Background/Purpose of study

The increasing aging of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery.

Background and Objectives: Pain is one of the most important outcome variables in epidemiologic studies of musculoskeletal disorders and is most commonly assessed retrospectively. This study examined the reliability/validity of retrospective pain ratings.

Methods: 400 individuals reporting low back pain (LBP) in a population-based survey were invited to participate in a year-long study of the course of LBP. At the start and end, they completed a questionnaire (demographics, symptoms, function, Chronic Pain Grade Questionnaire (CPGQ)). Each week, they completed a one-page diary (numeric rating scale for pain intensity, work limitations and social limitations due to LBP). Participants could choose between electronic or paper versions. Intraclass correlation coefficients indicated the agreement between the weekly ratings and the corresponding retrospective assessment (CPGQ).

Results: 348 individuals agreed to participate; 250 provided complete data-sets. Agreement between prospective and retrospective assessments was good (ICC pain=0.73, 95%CI 0.65–0.79; ICC work limitations=0.82, 95%CI 0.77–0.86; ICC social limitations=0.78, 95%CI 0.71–0.83). Separate analyses revealed no influence on the ICCs of completion-method, age and sex, but an influence of pain severity (severe: ICCs = 0.73, 0.88, 0.82, respectively; mild/moderate: 0.19, 0.22, 0.37, respectively) and pain duration (acute: 0.75, 0.81, 0.79, respectively; sub-acute/chronic: 0.52, 0.77, 0.57, respectively).

Conclusion: The results have important implications for clinical practice and epidemiological studies. For clinical practice, where patients with pain are being treated, retrospective pain assessments up to 6 months seem to be reliable. However, this is not the case in epidemiological studies in which many individuals with no or only moderate pain are involved.

In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their questionnaire at two-years. The groups did not differ in Core Outcome Measures Index score reduction, 3.6 (sd 2.5) (translaminar screws) vs 4.0 (sd 2.8) (transforaminal lumbar interbody fusion) (p = 0.39); ‘good’ global outcomes, 78% (translaminar screws) vs 78% (transforaminal lumbar interbody fusion) (p = 0.99) or satisfaction with treatment, 82% (translaminar screws) vs 86% (transforaminal lumbar interbody fusion) (p = 0.52).

The two fusion techniques differed markedly in their extent and the cost of the implants, but were associated with almost identical patient-orientated outcomes.

Extensive three-point stabilisation is not always required to achieve satisfactory patient-orientated results at two years.