The Swedish Spine Register: development, design and utility

The Swedish Spine Register enables monitoring of surgical activities focusing on changes in trends over time, techniques utilized and outcome, when implemented in general clinical practice. Basic requirements for a prosperous register are unity within the profession, mainly patient-based documentation and a well functioning support system. This presentation focuses on the development and design of the register protocol, problems encountered and solutions found underway. Various examples on how the results can be presented and utilized are given as well as validation. Register data demonstrate significant gender differences in lumbar disc herniation surgery with females having more pain, lower quality of life and more pronounced disability preoperatively while improvement after surgery is similar between genders. Quality of life after surgery for degenerative disorders is significantly improved for disc herniation, stenosis, spondylolisthesis and disc degenerative disorders. Over the last 10 years, surgical treatment for spinal stenosis has increased gradually while disc herniation surgery decreases regarding yearly number of procedures. An added function to the register enables more complex prospective clinical studies to include register data together with data suitable for the individual study. A common core set of demographic, surgical and outcome parameters would enable comparisons of clinical studies within and between nations

Correlation between disability and MRI findings in lumbar spinal stenosis: A prospective study of 109 patients operated on by decompression

Background and purpose MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study. Patients and methods The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm(2), and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm(2), and spondylolisthesis were studied. Results Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06). Interpretation Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent

SF-36 scores in lumbar spine disorders: profiles and comparison with other chronic conditions

OBJECTIVE. When using Health-Related Quality of Life (HRQoL) in assessing outcomes of treatment, normative data for different diagnoses are needed to allow comparisons across existing and future studies. Aim of this study is to determine the SF-36 scores in patients with surgical lumbar spine problems. METHODS. This is a prospective observational study of consecutive surgical patients in one institution included within the framework of a national registry for lumbar spine surgery. In addition to SF-36 questionnaire responses, local pain, radiating pain, analgesic intake and walking ability were recorded, together with several other demographic variables. RESULTS. 451 patients, median age 52 (13-88) years, operated from 1998 to 2002 were included in the study. 49,7 % were males. Pre operative SF-36 scores were significantly lower than the normative values for normal population and patients with aspecific LBP, especially in physical domains. Significant but not very strong correlation was found between SF-36 scores and the other preoperative clinical variables recorded. SF36 profiles have been compared between several subgroups, categorized according to diagnosis or demographic characteristics, but no single strong effect was noted on all 8 domains. In most comparisons, subgroups showed a rather homogeneous pattern, different from patients with aspecific LBP CONCLUSION. HRQoL reported by patients scheduled for lumbar spine surgery was much worse when compared not only with that of the normal population but also with patients with aspecific LBP. Normative SF-36 values provided may now be used as a benchmark comparison in future studies of patients with lumbar spine disorders

Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders

STUDY DESIGN A prospective observational study of visual analog scale (VAS) scores for pain in patients operated at one institution within the framework of a national registry. OBJECTIVE To describe the use of recording VAS for pain intensity in patients operated on for lumbar spine problems. SUMMARY OF BACKGROUND DATA There is no consensus regarding pain outcomes assessment in spine patients. Pain intensity, recorded on a VAS, is one of the most used measures. Still, many aspects of its interpretation are still debated or unclear. METHODS A total of 755 consecutive patients, mean age 50 years (range, 15-86 years), operated from 1993 to 1998 were included in the study; there were 420 males and 335 females. Diagnoses included herniated nucleus pulposus (45%), central stenosis (19%), lateral stenosis (14%), isthmic spondylolisthesis (9%), and degenerative disc disease (9%). Local pain, radiating pain, analgesic intake, and walking ability were recorded before surgery and at 4 and 12 months after surgery. The patients' opinions regarding the change in pain and satisfaction with the result were assessed separately. Correlation among variables reflecting perceived pain was sought. RESULTS Preoperative VAS mean values for local and radiating pain were significantly different in the five diagnostic groups. Significant but moderate correlation between different types of pain outcomes and with patient satisfaction was present in all cases. CONCLUSIONS Measuring pain intensity with VAS is a useful tool in describing spine patients. In the search for a standard in the evaluation of pain as an outcome, the differences between the various methods should be taken into account