1:12 8. Does Psychological Status Affect Outcome of PLIF Surgery?

4S

Proceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S

(p!.001). There was no difference in arthrosis between races or right versus left facet joints (pO.5). CONCLUSIONS: Facet arthrosis is a nearly universal finding in the human lumbar spine. Evidence of arthrosis begins early, with up to a third of adults !30 years old demonstrating some arthritic changes in the facets. The most common arthritic level appears to be L4-L5. Men have more facet arthritis than women, and this difference becomes most pronounced during the fourth decade of life. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts.

CONCLUSIONS: The results show that in our series preoperative psychological disturbance affects outcome in PLIF surgery. Patients who were classified as distressed somatic using the DRAM have less favorable outcome than the other groups. This group of patients may benefit from more formal psychological assessment before undergoing PLIF surgery. The DRAM appears to be a valid diagnostic test for predicting poor outcome in back surgery. FDA DEVICE/DRUG STATUS: Not applicable. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.024

doi: 10.1016/j.spinee.2006.06.023

1:12 8. Does Psychological Status Affect Outcome of PLIF Surgery? Raymond Pollock, PhD, Manoj Krishna, FRCS, Chandra Bhatia, MD, Chakria Bubithi; University Hospital of North Tees, Stockton-on-Tees, Cleveland, United Kingdom BACKGROUND CONTEXT: Low back pain has been shown to have a psychosomatic component. Increased bodily awareness and depressive symptoms are two factors that may affect outcome in spinal surgery. It is possible to assess these psychosomatic components using questionnaires. PURPOSE: To determine if psychological status in patients affects outcome in posterior lumbar interbody fusion (PLIF) surgery in order that they may be offered pre-surgical psychological counselling. STUDY DESIGN/SETTING: Prospective analysis of a case series consisting of patients who underwent PLIF surgery at a spinal unit in a university hospital in the northeast of England. PATIENT SAMPLE: Seventy-four patients who met the inclusion criteria of degenerative disc disease, spondylolisthesis, disc herniation, and postlaminectomy/postdiscectomy syndrome were entered into the study. OUTCOME MEASURES: Back pain related disability was assessed using the Oswestry Disability Index (ODI). Back and leg pain severity was measured using visual analogue (VAS) scales. Psychological status was measured preoperatively using the Distress and Risk Assessment Method (DRAM). This classifies low back pain patients into one of 4 groups based on a combination of scores from the Modified Somatic Perception Questionnaire (MSPQ 13 questions, scored 0–13) and modified Zung questionnaire (23 questions, scored 0–69): normal, at risk, distressed somatic, and distressed depressive. METHODS: During the study period beginning March 1997 through November 2003, patients who met the inclusion criteria underwent the PLIF procedure. Patients were assessed preoperatively and at follow-up using a self-administered questionnaire. On the basis of the preoperative MSPQ and Zung scores, patients were classified into one of 4 groups using the decision rules of the DRAM. The outcomes after surgery for each of the 4 groups were then compared. Statistical significance of outcomes between baseline and follow-up was tested using a paired t test after confirming normality of the data. RESULTS: The study group comprised 74 patients (49 females, 25 males; mean age at treatment, 45.6 years; age range 15–70). Minimum follow-up was 2 years. The preoperative DRAM scores showed that 14 had no psychological disturbance (normal), 39 were at-risk, 11 were distressed somatic, and 10 distressed depressive. There was no significant difference between the groups in the mean preoperative ODI (ANOVA, p5.426). There was a statistically and clinically significant improvement in the ODI after surgery for the normal, at-risk, and distressed depressive groups. In contrast, those who were distressed somatic showed no statistically or clinically significant improvement in their ODI (9.8 [5.2 to 24.8]; p5.177). Similarly the VAS scores for all groups, apart from the distressed somatic, showed a statistically and clinically significant improvement.

1:18 9. Systematic Review on the Efficacy and Safety of Intervertebral Disc Prostheses in the Lumbar Spine Francisco Kovacs, MD, PhD1, Gerard Urrutia, MD2, Betina Nishishinya, MD2, Javier Olabe, MD, PhD3, Marta Roque, BSc2, Josep Garcı´a, RN2, Marı´a Teresa Gil-Del-Real, MPH4; 1Fundacion Kovacs, Palma de Mallorca, Balearic Islands, Spain; 2Centro Cochrane Iberoamericano, Barcelona, Catalun˜a, Spain; 3Hospital Universitario Son Dureta, Palma de Mallorca, Balearic Islands, Spain; 4Fundacion Kovacs, Madrid, Spain BACKGROUND CONTEXT: Artificial disc prostheses have been proposed for the treatment of ‘‘discogenic’’ pain. The Spanish Agency for Health Technology Assessment requested a review of their effectiveness and safety. PURPOSE: Presently there are two basic implant designs: 1) total replacement of the disc; 2) replacement of the nucleus pulposus of the disc. The objective of this systematic review was to evaluate the existing scientific evidence on the efficacy and safety of total replacement intervertebral disc implants. STUDY DESIGN/SETTING: A systematic review on the efficacy and safety of total replacement intervertebral disc prostheses. PATIENT SAMPLE: For Charite´ 304 patients, and for Pro-Disc 500 patients with chronic ‘‘discogenic’’ pain. OUTCOME MEASURES: A clinically significant reduction in pain (VAS) and disability (Oswestry). METHODS: All controlled studies available in systematic searches in Medline, Embase, and the Cochrane Library were included. Two independent reviewers selected studies for inclusion, and assessed the validity of included studies according to the criteria proposed by the Cochrane Back Review Group. RESULTS: Charite´ III model: Four articles were detected, all based on the same study – a multicenter randomized, controlled clinical trial sponsored by the Food and Drug Administration (FDA). Data for this review were also taken from the FDA’s report of the trial on Internet, given the incomplete information in the articles. Three articles included only partial results, since they were based on one or two participating centers. In total, 304 patients took part in the study. This trial compared the implantation of a Charite´ III prosthesis with arthrodesis using a BAK cage device. Pain (VAS) and disability (Oswestry Disability Scale) were the principal variables measured. Pro-Disc II model: Three articles were detected, all based on the same study (which has not yet concluded) – a multicenter randomized, controlled clinical trial regulated by the FDA. This trial compares the implantation of a Pro-Disc II with arthrodesis using a bone graft. The articles include preliminary results as well as partial ones, since each was based on one participating center. The proposed study population is 500 patients. Pain (VAS) and disability (Oswestry) are the principal variables measured. Results on efficacy: The scientific evidence on Charite´ III proceeds from one clinical trial of low methodological quality. The success rates for Charite´ and BAK were 63% and 53%, respectively, in the intention to treat group (p!.0001). Charite´ showed an improvement over BAK in disability that did not hold up at 6 months. The preliminary results on Pro-Disc II are inconsistent, and one study shows differences in pain and disability between the two groups that were not significant at 6