Previous studies have stated that presence of concomitant back pain has a negative effect on the outcome of lumbar decompression/microdiscectomy but none have actually defined what level of back pain should be considered as significant. This is a study of consecutive patients who underwent a primary single level lumbar micro decompression /microdiscectomy performed by thirty nine surgeons at a single tertiary spinal centre between August 2011 and December 2014. The aim was to determine the differential effect of the intensity of back pain and leg pain as a predictor of outcome. Data was prospectively collected using SpineTango COMI questionnaires pre-operatively and at 3 months postoperatively. 995 patients who had a complete dataset were included in the analysis. Multivariate regression analysis and ROC curves were used to evaluate factors associated with poor outcome. At 3 months follow up 72.16% of patients were satisfied with the outcome of surgery. The VAS for low back pain was a significant predictor of poor outcome. Of patients with a VAS of 6 or more 34% had a poor outcome following surgery while of patients with a VAS of less than 6, 17% had a poor outcome at three months.Back ground:
Method and Result:
To define how pre-operative evaluation guides surgical planning in patients with atlanto-axial subluxation secondary to rheumatoid arthritis and to measure clinical outcome for the same group. Prospective evaluation of a consecutive cohort of 26 patients undergoing C1/2 fusion over 5 years (2004-2009). Pre-operative evaluation of posterior atlanto-dens interval (PADI), C1 lateral mass and C2 pedicle dimensions. Pre- and post-op Ranawat scores and visual analogue scores for neck and C2 pain C1/2 instability resulted from rheumatoid arthritis (21), trauma (4) and infection (1). C1 lateral mass mean height 4.4mm, C2 pedicle mean height 5.1mm and mean width 3.4mm (30% width <3mm). Ranawat scale improved Grade II to Grade I (p=0.07). Neck pain (pre-op mean 5.5, s.d. 2.8; post-op mean 1.6, s.d. 2.1, t<0.05) and C2 pain (pre-op mean 2.1, s.d. 3.3; post-op mean 0.5, s.d. 1.2, t<0.05) improved. No instrumentation failure. In the rheumatoid group, 17/21 patients had C1 lateral mass and C1/2 transarticular screws. 1 patient had a cranio-cervical fusion and 3 patients had other constructs. 3 patients had C2 numbness. No other neurological deficit. In a rheumatoid population, pre-operative evaluation often precludes the use of C2 pedicle screws. Rigid fixation with a C1 lateral mass and C1/2 transarticular polyaxial screw-rod system is associated with good clinical outcomes.
