Predictive Factors for the Outcome of Fusion in Adult Isthmic Spondylolisthesis

Ekman, Per; Möller, Hans; Hedlund, Rune

doi:10.1097/brs.0b013e3181a19e66

Cited by 53 publications

(67 citation statements)

References 27 publications

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“…Similarly, patients who were still fully capable of working preoperatively may have stronger coping abilities and better social resources, allowing for fast and thorough rehabilitation. This finding is supported by Ekman et al, 8 who found working status to be the strongest predictor of a positive outcome.…”

Section: Socio-demographic Factorssupporting

confidence: 80%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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OBJECTIVEThe accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation.METHODSA retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures.RESULTSSeventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p < 0.001, OR 9.7). Additionally, a higher incidence of revision surgery for screw malposition was observed for freehand procedures than for the robot-guided procedures (p < 0.001, OR 8.1). The VAS score for back pain improved significantly from 66.9 ± 25.0 preoperatively to 30.1 ± 26.8 at the final follow-up, as did the VAS score for leg pain (from 70.6 ± 22.8 to 24.3 ± 28.3) and ODI (from 43.4 ± 18.3 to 16.2 ± 16.7; all p < 0.001). Undergoing PLIF, a high body mass index, smoking status, and a preoperative ability to work were identified as predictors of a reduction in back pain. Length of hospital stay was 2.4 ± 1.1 days and operating time was 161 ± 50 minutes. Ability to work increased from 38.9% to 78.2% of patients (p < 0.001) at the final follow-up, and 89.1% of patients indicated they would choose to undergo the same treatment again.CONCLUSIONSIn adults with low-grade spondylolisthesis, the data demonstrated a benefit in using robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other techniques.

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Section: Socio-demographic Factorssupporting

confidence: 80%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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“…In previous outcome prediction studies specific for lumbar fusion patients, 25-30% of the variance in postsurgical ODI and pain VAS have been reported to be explained by regression models [9,41]. In our study, the models significantly explained 41.6, 36.0 and 25.6% of the variance in the 2-3 year measures of ODI, back pain VAS and EQ-5D, respectively.…”

Section: Discussionsupporting

confidence: 66%

“…Many possible reasons for mixed lumbar fusion surgery outcomes exist, including instrumentation failure, inadequate surgical technique and poor patient selection. Factors previously suggested to be predictive of pain and disability-related outcomes include pre-surgical pain/function [42], negative personality traits [19,31,40,41,44], emotional status [41], anxiety/depression [3,23,28,40,41], fear avoidance (FA) beliefs [28], negative outcome expectations [20,48] negative coping [3], smoking status [41], gender [9], exercise [9], litigation [23], duration of back pain and workers' compensation [3,19,40,41].…”

Section: Introductionmentioning

confidence: 99%

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

2011

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Prediction studies testing a thorough range of psychological variables in addition to demographic, workrelated and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Postoperative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and postoperative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

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“…25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Data obtained from outcome studies do not support 1 method over another and each technique has its associated complications. 28,[42][43][44][45][46][47][48][49][50] Most of the published literature is retrospective with no standardization of either outcome measures or process measures. 43,51 The limited outcome studies suggest that a solid fusion, regardless of the technique or the approach, is important for successful patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

Thirukumaran

Raudenbush

et al. 2016

SPINE

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Predictive Factors for the Outcome of Fusion in Adult Isthmic Spondylolisthesis

Cited by 53 publications

References 27 publications

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

National Trends in the Surgical Management of Adult Lumbar Isthmic Spondylolisthesis

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