni-Holm adjustment (α=0.05)

Results: The 4 groups had similar demographic characteristics. Statistical analyses showed no significant outcome differences between the classic and the other indications. For example a outcomes for group IV: NASS back pain pre-post: 72.0/31.7 EQ-5D pre-post: 0.32/0.69.

Discussion and Conclusion: Our analysis revealed no differences between patients with herniated NP combined with neural compression and patients with stenosis of recesses regarding pain alleviation and QoL improvement. The findings suggest that these diagnoses may not have to be considered as absolute contraindications for TDR anymore. The results of this multicenter observational study however, need to be verified in a controlled or experimental study design.