Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

<p>Abstract</p> <p>Background</p> <p>To assess safety, risk factors and clinical outcomes in elderly patients with spinal stenosis after decompressive laminectomy.</p> <p>Methods</p> <p>A prospective cohort of patients 70 years and older with spinal stenosis undergoing conventional laminectomy without fusion (n = 101) were consecutively enrolled from regular clinical practice and reassessed at 3 and 12 months. Primary outcome was change in health related quality of life measured (HRQL) with EuroQol-5 D (EQ-5D). Secondary outcomes were safety assessment, changes in Oswestry disability index (ODI), Visual Analogue Scale (EQ-VAS) score for self reported health, VAS score for leg and back pain and patient satisfaction. We used regression analyses to evaluate risk factors for less improvement.</p> <p>Results</p> <p>The mean EQ-5 D total score were 0.32, 0.63 and 0.60 at baseline, 3 months and 12 months respectively, and represents a statistically significant (P < 0.001) improvement. Effect size was > 0.8. Mean ODI score at baseline was 44.2, at 3 months 25.6 and at 27.9. This represents an improvement for all post-operative scores. A total of 18 (18.0%) complications were registered with 6 (6.0%) classified as major, including one perioperative death. Patients stating that the surgery had been beneficial at 3 months was 82 (89.1%) and at 12 months 73 (86.9%). The only predictor found was patients with longer duration of leg pain had less improvement in ODI (P < 0.001). Increased age or having complications did not predict a worse outcome in any of the outcome variables.</p> <p>Conclusions</p> <p>Properly selected patients of 70 years and older can expect a clinical meaningful improvement of HRQL, functional status and pain after open laminectomy without fusion. The treatment seems to be safe. However, patients with longstanding leg-pain prior to operation are less likely to improve one year after surgery.</p

The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study

ObjectiveTo investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis.MethodsProspectively collected data were retrieved from the Norwegian Registry for Spine Surgery. Clinically significant deterioration was defined as an 8-point increase in Oswestry disability index (ODI) between baseline and 12 months' follow-up.ResultsThere were 2181 patients enrolled in the study. Of 1735 patients with complete 12 months follow-up, 151 (8.7%) patients reported deterioration. The following variables were significantly associated with deterioration at 12 months' follow-up; decreasing age (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00–1.04, P = 0.046), tobacco smoking (OR 2.10, 95% CI 1.42–3.22, P = 0.000), American Society of Anesthesiologists grade ≥3 (OR 1.80, 95% CI 1.07–2.94, P = 0.025), decreasing preoperative ODI (OR 1.05, 95% CI 1.02–1.07, P = 0.000), previous surgery at the same level (OR 2.00, 95% CI 1.18–3.27, P = 0.009), and previous surgery at other lumbar levels (OR 2.10, 95% CI 1.19–3.53, P = 0.009).ConclusionsOverall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery

Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study

Objective To compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic low back pain

Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine?: A study of responding and non-responding cohort participants from a clinical spine surgery registry

Loss to follow-up may bias the outcome assessments of clinical registries. In this study, we wanted to determine whether outcomes were different in responding and non-responding patients who were included in a clinical spine surgery registry, at two years of follow-up. In addition, we wanted to identify risk factors for failure to respond. 633 patients who were operated for degenerative disorders of the lumbar spine were followed for 2 years using a local clinical spine registry. Those who did not attend the clinic and those who did not answer a postal questionnaire—for whom 2 years of outcome data were missing—and who would be lost to follow-up according to the standard procedures of the registry protocols, were defined as non-respondents. They were traced and interviewed by telephone. Outcome measures were: improvement in health-related quality of life (EQ-5D), leg pain, and back pain; and also general state of health, employment status, and perceived benefits of the operation. We found no statistically significant differences in outcome between respondents (78% of the patients) and nonrespondents (22%). Receipt of postal questionnaires (not being summoned for a follow-up visit) was the strongest risk factor for failure to respond. Forgetfulness appeared to be an important cause. Older patients and those who had complications were more likely to respond. Interpretation A loss to follow-up of 22% would not bias conclusions about overall treatment effects and, importantly, there were no indications of worse outcomes in non-respondents

Distinct nonequilibrium plasma chemistry of C2 affecting the synthesis of nanodiamond thin films from C2H2 (1%)/H2/Ar-rich plasmas

6 pages, 5 figures, 6 tables.We show that the concentrations of the species C2 (X 1Σg+), C2 (a 3Πu), and C2H exhibit a significant increase when the argon content grows up to 95% in medium pressure (0.75 Torr) radio frequency (rf) (13.56 MHz) produced C2H2 (1%)/H2/Ar plasmas of interest for the synthesis of nanodiamond thin films within plasma enhanced chemical vapor deposition devices. In contrast, the concentrations of CH3 and C2H2 remain practically constant. The latter results have been obtained with an improved quasianalytic space–time-averaged kinetic model that, in addition, has allowed us to identify and quantify the relative importance of the different underlying mechanisms driving the nonequilibrium plasma chemistry of C2. The results presented here are in agreement with recent experimental results from rf CH4/H2/Ar-rich plasmas and suggest that the growth of nanodiamond thin films from hydrocarbon/Ar-rich plasmas is very sensitive to the contribution of C2 and C2H species from the plasma.This work was partially funded by CICYT (Spain) under a Ramón y Cajal project and under Project No. TIC2002- 03235. One of the authors (F.J.G.V.) acknowledges a Ramón y Cajal contract from the Spanish Ministry of Science and Technology (MCYT). One of the authors (J.M.A.) acknowledges partial support from CICYT (Spain) under Project No. MAT 2002-04085-C02-02.Peer reviewe

Persistent Use of Prescription Opioids Before and After Lumbar Spine Surgery: Observational Study With Prospectively Collected Data From Two Norwegian National Registries

Study Design - Prospective pharmacoepidemiologic study. Objective - To investigate clinical and sociodemographic factors associated with persistent opioid use in the years following spine surgery among patients with persistent opioid use preceding lumbar spine surgery. Summary of Background Data - It is unknown whether successful spine surgery leads to a cessation of preoperative persistent opioid use. Materials and Methods - Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked for patients operated for degenerative lumbar spine disorders between 2007 and 2017. The primary outcome measure was persistent opioid use in the second year after surgery. Functional disability was measured with the Oswestry Disability Index (ODI). Factors associated with persistent opioid use in the year before, and two years following, surgery were identified using multivariable logistic regression analysis. The variables included in the analysis were selected based on their demonstrated role in prior studies. Results - The prevalence of persistent opioid use was 8.7% in the year before surgery. Approximately two-thirds of patients also met the criteria for persistent opioid use the second year after surgery. Among patients who did not meet the criteria for persistent opioid use the year before surgery, 991 (3.3%) patients developed persistent opioid use in the second year following surgery. The strongest association was exhibited by high doses of benzodiazepines in the year preceding surgery (OR 1.7, 95% CI 1.26 to 2.19, P Conclusion - A substantial proportion of patients reported sustained opioid use after surgery. Patients with persistent opioid use before surgery should be supported to taper off opioid treatment. Special efforts appear to be required to taper off opioid use in patients using high doses of benzodiazepines. Level of Evidence - 2; Prospective observational study