Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

Abstract

Aim:To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Materials & methods: Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Results: Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Conclusion: Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection. Summary points• In late life, low back pain with and without leg pain is frequently associated with functional disability, psychosocial impairment, poor sleep quality and depression.• A substantial body of literature has identified comorbidities that predict suboptimal spine surgery outcome, including musculoskeletal conditions, impaired gait, cardiovascular disease, and mood and anxiety disorders.• We observed that mild cognitive impairment and the presence of widespread pain may be two potential predictors of satisfaction and disability following lumbar surgery. Given the relatively high frequency at which these two conditions occur in older adults in clinical settings, future projects are warranted to understand their potential impact on surgical outcome, functioning and satisfaction.• Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery.• Depression and anxiety both improved at the 3-month follow-up with moderate effect sizes for both.For reprint orders, please contact: reprints@futuremedicine.com

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

“…The increasing number of affected patients and the growing socioeconomic consequences of DLSS underscore the need for an accurate diagnosis. Clinical judgement is generally based on symptom severity, functional deficits, physical examination and radiographic imaging [6]. However, psychological and sociodemographic factors as well as the course of disease, seem to influence the clinical presentation of DLSS (e.g.…”

“…There is no “gold standard” for the diagnosis of DLSS [5]. Clinical judgement is generally based on symptom severity, functional deficits, physical examination and radiographic imaging [6]. The most promising imaging test is magnetic resonance imaging (MRI) [5].…”

Sleep Quality in Spine Surgery

“…13 In elderly patients undergoing lumbar spinal surgery, postoperative improvement in sleep quality has been demonstrated to correlate with improvements in disability. 14 A study by Yavuz and Uysal 15 demonstrated that, after single-level lumbar microdiscectomy, patient-reported sleep quality improved by 64% compared with patients who underwent extended conservative therapy who reported sleep improvement by 38%, in a similar pattern as pain improvement between groups. A retrospective review by Hu et al 16 demonstrated that 82% of patients with thoracolumbar kyphosis secondary to ankylosing spondylitis reported poor sleep at baseline.…”

Sleep Quality in Spine Surgery

“…In a systematic review focusing on sleep disruption and chronic low back pain, it was observed that improvements in self-reported sleep duration and quality were significantly associated with improvements in lower back pain 13. In elderly patients undergoing lumbar spinal surgery, postoperative improvement in sleep quality has been demonstrated to correlate with improvements in disability 14. A study by Yavuz and Uysal15 demonstrated that, after single-level lumbar microdiscectomy, patient-reported sleep quality improved by 64% compared with patients who underwent extended conservative therapy who reported sleep improvement by 38%, in a similar pattern as pain improvement between groups.…”