Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.BACKGROUND AND PURPOSE: Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery. METHODS: 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and degree of leg and back pain (VAS) were obtained preoperatively. The mean age was 39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the patients. The change in EQ-5D score at the 2-year follow-up was analyzed by testing for correlation and by using a multiple regression model including all baseline factors (age, sex, duration of pain, degree of leg and back pain, and baseline EQ-5D score) as potential predictors. RESULTS: 85% of the patients reported improvement in EQ-5D two years after surgery and this result remained at the long-term follow-up. The mean difference (change) between the preoperative EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p < 0.001), respectively. However, the HRQoL for this patient group did not reach the mean level of previously reported values for a normal population of the same age range at any of the follow-ups. The changes in EQ-5D score between the 2- and 7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2). There was a correlation between baseline leg pain and the change in EQ-5D at the 2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However, when using regression analysis the only statistically significant predictor for change in EQ-5D was baseline EQ-5D score. INTERPRETATION: Our findings suggest that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation surgery, but there was no further improvement after 5 more years. Low quality of life and severe leg pain at baseline are important predictors of improvement in quality of life after lumbar disc herniation surgery.Marianne och Marcus Wallenberg Foundation ALF Vastra Gotaland. Gothenburg Medical Association. Swedish Society of Medicine. Felix Neubergh Foundation

Lumbar disc herniation. Clinical outcome and segmental stability using a new radiological classification and radiostereometry

Satisfactory results following conventional lumbar discectomy have been reported in 70-90% of cases. Remaining or recurrent low back pain or sciatica is, however, seen in many patients for reasons not yet fully understood. A relationship has previously been shown between the morphologic characteristics, i.e. shape and direction, of the disc herniation on preoperative films and the clinical results after surgery. Disturbed motion pattern or instability of the operated motion segment has also been presented as possible cause to poor postoperative results. Aims: To analyze 1) the relation between morphological characteristics of LDH on preoperative films analyzed with a new classification and the postoperative results and 2) the effect of the surgical procedure on inducible displacement of motion segments subjected to surgery for LDH, and 3) the relation between this inducible displacement and the portoperative results. Patients and methods: A new morphological classification of lumbar disc herniations was developed based on computed tomography (CT) and magnetic resonance tomography (MRI) images and subsequently applied on a retrospective study population comprising 142 patients. Following a reliability analysis of the classification, the preoperative images of 150 patients in a prospective study were graded according to the proposed classification and compared to 2 years outcome after surgery. Radiostereometric analysis (RSA) was used in 21 patients to prospectively analyze postoperative inducible segmental motion (inducible displacement) of the operated segment between supine and standing position over a 5 year period and results of RSA before discharge were compared to the clinical results 5 years after surgery. Results and conclusions: A high intra- and interrater reliability was found for the proposed classification. Larger sagittal and longitudinal distribution of the disc herniations were found on grading of CT images compared to MRI images. Morphologic characteristics of the herniation such as position in the spinal canal, direction and size were of no importance for the postoperative clinical results. The RSA analysis revealed a stiffening of the lumbo-sacral segments but no increase of inducible displacement 5 years after surgery. The pattern of inducible displacement in the sagittal plane at the two operated levels, which might be explained by grades of degeneration, was associated with a poor clinical outcome

Clinical application of a new three-dimensional radiological classification of lumbar disc herniations

The results after lumbar discectomy are usually satisfactory. However, there is a group of patients with less favorable result. The predictive factors affecting the result are not fully understood. In this paper a new radiological classification for lumbar disc herniations has been used in order to study the predictive value of the type and location of the herniation for the postoperative result. 142 patients operated with standard lumbar discectomy were included in the study. The preoperative CT-scans were used to classify the disc herniations in the transverse, sagittal and longitudinal directions and the size of the herniations were calculated. At a mean of 7.7 years postoperatively a patient administrated questionnaire was used to compare the clinical results to the radiological findings. A significantly smaller size of the lumbar disc herniation was found with increasing age, which could reflect the increased degeneration of the disc. Patients with a wide transverse distribution of the herniation seem to have a less favorable postoperative outcome in terms of higher rate of repeat surgery (p = 0.056). No other correlations were found

Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldSTUDY DESIGN: A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES: To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA: Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS: The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS: Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS: Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results

A comparison of radiostereometric analysis and computed tomography for the assessment of lumbar spinal fusion in a sheep model

Objective: The aim of this animal study is to evaluate the accuracy of radiostereometric analysis (RSA) compared with computed tomographic (CT) scan in the assessment of spinal fusion after anterior lumbar interbody fusion (ALIF) using histology as a gold standard. Methods: Three non-adjacent ALIFs (L1–L2, L3–L4, and L5–L6) were performed in nine sheep. The sheep were divided into three groups of three sheep. All the animals were humanely killed immediately after having the last scheduled RSA. The lumbar spine was removed and in vitro fine cut CT and histopathology were performed. Results: Using histological assessment as the gold standard for assessing fusion, RSA demonstrated better results (100% sensitivity and 66.7% specificity; positive predictive value [PPV] = 27.3%, negative predictive value [NPV] =100.0%) compared with CT (66.7% sensitivity and 60.0% specificity [PPV = 16.7%, NPV = 93.8%]). Conclusions: RSA demonstrated higher sensitivity and specificity when compared with CT. Furthermore, RSA has the advantage of much lower radiation exposure compared with fine cut CT. Further studies are required to see if RSA remains superior to CT scan for the assessment spinal fusion in the clinical setting.Ali Humadi, Brian J. C. Freeman, Rob J. Moore, Stuart Callary, Klas Halldin, Vikram David, William Maclaurin, Paul Tauro, Mark Schoenwaelde

The \u3b1-synuclein PET tracer [18F] ACI-12589 distinguishes multiple system atrophy from other neurodegenerative diseases

Abstract: A positron emission tomography (PET) tracer detecting alpha-synuclein pathology will improve the diagnosis, and ultimately the treatment of alpha-synuclein-related diseases. Here we show that the PET ligand, [18F]ACI-12589, displays good in vitro affinity and specificity for pathological alpha-synuclein in tissues from patients with different alpha-synuclein-related disorders including Parkinson's disease (PD) and Multiple-System Atrophy (MSA) using autoradiography and radiobinding techniques. In the initial clinical evaluation we include 23 participants with alpha-synuclein related disorders, 11 with other neurodegenerative disorders and eight controls. In vivo [18F]ACI-12589 demonstrates clear binding in the cerebellar white matter and middle cerebellar peduncles of MSA patients, regions known to be highly affected by alpha-synuclein pathology, but shows limited binding in PD. The binding statistically separates MSA patients from healthy controls and subjects with other neurodegenerative disorders, including other synucleinopathies. Our results indicate that alpha-synuclein pathology in MSA can be identified using [18F]ACI-12589 PET imaging, potentially improving the diagnostic work-up of MSA and allowing for detection of drug target engagement in vivo of novel alpha-synuclein targeting therapies. A PET tracer for alpha-synuclein would help diagnosis and treatment of alpha-syn-related diseases. Here the authors show that ACI-12589 shows an uptake in the cerebellar white matter in patients with multiple-system atrophy