Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis

Koenders, Niek; Rushton, Alison; Verra, Martin L.; Willems, Paul; Hoogeboom, Thomas J.; Staal, J. Bart

doi:10.1007/s00586-018-5680-3

Cited by 39 publications

(23 citation statements)

References 84 publications

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“…In addition, while our MRSmiss patients were slightly older (44.2 vs 39.3; p = 0.047), there were no statistically significant differences in other potential confounding factors such as race, smoking, BMI, and worker's compensation status (Table 2; p > 0.08) [36][37][38][39]. Nonetheless, given our sample size is comparable to prior studies reporting pain and disability following lumbar fusion [40], our data firmly support the notion that proper level selection in fusion surgery is important, and that limitations in this regard may explain discordance between historically improving rates of technical success (e.g., radiographically confirmed fusion) and lack of proportionate gains in patient outcomes [41].…”

Section: Discussionsupporting

confidence: 54%

Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain

et al. 2019

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Purpose The goal of this study was to refine clinical MRS to optimize performance and then determine whether MRS-derived biomarkers reliably identify painful discs, quantify degeneration severity, and forecast surgical outcomes for chronic low back pain (CLBP) patients. Methods We performed an observational diagnostic development and accuracy study. Six hundred and twenty-three (623) discs in 139 patients were scanned using MRS, with 275 discs also receiving provocative discography (PD). MRS data were used to quantify spectral features related to disc structure (collagen and proteoglycan) and acidity (lactate, alanine, propionate). Ratios of acidity to structure were used to calculate pain potential. MRS-SCOREs were compared to PD and Pfirrmann grade. Clinical utility was judged by evaluating surgical success for 75 of the subjects who underwent lumbar surgery. Results Two hundred and six (206) discs had both a successful MRS and independent pain diagnosis. When comparing to PD, MRS had a total accuracy of 85%, sensitivity of 82%, and specificity of 88%. These increased to 93%, 91%, and 93% respectively, in non-herniated discs. The MRS structure measures differed significantly between Pfirrmann grades, except grade I versus grade II. When all MRS positive discs were treated, surgical success was 97% versus 57% when the treated level was MRS negative, or 54% when the non-treated adjacent level was MRS positive. Conclusion MRS correlates with PD and may support improved surgical outcomes for CLBP patients. Noninvasive MRS is a potentially valuable approach to clarifying pain mechanisms and designing CLBP therapies that are customized to the patient. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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Section: Discussionsupporting

confidence: 54%

Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain

et al. 2019

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“…Previous data from the Swedish National Spine Register identified that 25% of patients reported no change or worsened pain following LSFS, and at 1 year 40% of patients reported dissatisfaction regarding their outcomes [14]. Conversely, in a recent systematic review and meta-analysis of 25 prospective cohort studies (n = 1777), the clinical course of pain (both leg and back pain) and disability in patients following LSFS for degenerative disorders of the lumbar spine was analysed [15]. The results demonstrated that leg pain, back pain and disability outcomes improved significantly, immediately following LSFS (within first 4 weeks).…”

Section: Introductionmentioning

confidence: 99%

“…The results demonstrated that leg pain, back pain and disability outcomes improved significantly, immediately following LSFS (within first 4 weeks). Results also indicated that in the longterm (evaluation was only possible to 24 months as no data were available >24 months) leg pain outcomes might remain more reduced and for longer than back pain and disability [15].…”

Section: Introductionmentioning

confidence: 99%

Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries

et al. 2020

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The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45–64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants’ recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients’ perspectives. Recognition of a patient’s trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes.

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“…The efficacy of the fusion surgery is established in several indications. 3,4 Some indications are more controversial: some recent studies question the need of combining fusion to decompression in degenerative spondylolisthesis, 5,6 and LSF in degenerative disc disease (DDD) is probably not reasonable in most cases. 7 The knowledge of the long-term consequences of LSF is important.…”

Section: Introductionmentioning

confidence: 99%

Disability, Health-Related Quality of Life and Mortality in Lumbar Spine Fusion Patients—A 5-Year Follow-Up and Comparison With a Population Sample

Toivonen

Pekkanen

Neva

et al. 2020

Global Spine Journal

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Study Design: Prospective follow-up study. Objectives: We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. Methods: 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. Results: The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was −26 (95% CI: −24 to −28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. Conclusions: Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population.

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Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis

Cited by 39 publications

References 84 publications

Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain

Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain

Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries

Disability, Health-Related Quality of Life and Mortality in Lumbar Spine Fusion Patients—A 5-Year Follow-Up and Comparison With a Population Sample

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