Identifying subsets of patients with single-level degenerative disc disease for lumbar fusion: the value of prognostic tests in surgical decision making

Staartjes, Victor E.; Vergroesen, Pieter-Paul A.; Zeilstra, D. J.; Schröder, Marc

doi:10.1016/j.spinee.2017.08.242

Cited by 23 publications

(23 citation statements)

References 46 publications

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“…If the genetic predisposition for herniation were similar to that of degeneration, one would also expect a higher prevalence of tandem herniations. In general, patients with symptomatic disc herniation present in their second to fourth decade of life, whereas problems pertaining disc degeneration increase linearly with age [2,9,18-19]. These findings infer that disc herniation is not usually the result of disc degeneration.…”

Section: Discussionmentioning

confidence: 99%

“…While there is very limited evidence on tandem herniated discs in the peer-reviewed literature, a few studies examine simultaneous lumbar and cervical disc degeneration. Multiple radiological reports discuss multi-segment disc degeneration, which appears to be age-related [2-3,18,29-30]. While these identifiable degenerative changes seem to occur concurrently in the lumbar and cervical spine in 24% to 79%, virtually all are asymptomatic [3,9,29-30].…”

Section: Discussionmentioning

confidence: 99%

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Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature

Siccoli

Staartjes

Wispelaere

et al. 2019

Cureus

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Introduction Lumbar disc herniation (LDH) and cervical disc herniation (CDH) represent a relevant public health problem. Patients with symptomatic tandem herniations of the cervical and lumbar spine are rare and not described in the literature. In these patients, certain variables may predispose the development of disc herniation which could increase the understanding of the development of disc herniations. Our aim is to present the first case series of tandem disc herniation, and to elucidate whether tandem herniation is attributable to a certain propensity for disc herniation or not. Methods From a prospective registry, patients with symptomatic tandem disc herniations were included, and the literature was reviewed on the comparative pathophysiology, genetics, and epidemiology of disc herniation and disc degeneration. Results Out of 3,156 patients with disc herniations in our registry, 16 presented with symptomatic tandem LDH and CDH that required discectomy. Therefore, we estimate the incidence of tandem disc herniation at 0.51% (95% confidence interval (CI): 0.26% - 0.75%) in the surgical population. The mean number of degenerated lumbar discs was 2.1 ± 1.1. Compared to the 1,241 patients with isolated LDH, no investigated factors were significantly associated with tandem herniations. Conclusion From a genetic, pathophysiological, and epidemiological position, disc herniation is not commonly a consequence of disc degeneration. Rather, degeneration and herniation seem to exist as two separate and distinctly different processes. Based on the literature, it is tenable that tandem disc herniation does not deviate from the normal pathophysiology, but rather occurs in the rare case that two individual herniated discs coincide.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature

Siccoli

Staartjes

Wispelaere

et al. 2019

Cureus

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“…25 The decision to operate is largely clinically driven and thus a secure and thorough understanding of the features which most affect patients is crucial to guide decision making. [26][27][28][29] Historically, the assessment of surgical success was based on largely subjective clinical and/or radiological assessment by the surgeon. This is inadequate given the poor correlation between magnetic resonance imaging findings and symptoms described above and has since been superseded by the development of patient-reported outcome measures (PROMs).…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

Sunderland

Foster

Dheerendra

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes. Methods: We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries.Results: Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months ¼ 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months ¼ 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (À2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%).Conclusions: Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.

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Section: Introductionmentioning

confidence: 99%

“…Lumbar interbody fusion has been suggested as a treatment option for chronic low back pain (CLBP) associated with single-level degenerative disc disease (DDD) [1-4]. Through the removal of the degenerated disc as a potential pain generator and fusion of the adjacent vertebrae, the surgery aims to reduce hypermobility and microinstability, hence mitigating pain stimuli [1,5-6]. In particular, anterior lumbar interbody fusion (ALIF) has been highlighted as a promising surgical technique, since the minimum clinically important difference (MCID) in patient-reported outcomes (PROMs) can be achieved with minimal blood loss and relatively short surgical times [1-4].…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

Vieli¹,

Staartjes²,

Eversdjik³

et al. 2019

Cureus

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IntroductionAs a possible treatment option for chronic lower back pain (CLBP) due to single-level degenerative disc disorder (DDD), the efficacy of anterior lumbar interbody fusion (ALIF) has been reviewed various times in the existing literature. Nevertheless, a scarcity of data exists pertaining to ALIF procedures carried out in a short-stay setting using an Enhanced Recovery after Surgery (ERAS) protocol, particularly concerning the safety.MethodsProspectively collected data are analyzed to study the efficacy and safety of short-stay ERAS ALIF in treatment of single-level DDD. Visual Analog Scale (VAS) in both back and leg pain along with the Oswestry Disability Index (ODI) were used to collect measure outcomes. The primary endpoint was a minimum clinically important difference (MCID) of ≥30% for the ODI at 12 months.ResultsForty-four patients underwent surgery after failed long-term conservative treatment. MCID was achieved in 78%. Age was the only significant factor in association with MCID (p = 0.03), while gender, Modic changes, results of prognostic tests, prior surgery and smoking status had no significant influence on either MCID or change scores for any outcome measure. One complication in the form of transient new radiculopathy occurred in one patient (2.3%).ConclusionWith overall positive outcomes in terms of both efficacy and safety, an ALIF procedure with subsequent implementation of an ERAS protocol in a short-stay setting can be an option for strictly selected patients with CLBP. Further study, however, possibly with a larger sample size, would be necessary to substantiate these findings.

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Identifying subsets of patients with single-level degenerative disc disease for lumbar fusion: the value of prognostic tests in surgical decision making

Cited by 23 publications

References 46 publications

Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature

Tandem Disc Herniation of the Lumbar and Cervical Spine: Case Series and Review of the Epidemiological, Pathophysiological and Genetic Literature

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

Safety and Efficacy of Anterior Lumbar Interbody Fusion for Discogenic Chronic Low Back Pain in a Short-stay Setting: Data From a Prospective Registry

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