Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale

The Spine J에 9월에 게재된 논문 입니다. 일상생활을 하는데에 있어 불편함 정도를 나타내는 ODI와 허리와 다리의 통증지수를 나타내는 VAS를 비교하여 어떤것이 요추의 움직임을 나타내는 지표로서 더 적절한 평가도구인지를 평가하는 연구 입니다.

VAS보다 ODI가 요추 움직임을 나타내는 임상평가항목으로서 더 적절하다는 결론 입니다^^

링크 타고 가시면 전문 보실 수 있습니다~

*Title: Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale.

일상생활 장애지수(ODI)는 통증지수(VAS)보다 요추의 움직임을 나타내는 지표로서 더 좋다.

*Authors: Ruiz FK, Bohl DD, Webb ML, Russo GS, Grauer JN

*Bibliography: SpineJ. 2014 Sep 1;14(9):1860-5.

BACKGROUND CONTEXT

The utility of various outcome measures that are used in both research and clinical practice have been studied, but the connection with range of motion (ROM) has not been well documented.

PURPOSE

To assess objectively the postulated correlation of lumbar complaints (based on standardized outcome measures) with extremes of lumbar ROM and functional ROM (fROM) with activities of daily living (ADLs) as assessed with an electrogoniometer.

STUDY DESIGN/SETTING

clinical cohort study

PATIENT SAMPLE

▶Subject: undergo a lumbar intervention (injection, decompression, and/or fusion)

OUTCOME MEASURES

1) Visual Analogue Scale (VAS)

2) Oswestry Disability Index (ODI)

-for axial extremity, lower extremity, and combined axial and lower extremity

METHODS

-Pain and disability scores were assessed with the VAS score and ODI.

-Electrogoniometer was used to measure ROM (extremes of motion in three planes) and fROM (functional motion during 15 simulated activities of daily living).

-Pain and disability scores were analyzed for statistically significant association with the motion assessments using linear regression analyses.

RESULTS

▶Subjects: 28 men and 39 women

▶Average age: 55.6 yrs(18-79 yrs)

-The ODI and VAS were associated positively (p<.001).

-Combined axial and lower extremity VAS scores were associated with lateral and rotational ROM (p<.05), but not with flexion/extension or any fROM.

-Similar findings were noted for separately analyzed axial and lower extremity VAS scores.

-ODI correlated inversely with ROM in all planes, and fROM in at least one plane for 10 of 15 ADLs (p<.05).

CONCLUSIONS

-Extremes of lumbar motion and motions associated with ADLs are of increasing clinical interest.

-ODI appears to be a better predictor of these motion parameters than the VAS (axial extremity, lower extremity, or combined) and may be more useful in the clinical setting when considering functional movement parameters.

The Spine Journal 7월호 논문 목록

The Spine Journal에서 나온 7월호 논문 목록 입니다.

일부만 가져왔으니 나머지는 저널 홈페이지에서 보시면 됩니다^^ (이레 링크 참조)

출처: The Spine Journal

Postoperative bracing after spine surgery for degenerative conditions: a questionnaire study

Brief review

이 연구는 한 학회에 참가한 척추전문의들에게 본인의 환자에게 보조기를 사용하는 것과 관련하여 설문을 진행한 질의연구 입니다. 

설문의 초점은 외과의들이 환자 수술 후에 사용하는 보조기의 종류, 치료기간, 사용이유 등에 관한 것 입니다.

응답자들이 수술을 마친 본인의 환자들에게 보조기를 사용 할 때에, 고정을 위한 가장 적절한 종류, 기간, 적응증에 따른 합의가 부족하다는 결론입니다.

*Title: Postoperative bracing after spine surgery for degenerative conditions

: a questionnaire study

퇴행성질환을 위한 척추수술 후의 보조기 착용: 질의 연구

*Author: Jesse E. Bible, Debdut Biswas, Peter G. Whang, Andrew K. Simpson, Glenn R. Rechtine, Jonathan N. Grauer

*Bibliography: The Spine Journal Volume 9, Issue 4 ,Pages 309-316, April 2009

Background context:

-A variety of orthoses are routinely applied after spinal procedures.

-But the proper indications for postoperative bracing are not well established.

Purpose

To assess the postoperative bracing patterns of spine surgeons.

Study design/setting

Questionnaire study

Patient sample

Spine surgeons attending the “Disorders of the Spine” conference (January 2008, Whistler, Canada).

Outcome measures

Frequencies of bracing after specific surgical procedures.

Methods

▶Subject: spine surgeons attending the “Disorders of the Spine” conference.

▶Questionnaire contents: typically immobilize patients after specific spinal procedures, the type of orthosis used, the duration of treatment, the rationale for bracing.

Results

-Ninety-eight of 118 surgeons completed the survey (response rate: 83%).

1. The frequency of bracing in academic and private/ in orthopedic and neurosurgical practices

--> similar

2.The difference in the bracing tendencies of fellowship and non-fellowship trained surgeons: -----> statistically significant (61% vs. 46%, p<.0001).

3. The duration (clinical experience): no influence the propensity of surgeons to use orthoses.

4. Employed more regularly: after cervical surgery > lumbar surgery (63% vs. 49%, p<.0001).

6. In the anterior cervical spine, orthoses were used more often as the complex procedure.

(increased single --▶ multilevel constructs (55% vs. 76%, p<.0001) )

7. The frequencies of bracing in noninstrumented and instrumented lumbar fusions

-->not significantly different.

Conclusions

-Most of the respondents brace their patients postoperatively, there is an obvious lack of consensus regarding the most appropriate type, duration, and indications for immobilization.

-Clinical studies may play a helpful role in evaluating the efficacy of postoperative bracing protocols.

Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy

Brief review

이 논문은 환자 만족도의 질과 유효성을 평가하는 내용 입니다.

10가지 항목으로 평가하였고, 환자의 만족도는 척추 수술의 질과 유효성을 결정하기에는 충분치 않다는 결론 입니다. 

이와 관련하여 The Spine Journal에 환자만족도가 합리적인 측정결과인지에 대한 Commentary도 출판되어 있으니 참고하시기 바랍니다.

(http://www.thespinejournalonline.com/article/S1529-9430(12)00996-5/abstract) 

*Title: Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy.

수술적 척추 치료의 질과 유효성의 결정: 환자의 만족도는 유효한 대용물이 아니다.

*Author: Saniya S. Godil, Scott L. Parker, Scott L. Zuckerman, Stephen K. Mendenhall, Clinton J. Devin, Anthony L. Asher, Matthew J. McGirt

*Bibliography: Spine J. 2013 Sep;13(9):1006-12.

BACKGROUND CONTEXT: .

Patients' satisfaction has commonly used metric as a proxy. But It has yet to be validated as a measure of overall quality of surgical spine care.

PURPOSE:

To determine whether patient satisfaction is a valid measure of safety and effectiveness of care in a prospective longitudinal spine registry.

STUDY DESIGN: Prospective longitudinal cohort study.

PATIENT POPULATION:

All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center.

OUTCOME MEASURES:

Patient-reported outcome instruments as follow.

1. numeric rating scale [NRS]

2. Oswestry disability index [ODI]

3. neck disability index [NDI]

4. short-form 12-item survey [SF-12]

5. Euro-Qol-5D [EQ-5D]

6. Zung depression scale

7. Modified Somatic Perception Questionnaire[MSPQ] (anxiety scale)

8. return to work

9. patient satisfaction with outcome

10. patient satisfaction with provider care.

METHODS:

▶Subject: undergoing elective spine surgery for degenerative conditions (over a 6-month period)

▶Measurement: NRS, ODI, NDI, SF-12, EQ-5D, Zung depression scale, and MSPQ anxiety scale, return to work, patient satisfaction with outcome, and patient satisfaction (3 months after treatment)

RESULTS:

422 patients (84%) completed all questionnaires 3 months after surgery during the reviewed time period (mean age 55±14 years).

(Lumbar surgery was performed in 287 (68%) and Cervical surgery in 135 (32%) patients)

-complications: 51 patients (12.1%) (90-day)

-readmissions: 21 (5.0%)

-return to operating room: 12 (2.8%)

-patients satisfied with provider care: 358 (84.8%)

-patients satisfied with outcome: 288 (68.2%)

-In ROC analyses, improvement in quality of life(SF-12), disability(ODI/NDI) differentiated satisfaction VS dissatisfaction with care with very poor accuracy (AUC 0.49-0.69).

CONCLUSIONS:

-Patient satisfaction is not a valid measure of overall quality or effectiveness of surgical spine care.

-Patient satisfaction metrics likely represent the patient's subjective contentment with health-care service, a distinct aspect of care.

-Satisfaction metrics are important patient-centered measures of health-care service but should not be used as a proxy for overall quality, safety, or effectiveness of surgical spine care.

Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients

Brief review

*Title: Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients

척추경나사못고정술에서 골밀도의 영향: 고령환자의 후방 요추체간 유합술에서 척추경 나사못 고정의 연구

*Author: Koichiro Okuyama, Eiji Abe, Tetsuya Suzuki, Yasuki Tamura, Mitzuho Chiba, Kozo Sato

*Bibliography: TheSpine Journal1(2001)402-407.

Background context: 

-Some biomechanical studies have demonstrated that bone mineral density of the lumbar spine (BMD) affects the stability of pedicle screws in vitro.

-Common problem: screw bending, breakage, loosening(radiolucency in the bone screw interface).

Purpose: 

-To investigate influence of BMD on loosening and related failure of pedicle screws in vivo.

Study design/setting: 

-A clinical study of 52 patients who underwent pedicle screw fixation augmenting posterior lumbar interbody fusion (PLIF).

Patient sample:

▶Subject number: 52 patients (13 men + 39 women)

▶Mean age: 63 years (range, 45–76 yr)

▶Mean follow-up period: 2.8 years (range, 2–6 yr).

Outcome measures: 

-statistically analyzed(Relationship between BMD, screw loosening, and its related failures)

Methods:

-BMD was measured by the dual energy X-ray absorptiometry (DEXA) method.

-Two authors did radiographic assessments.

▶52 patients were divided into 3 groups as below.

1. Union: n=40

(no movement on the lateral view in the flx-ext in the fixed segment and continuity of trabecular bony bridging at the fixed interbody space.)

2. Non union: n=4

(any movement or discontinuity)

3. Undetermined union: n=8

(continuity of the trabecular bony bridging was vague in spite of no movement of the fixed segment in the flx-ext.)

Results:

The mean BMD values are as follow. (Unit: g/cm2 / mean±S.D.)

▶All patients: 0.879±0.215

▶Patients with or without screw loosening

-with screw loosening: 0.720±0.078 (n=11)

-without screw loosening: 0.922±0.221 (n=41).

>>Significant difference between with and without screw loosening 

(the mean BMD of patients ,P<.01).

▶Union patients

-Union patients: 0.934±0.210 (n=40)

-Non union: 0.674±0.104 (n=4)

-Undetermined union: 0.710±0.116 (n=8)

>>Union was significantly greater than those with Nonunion and Undetermined union (P<.05).

Conclusion:

-BMD has a close relation with the stability of pedicle screws

-BMD value below 0.674±0.104 g/cm2 suggests a potential increased risk of “nonunion” when pedicle screw fixation is performed in conjunction with PLIF.

Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.

Brief review

*Title: Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.

외래환자의 신경공경유요추체유합술 시행 가능성에 대한 예비결과

*Author: Alan T. Villavicencio, Ewell Lee Nelson, Alexander Mason, Sharad Rajpal, Sigita Burneikiene

*Bibliography: JSpinal Disord Tech. 2013 Aug;26(6):298-304

STUDY DESIGN: A retrospective chart review study

OBJECTIVE:

-The primary objective: To examine whether it is safe and effective to perform instrumented lumbar interbody fusions by comparing 2 groups (same day vs stayed overnight).

-The secondary objective: To identify the need for prolonged observation for complications that may occur in the immediate postoperative period.

SUMMARY OF BACKGROUND DATA: 

There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting.

METHODS:

▶Subject number: Ambulatory Surgery Center(ASC): 27/  Hospital Outpatient Departments (HOD): 25

▶Mean age: 49.8 years (19-72 y)

▶evaluation method:

-The safety of outpatient lumbar fusions: analyzing complications that occurred when the seventh postoperative day (0-7 POD).

- The efficacy of surgical intervention: change in pain, patient satisfaction scores, and fusion rates

RESULTS:

-no cases of pneumonia, urinary tract infection, or thromboembolic complications.

-4 patients(14%) in ASC and 1 patient(4%) in HOD had complications within 7 days postoperatively.

-->not statistically significant in difference (P=0.36, Fisher exact test).

-Lower back and leg pain was significantly (P<0.0001) decreased postoperatively as follow.

>The average back pain: 74.5 (range: 0-100)  --> 18.8 (range: 0-90)

>The average leg pain: 54.2 (range, 0-100) --> 9.1 (range, 0-60)

*using 0-100 visual analog scale

CONCLUSIONS: 

This study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure.