Risk Factors of Postoperative Low Back Pain for Lumbar Spine Disease

Gu, Jiaao; Guan, Feifei; Lin, Zhenguo; Guan, Guofa; Chi, Zhiyong; Wang, Haojun; Yu, Zhange

doi:10.1016/j.wneu.2016.07.010

Cited by 24 publications

(20 citation statements)

References 22 publications

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“…Besides the technique aspect, regional long-acting analgesia (i.e., Exparel) and a significantly shorter operation time (mean operative time 110 minutes) were also demonstrated to be extremely helpful in reducing patients' pain levels. 24,25 In return, our patients in the ERAS program required less opioid consumption, and achieved early mobility.…”

Section: Discussionmentioning

confidence: 77%

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Chang

Huang

et al. 2020

Neurospine

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The concept of enhanced recovery after surgery (ERAS) is relatively new to the neurosurgical field. The introduction of an ERAS protocol in lumbar fusion surgery has aimed to accelerate patient recovery from surgery by reducing in-hospital opioid consumption. Methods: Patients with 1-or 2-level degenerative lumbar spine disease and who underwent ERAS transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. Patients' general demographic data, in-hospital opioid dosage (converted to morphine equivalents), and hospital stay were compared to those who underwent standard minimally-invasive (MIS)-TLIF. Results: Twenty-four patients who received ERAS TLIF (the ERAS group) were compared to a series of 24 patients who received standard MIS-TLIF (the MIS group). The demographic data were similar. The operation time and blood loss significantly favored ERAS TLIF. The average daily opioid consumption was remarkably lower in the ERAS group than the MIS group. Average opioid dosage throughout the entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group. The average length of hospital stay was substantially shorter in the ERAS group (1.4 ± 1.13 days vs. 4.0±1.98 days, p<0.001). Conclusion: The present study demonstrated a significant decline in the consumption of opioids and in the hospital length of stay for patients undergoing ERAS TLIF for 1-or 2-level degenerative lumbar spine disease.

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Section: Discussionmentioning

confidence: 77%

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Chang

Huang

et al. 2020

Neurospine

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“…Of the six included studies, three were retrospective cohort studies [16][17][18], two were prospective cohort studies [15,19], and one was a secondary analysis of a previous randomised control trial [13]. Two studies examined the effect of pre-operative fat infiltration on improvement in LBP (Visual Analogue Scale [VAS]) only [17,18], two studies examined the effect of pre-operative fat infiltration on improvement in both LBP (VAS) and disability (Oswestry Disability Index [ODI]) [13,15], one study examined the effect of both pre-operative fat infiltration and cross-sectional area on improvement in disability (ODI) only [19], and one study examined the effect of pre-operative cross-sectional area on improvement in disability (ODI) only [16]. No studies examined the effect of multifidus cross-sectional area on LBP rating scales.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…At present, there is some evidence to suggest that changes in the morphology of multifidus following a surgical procedure are associated with worse clinical outcomes, although the magnitude of this effect is unclear [10][11][12][13][14]. Furthermore, the association between the pre-operative morphological condition of multifidus and post-operative clinical outcomes is not well described [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review

et al. 2020

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Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and postoperative changes in pain and disability. Methods We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool. Results The initial search yielded 436 studies, of which 6 studies were included in the analysis. Four studies were at a low risk of bias. These studies included a total of 873 patients undergoing spinal surgery. An association between low fat infiltration and greater improvement in LBP and disability following surgery was identified. There was insufficient evidence to identify a relationship between cross-sectional area (CSA) and LBP or disability. Conclusions This systematic review found evidence for an association between low multifidus fat infiltration on MRI at baseline and greater reductions in measures of LBP and disability following surgical treatment. There is also limited evidence for an association between larger pre-operative multifidus CSA and improvements in disability, but not pain. The findings of this review should be interpreted with caution due to the small quantity of the available literature.

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“…For example, ERAS-transforaminal lumbar interbody fusion (TLIF) advocated by Wang et al adopted multimodal technology to maximize patient recovery in a very short period following lumbar fusion surgery, a procedure notorious for post-operative pain and the need for hospitalization [15,27]. Their technique combined an exceedingly minimally-invasive procedure and instruments, including intravenous anesthesia without intubation, endoscopic discectomy, expandable mesh cages, percutaneous pedicle screws, and a regional long-acting analgesic agent [7,28,29]. Their results demonstrated early discharge and durable outcomes for patients undergoing ERAS-TLIF surgery, and successfully addressed the principle of the ED program for lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study

Huang

Chang

et al. 2020

IJERPH

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Early discharge (ED) has emerged and gained popularity in spine surgery. However, the benefits of ED in lumbar fusion have not yet been validated by large cohort studies. To evaluate the effects of ED on readmissions and reoperations in lumbar fusion, this study utilized a national database to enroll patients who had undergone lumbar fusion surgery at age 50–70 years, and grouped them into an ED group or a comparison group. In the comprehensive follow-up of 180 days post-operation, the two groups were compared. There were 18,008 patients in the cohort, including 2172 in the ED group and 15,836 in the comparison group. The ED group was slightly younger (59.9 vs. 60.7 years, p < 0.001), more male predominant (44.9% vs. 36.9%, p < 0.001), and had fewer medical comorbidities. The ED group had less incidences of readmission than the comparison group. (Crude hazard ratio = 0.73, and adjusted HR = 0.75, both p < 0.001). Overall, the cumulative incidences of readmission in the ED group (9.5%) were lower than those in the comparison group (12.8%, p < 0.001), whereas reoperations were insignificantly different (1.5% vs. 1.2%, p = 0.189). For patients aged 50–70 years and who require lumbar fusion surgery, ED could yield a 25% reduced risk of readmission for any cause within 180 days post-operation. Since the reoperation rates remained similar, our results suggest that ED may be a promising option for elderly patients undergoing lumbar spinal fusion surgery.

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Risk Factors of Postoperative Low Back Pain for Lumbar Spine Disease

Cited by 24 publications

References 22 publications

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study

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