The aim of this study was to determine whether obesity affects pain, surgical and functional outcomes following lumbar spinal fusion for low back pain (LBP).

A systematic literature review and meta-analysis was made of those studies that compared the outcome of lumbar spinal fusion for LBP in obese and non-obese patients. A total of 17 studies were included in the meta-analysis. There was no difference in the pain and functional outcomes. Lumbar spinal fusion in the obese patient resulted in a statistically significantly greater intra-operative blood loss (weighted mean difference: 54.04 ml; 95% confidence interval (CI) 15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio: 1.91; 95% CI 1.68 to 2.18; n = 43858; p < 0.001) and longer duration of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p < 0.001). Obese patients have greater intra-operative blood loss, more complications and longer duration of surgery but pain and functional outcome are similar to non-obese patients. Based on these results, obesity is not a contraindication to lumbar spinal fusion.

Cite this article: Bone Joint J 2015;97-B:1395–1404.

Introduction

This study aims to evaluate the impact of associated psychological co-morbidities (Depression/Anxiety), smoking history, gender, work benefits and employment status on the clinical outcome following anterior cervical disc replacement (ACDR).

Purposes: To evaluate the effectiveness of Posterior Lumbar Interbody Fusion (PLIF) surgery in resolving back and back related leg pain and its effect on quality of life.

Methods: Two hundred and twenty six patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation and postlaminec-tomy/postdiscectomy syndrome unresolved by conservative therapy were entered into the study. Patients were assessed using a self-administered questionnaire containing the Oswestry disability index (ODI) for back pain related disability, visual analogue scales (VAS) for back and leg pain severity (0 = none, 10 = worst imaginable pain) and the SF-36 general health questionnaire. Outcomes were assessed preoperatively and at a minimum of 2 years follow-up. Statistical significance was tested using a paired t-test after confirming normality of the data.

Results: Of the 226 patients,182 (99 females, 83 males; mean age at treatment, 45.3 years; age range 15 – 67 years) returned follow-up questionnaires (81% response). The mean duration of follow-up was 26.4 months (range 24 – 60 months). The ODI showed a statistically and clinically significant improvement between baseline (52.1) and follow-up (29.5), (22.6(17.8 to 27.5); P= 0.000). This represents a 43% improvement in functional ability. There was a statistically and clinically significant improvement between VAS back pain scores at baseline (7.7) and follow-up (3.9), (3.8 (3.1 to 4.4); P = 0.000 ). This represents a reduction of 49%. Similarly VAS leg pain at baseline (6.6) and follow-up (3.2) ,(3.4 (2.7 to 4.2); P = 0.000) showed a reduction of 52% which was also statistically and clinically significant. All dimensions of the SF-36 except role physical showed a statistically and clinically significant improvement.

Conclusion: The results show that in our series, there is a statistically and clinically significant improvement in pain, functional ability and quality of life after PLIF surgery in patients with chronic back and leg pain unresolved by conservative therapy.

Purposes: To evaluate the effectiveness of Posterior Lumbar Interbody Fusion (PLIF) surgery in resolving back and back related leg pain and its effect on quality of life.

Methods: Two hundred and twenty six patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation and postlaminec-tomy/postdiscectomy syndrome unresolved by conservative therapy were entered into the study. Patients were assessed using a self-administered questionnaire containing the Oswestry disability index (ODI) for back pain related disability, visual analogue scales (VAS) for back and leg pain severity (0 = none, 10 = worst imaginable pain) and the SF-36 general health questionnaire. Outcomes were assessed preoperatively and at a minimum of 2 years follow-up. Statistical significance was tested using a paired t-test after confirming normality of the data.

Results: Of the 226 patients,182 (99 females, 83 males; mean age at treatment, 45.3 years; age range 15 – 67 years) returned follow-up questionnaires (81% response). The mean duration of follow-up was 26.4 months (range 24 – 60 months). The ODI showed a statistically and clinically significant improvement between baseline (52.1) and follow-up (29.5), (22.6(17.8 to 27.5); P= 0.000). This represents a 43% improvement in functional ability. There was a statistically and clinically significant improvement between VAS back pain scores at baseline (7.7) and follow-up (3.9), (3.8 (3.1 to 4.4); P = 0.000 ). This represents a reduction of 49%. Similarly VAS leg pain at baseline (6.6) and follow-up (3.2) ,(3.4 (2.7 to 4.2); P = 0.000) showed a reduction of 52% which was also statistically and clinically significant. All dimensions of the SF-36 except role physical showed a statistically and clinically significant improvement.

Conclusion: The results show that in our series, there is a statistically and clinically significant improvement in pain, functional ability and quality of life after PLIF surgery in patients with chronic back and leg pain unresolved by conservative therapy.

Objective : To share our experience developing an integrated spinal service, including a Spinal Assessment Clinic (SAC), Data Collection Centre, self-help Spinal Fitness Programme, three month Multi-disciplinary Spinal Rehabilitation Programme surgical service and Spinal Support Group. The Service was commended in the National Nye Bevan Awards and won the Millennium Nurse of the Year award surgical category.

Design: The SAC has operated for three and a half years and includes two nurse practitioners and an extended scope physiotherapist. Over 1000 patients per year are assessed, investigated, educated and commenced on a management plan by the practitioners, including data collection pre and post treatment. The three-month Rehabilitation programme is based in a sports complex and runs in collaboration with the private sector. The patients seen by MK are fully investigated and have failed conservative measures. The patient-led Spinal Support Group counsels all patients prior to treatment, feeding back related problems. The sole consultant (MK) has developed formal links with another spinal surgeon combining operating, clinical and audit sessions.

Outcome measures: Reduced out-patient waiting times, patient satisfaction survey, discharge rate following self-help Spinal Fitness Programme, number of complaints.

Results: Waiting time reduced from 89 to 16 weeks, urgent cases are seen within twenty-four hours. One hundred patients polled by questionnaire: 70% regarded their experience through SAC as excellent, 28% good and 2% fair. 70% were discharged six months following the self- help Spinal Fitness Programme. SAC had three complaints in three years, none for a missed diagnosis.

Conclusion: We would commend this service model for consideration by our colleagues.