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Patient-reported outcome measures: the accuracy of patient-reported revision spinal surgery
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Podium Presentations / The Spine Journal 16 (2016) S45–S63
STUDY DESIGN/SETTING: Pragmatic randomised clinical pilot study in Primary Care Outpatients Physiotherapy. PATIENT SAMPLE: 23 CLBP patients sub-classified with flexion and extension control impairment. OUTCOME MEASURES: Physiologic: Spinal movement range (ROM) during flexion-extension, reaching, lifting. Self-reported: Oswestry Disability Questionnaire (ODQ), pain (visual analogue scale [VAS]), Tampa Scale of Kinesiophobia (TSK), Distress and Risk Assessment Method (DRAM). Functional: International Physical Activity Questionnaire (IPAQ). METHODS: Participants were randomised into CB-CFT (N=13), current best practice (C) (N=10). Unpaired t test assessed mean change betweengroup difference (p>.05). Funding: National Institute of Social Care and Health Research, Wales. No conflicts of interest. RESULTS: No between-group differences at baseline, CB-CFT showed significant increase in lumbar ROM during flexion-extension and thoracic ROM during lifting compared to reduction in C. No between-group differences shown in thoracic ROM during flexion-extension, thoracic and lumbar ROM during reaching. Statistically significant improvements demonstrated in disability (ODQ)[CB-CFT=14.9(8.0),C=5.2(12.4)], pain (VAS)[CBCFT=2.1(1.5),C=0.7(1.8)], TSK[CB-CFT=12.4(7.2),C=4.1(2.6)], IPAQ[CBCFT=1,855.6 min(1,085),C=19 min(1,672)]. DRAM between-group change wasn’t significant. CONCLUSIONS: Preliminary evidence for positive effect on spinal kinematics and function were demonstrated to inform full scale randomised controlled trial. CONFLICTS OF INTEREST: None. FUNDING SOURCES: National Institute of Social Care and Health Research, Wales. http://dx.doi.org/10.1016/j.spinee.2016.01.027
Patient-reported outcome measures: the accuracy of patient-reported revision spinal surgery Elmajee Mohammed, Aljawadi Ahmed, Ben-nafa Walid, Rajat Verma, Saeed Mohammad, Siddique Irfan; Salford Royal NHS Foundation Trust (SRFT), UK BACKGROUND CONTEXT: Patient-reported outcome measures form a major part of registry data collection and, beyond functional outcome scores, may be utilised to establish whether patients have undergone revision spinal surgery and additionally whether this was performed at the same or a different spinal level. PURPOSE: We aimed to establish the accuracy of patient-reported revision surgery. STUDY DESIGN/SETTING: Analysis of prospectively collected data. PATIENT SAMPLE: 4,247 patient-reported outcome measures collected at 3 months postoperatively. OUTCOME MEASURES: Validation against patient’s electronic patient records. METHODS: 4,247 patients who completed PROMS at 3 months postoperatively between August 2011 and August 2015 were included in the study. The surgical history of these patients was accessed to compare it with the answers obtained from the patients’ questionnaire. Any intervention including revision surgery, management of complications and spinal injection from the time of the last lumbar surgery to date of the questionnaire were noted and compared with the responses given by patients. RESULTS: A number of 4,143 patients reported no further surgeries. 4,116 out of 4,143 patients were truly negative, and 27 were falsely negative as they had further surgical interventions. 104 patients reported revision surgery. 72 patients out of 104 were truly positive and described the correct segment, whereas the remaining 32 patients were falsely positive. This is because they had no surgeries, spinal injections or surgery at a different level. Thus the sensitivity of this question was found to be 72.7%, and specificity 99.2%. CONCLUSIONS: This study demonstrates the utility of this question to assess the revision surgery rates in spinal surgery. However, with the lower
than expected sensitivity, revision rates may be reported as higher than they actually are by patients. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.028
Lumbar spine computed tomography (CT)-based fractal analysis may help in detecting decreased quality of bone prior to urgent spinal procedures (novel technique) Marcin Czyz, Kamil Eyvazov, Hesham Radwan, Bronek M. Boszczyk; Centre for Spinal Studies and Surgery, D Floor, West Block, Queen’s Medical Centre, Derby Rd, Nottingham NG7 2UH, UK BACKGROUND CONTEXT: To date no reliable method is available determining parameters of bone density based on a standard computed tomography (CT) imaging in the emergency set-up. Fractals are mathematical sets used to describe the complexity of objects and images and have been already used in studies of trabecular bone structure. PURPOSE: To assess the efficacy of the CT-based fractal analysis in detecting patients with poor quality of bone prior to urgent spinal procedures. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: The group 15 patients (total of 45 vertebrae) in whom the Dual Energy Xray Absorptiometry (DEXA) scan and lumbar spine CT was performed at an interval of no more than 3 months. OUTCOME MEASURES: Nil. METHODS: Diagnostic axial CT scans of L2, L3 and L4 vertebrae were processed to determine the fractal dimension (FD) of the trabecular structure of each spinal level. Box-count method and ImageJ 1.49 software were used. FD was compared to results of the DEXA scan: bone mineral density (BMD), T-score and Z-score. RESULTS: The FD was significantly higher in a group of patients with decreased bone quality (T-score<−1.0) (p=.002) and correlated with BMD (−0.55; p<.001), T-score (−0.52; p<.001) and Z-score (−0.43; p=.0035). ROC curve analysis revealed cut-off value of ED>1.48, indicating decreased bone quality (p=.0002; AUC 0.77; 95% CI 0.62–0.88). CONCLUSIONS: Fractal analysis of the lumbar spine CT images may be useful while determining quality of bone prior to urgent spinal instrumentations (eg, metastatic/traumatic cord compression) when the DEXA scan might be hardly accessible. Further studies of a wide prospective cohort are warranted. CONFLICTS OF INTEREST: None. FUNDING SOURCES: The Kosciuszko Foundation. http://dx.doi.org/10.1016/j.spinee.2016.01.029
Lumbar stability following graded unilateral and bilateral graded facetectomy—a finite element model study Sashin Ahujaa,b, Abdul Gaffar Dudhniwalaa,b, A. Tsouknidasa,b, S. Sarrigiannidisa,b, N. Michailidisa,b; aWelsh Centre for Spinal Surgery & Trauma, University Hospital of Wales, UK; bDepartment of Mechanical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece BACKGROUND CONTEXT: Excessive facet joint excision during lumbar decompression can cause segmental instability. PURPOSE: To assess segmental instability following graded facetectomy. STUDY DESIGN/SETTING: This biomechanical study was performed using L3–S1 finite element model. PATIENT SAMPLE: Verified and validated L3–S1 finite element model. OUTCOME MEASURES: The effect of progressive graded decompression of L4–L5 on the mobility, facet loading and intradiscal pressure.
Podium Presentations / The Spine Journal 16 (2016) S45–S63
STUDY DESIGN/SETTING: Pragmatic randomised clinical pilot study in Primary Care Outpatients Physiotherapy. PATIENT SAMPLE: 23 CLBP patients sub-classified with flexion and extension control impairment. OUTCOME MEASURES: Physiologic: Spinal movement range (ROM) during flexion-extension, reaching, lifting. Self-reported: Oswestry Disability Questionnaire (ODQ), pain (visual analogue scale [VAS]), Tampa Scale of Kinesiophobia (TSK), Distress and Risk Assessment Method (DRAM). Functional: International Physical Activity Questionnaire (IPAQ). METHODS: Participants were randomised into CB-CFT (N=13), current best practice (C) (N=10). Unpaired t test assessed mean change betweengroup difference (p>.05). Funding: National Institute of Social Care and Health Research, Wales. No conflicts of interest. RESULTS: No between-group differences at baseline, CB-CFT showed significant increase in lumbar ROM during flexion-extension and thoracic ROM during lifting compared to reduction in C. No between-group differences shown in thoracic ROM during flexion-extension, thoracic and lumbar ROM during reaching. Statistically significant improvements demonstrated in disability (ODQ)[CB-CFT=14.9(8.0),C=5.2(12.4)], pain (VAS)[CBCFT=2.1(1.5),C=0.7(1.8)], TSK[CB-CFT=12.4(7.2),C=4.1(2.6)], IPAQ[CBCFT=1,855.6 min(1,085),C=19 min(1,672)]. DRAM between-group change wasn’t significant. CONCLUSIONS: Preliminary evidence for positive effect on spinal kinematics and function were demonstrated to inform full scale randomised controlled trial. CONFLICTS OF INTEREST: None. FUNDING SOURCES: National Institute of Social Care and Health Research, Wales. http://dx.doi.org/10.1016/j.spinee.2016.01.027
Patient-reported outcome measures: the accuracy of patient-reported revision spinal surgery Elmajee Mohammed, Aljawadi Ahmed, Ben-nafa Walid, Rajat Verma, Saeed Mohammad, Siddique Irfan; Salford Royal NHS Foundation Trust (SRFT), UK BACKGROUND CONTEXT: Patient-reported outcome measures form a major part of registry data collection and, beyond functional outcome scores, may be utilised to establish whether patients have undergone revision spinal surgery and additionally whether this was performed at the same or a different spinal level. PURPOSE: We aimed to establish the accuracy of patient-reported revision surgery. STUDY DESIGN/SETTING: Analysis of prospectively collected data. PATIENT SAMPLE: 4,247 patient-reported outcome measures collected at 3 months postoperatively. OUTCOME MEASURES: Validation against patient’s electronic patient records. METHODS: 4,247 patients who completed PROMS at 3 months postoperatively between August 2011 and August 2015 were included in the study. The surgical history of these patients was accessed to compare it with the answers obtained from the patients’ questionnaire. Any intervention including revision surgery, management of complications and spinal injection from the time of the last lumbar surgery to date of the questionnaire were noted and compared with the responses given by patients. RESULTS: A number of 4,143 patients reported no further surgeries. 4,116 out of 4,143 patients were truly negative, and 27 were falsely negative as they had further surgical interventions. 104 patients reported revision surgery. 72 patients out of 104 were truly positive and described the correct segment, whereas the remaining 32 patients were falsely positive. This is because they had no surgeries, spinal injections or surgery at a different level. Thus the sensitivity of this question was found to be 72.7%, and specificity 99.2%. CONCLUSIONS: This study demonstrates the utility of this question to assess the revision surgery rates in spinal surgery. However, with the lower
than expected sensitivity, revision rates may be reported as higher than they actually are by patients. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.028
Lumbar spine computed tomography (CT)-based fractal analysis may help in detecting decreased quality of bone prior to urgent spinal procedures (novel technique) Marcin Czyz, Kamil Eyvazov, Hesham Radwan, Bronek M. Boszczyk; Centre for Spinal Studies and Surgery, D Floor, West Block, Queen’s Medical Centre, Derby Rd, Nottingham NG7 2UH, UK BACKGROUND CONTEXT: To date no reliable method is available determining parameters of bone density based on a standard computed tomography (CT) imaging in the emergency set-up. Fractals are mathematical sets used to describe the complexity of objects and images and have been already used in studies of trabecular bone structure. PURPOSE: To assess the efficacy of the CT-based fractal analysis in detecting patients with poor quality of bone prior to urgent spinal procedures. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: The group 15 patients (total of 45 vertebrae) in whom the Dual Energy Xray Absorptiometry (DEXA) scan and lumbar spine CT was performed at an interval of no more than 3 months. OUTCOME MEASURES: Nil. METHODS: Diagnostic axial CT scans of L2, L3 and L4 vertebrae were processed to determine the fractal dimension (FD) of the trabecular structure of each spinal level. Box-count method and ImageJ 1.49 software were used. FD was compared to results of the DEXA scan: bone mineral density (BMD), T-score and Z-score. RESULTS: The FD was significantly higher in a group of patients with decreased bone quality (T-score<−1.0) (p=.002) and correlated with BMD (−0.55; p<.001), T-score (−0.52; p<.001) and Z-score (−0.43; p=.0035). ROC curve analysis revealed cut-off value of ED>1.48, indicating decreased bone quality (p=.0002; AUC 0.77; 95% CI 0.62–0.88). CONCLUSIONS: Fractal analysis of the lumbar spine CT images may be useful while determining quality of bone prior to urgent spinal instrumentations (eg, metastatic/traumatic cord compression) when the DEXA scan might be hardly accessible. Further studies of a wide prospective cohort are warranted. CONFLICTS OF INTEREST: None. FUNDING SOURCES: The Kosciuszko Foundation. http://dx.doi.org/10.1016/j.spinee.2016.01.029
Lumbar stability following graded unilateral and bilateral graded facetectomy—a finite element model study Sashin Ahujaa,b, Abdul Gaffar Dudhniwalaa,b, A. Tsouknidasa,b, S. Sarrigiannidisa,b, N. Michailidisa,b; aWelsh Centre for Spinal Surgery & Trauma, University Hospital of Wales, UK; bDepartment of Mechanical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece BACKGROUND CONTEXT: Excessive facet joint excision during lumbar decompression can cause segmental instability. PURPOSE: To assess segmental instability following graded facetectomy. STUDY DESIGN/SETTING: This biomechanical study was performed using L3–S1 finite element model. PATIENT SAMPLE: Verified and validated L3–S1 finite element model. OUTCOME MEASURES: The effect of progressive graded decompression of L4–L5 on the mobility, facet loading and intradiscal pressure.