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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 24 - 24
1 Sep 2021
Saravi B Lang G Ülkümen S Südkamp N Hassel F
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Endoscopic spine surgery is a promising and minimally invasive technique for the treatment of disc herniation and spinal stenosis. However, the literature on the outcome of interlaminar endoscopic decompression (IED) versus conventional microsurgical technique (CMT) in patients with lumbar spinal stenosis is scarce. We analyzed 88 patients (IED: 36/88, 40.9%; CMT: 52/88, 59.1%) presenting with lumbar central spinal stenosis between 2018–2020. Surgery-related (operation time, complications, time to hospital release (THR), ASA score, C-reactive protein (CRP), white blood cell count (WBC), side (unilateral/bilateral), patient-reported (ODI, NRS (leg-, back pain), eQ5D, COMI), and radiological (preoperative dural sack cross-sectional area (DSCA), Shizas score (SC), left (LRH) and right (RRH) lateral recess heights, left (LFA) and right (RFA) facet angle) parameters were extracted. Complication (most often re-stenosis due to hematoma and/or residual sensorimotor deficits) rates were higher in the endoscopic (38.9%) than microsurgical (13.5%) treatment group (p<0.01). Age, THR, SC, CRP, and DSCA revealed significant correlations with 3 weeks and 1 year postoperatively evaluated ODI, COMI, eQ5D, NRS leg, or NRS back values in our cohort. We did not observe significant differences in the endoscopic versus microsurgical group for the patient-reported outcomes. Age, THR, SC, CRP, and DSCA revealed significant correlations with patient-centered outcomes and should be considered in future studies. Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach, although it was associated with higher complication rates in our single-center study experience. This was probably because of the surgeons' lack of experience with this method and the resulting different learning curve compared with the conventional technique


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 10 - 10
1 May 2017
Anderton M Hoggett L Khatri M
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Background. PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals. Aims. 1). To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores. 2). Evaluate PROMs data collection compliance. Methods. We studied PROMs data, taken prospectively as part of routine clinical care for all patients who underwent single level day case microdiscectomy between January 2013 to December 2015. PROMs included VAS for back and leg pain, EQ5D and ODI scores. Preoperative PROMs were compared to all available postoperative PROMs at 3 months, 6 months, 12 months and 24 months. Paired student T-tests were used to compare preoperative to postoperative scores. Results. Preoperative PROMs were recorded for 132 patients. Postoperative PROMs were recorded for 48 patients at 3 months, 51 patients at 6 months, 37 patients at 12 months and 15 patients at 24 months. Significant postoperative improvements (p<0.05) were found at all time points for back pain, leg pain, EQ5D and ODI, with the exception EQ5D at 24 months (p = 0.10). Conclusion. There was significant improvement in VAS back and leg scores, as well as ODI scores over 24 months. Further work is needed to improve compliance with postoperative PROMs and to optimise the benefit of these health assessment tools. No conflicts of interest. No funding obtained


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 14 - 14
1 Oct 2022
Williamson E Boniface G Marian I Dutton S Maredza M Petrou S Garrett A Morris A Hansen Z Ward L Nicolson P Barker K Fairbank J Fitch J Rogers D Comer C French D Mallen C Lamb S
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Purpose and background. To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition. Methods and results. A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness. Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds. Conclusions. The BOOST programme improves mobility and reduces falls in older adults with NC compared to BPA at 12 months follow-up. It is good value for the NHS. Future iterations of the programme will consider ways to reduce symptoms and disability long-term. Conflicts of interest: No conflicts of interest. Sources of funding: National Institute of Health Research – Programme for Applied Research NIHR - PTC-RP-PG-0213-20002: Better Outcomes for Older people with Spinal Trouble (BOOST). Publication and presentations: The clinical effectiveness paper has just been accepted for publication in the Journal of Gerontology Series A. The health economic analysis is not yet published. It was presented at the Physiotherapy UK conference and the International Back and Neck Pain Forum in 2021


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 33 - 33
1 Sep 2019
Dutmer A Reneman M Wolff A Soer R Preuper HS
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Introduction. A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine Cohort will provide a 10-year prospective insight into the burden of CLBP for patients referred to multispecialty tertiary spine care in the Netherlands. This study reports first baseline results. Objective. To study the personal and societal impact of CLBP in patients visiting the UMCG tertiary spine center. Patients. Adult patients with CLBP. Methods. Patient-reported baseline questionnaire and health insurance costs one year prior to visiting the Spine Center. Primary outcomes: NIH minimal dataset Impact Stratification score (range 8–50), functioning (Pain Disability Index, PDI; 0–70), quality of life (EuroQol-5D, EQ5D; -0.33–1.00), work ability (single-item Work Ability Score, WAS; 0–10), work participation (absenteeism, disability), and health insurance costs. Descriptive statistics were applied. Results. N=1503 patients (age m=46.3, sd=12.8 years, 57% female) were included. NIH Impact Stratification m=35.2±7.5; severe impact (≥35) for 58% of patients. PDI = 38.2±14.1; EQ5D = 0.44±0.30; WAS = 3.8±2.9. Absenteeism: 43% of workers. Permanent work disability: 17%. Health insurance costs: med= €2432, IQR €4739. Discussion And Conclusions. In patients seeking multispecialty tertiary spine care, the personal and societal impact of CLBP is very high. Costs are substantially higher than what is already known about the burden of the average patient with CLBP. Clinical Message. More effective personalized stepped and matched care is urgently needed to reduce the burden of CLBP in a subgroup of patients seeking multispecialty tertiary spine care. No conflicts of interest. Sources of Funding: Funding from the University Medical Center Groningen


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 135 - 135
1 Apr 2012
Timothy J Phillips H Michaels R Pal D
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The aim of this study was to prospectively assess the outcome of patients with metastatic spinal disease who underwent minimally invasive fixation of the spine for intractable pain or spinal instability. This is a prospective audit of patients with metastatic spinal cord disease who have undergone minimally invasive fixation of the spine from August 2009 until the present date. This was assessed by pre and post-operative Oswestry Disability Index (ODI), EQ5D and Tokuhashi scores. Intra- and post-operative complications, time to theatre, length of inpatient stay, analgesia requirements, mobility, chest drain requirement and post-operative HDU and ITU stays were also recorded. So far, 10 patients have met the criteria. There were no intra-operative complications. Post-operatively, there were no complications, chest drains, increase in analgesia or stay on the HDU or ITU. All patients showed an improvement in mobility. The mean post-operative day of mobilisation was 2 days, post-operative days until discharge 5.3 days and length of inpatient stay was shorter than traditional surgery. Blood loss was minimum except one patient with metastatic renal cell carcinoma who needed transfusion intraoperatively. ODI, VAS and EQ-5D scores were calculated and were significantly improved compared to preoperatively. This novel approach to management of metastatic spinal disease has resulted in improved mobility, short inpatient stays without the need for chest drains, HDU or ITU and an improved the quality of life in pallliative patients. This is a completely new strategy to treat the pain in these patients without the usual associated risks of surgery and has major advantages over traditional surgical techniques which may preclude this group of patients having any surgical stabilisation procedure at all


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 38 - 38
1 Jan 2012
Axén I Jensen I Bodin L Halasz L Lange F Lövgren PW Rosenbaum A Leboeuf-Yde C
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Aim. The aim of this study was to describe, by means of weekly measures, the course of low back pain (LBP) in chiropractic patients. The primary outcome was number of days with bothersome pain, which was analyzed for association with known predictor variables (gender, leg pain, occupation and self rated health). Patients were followed for six months. Method. A novel approach is used: short message services, SMS, sent to the respondents' mobile phones. Using specifically designed software, respondents received an SMS every week, which they responded to also using SMS. The question was: “How many days this previous week has your low back pain been bothersome (i.e. affected your daily activities or routines)? Please answer by a number from 0 to 7.”. Baseline variables were collected during the chiropractic consultation. Patients were further assessed at the 4. th. visit. A follow-up questionnaire was sent to the respondents at the end of the six months. The associations of the primary outcome with baseline variables were investigated using mixed linear models. Preliminary results. Compliance among 244 patients was high; 82.5 %. In the final model, duration (more or less than 30 days the previous year), EQ5D start score (self rated health) and self-rated improvement at the 4. th. visit were significantly associated with the number of days with bothersome pain during the following 26 weeks. Conclusion. Using this method of data collection, we have evaluated the course of the LBP condition in detail. The method seems promising because of good compliance and minimal recall bias


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1709 - 1716
1 Dec 2020
Kanda Y Kakutani K Sakai Y Yurube T Miyazaki S Takada T Hoshino Y Kuroda R

Aims

With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values.

Methods

We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected.