Evidence-Based Medicine
Copyright ©The Author(s) 2015.
World J Orthop. Jul 18, 2015; 6(6): 483-490
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.483
Table 1 Information used to predict post surgery outcomes
Patient characteristics and history
Patient personality and expectations1, including motivation
Age, occupation/unemployment, social issues, smoking, weight
Presence or absence of personal injury or yellow flags
Diabetes, other medical co-morbidities
Clinical information including patient history, e.g., symptoms duration
Use of outcome data, e.g., DRAM, GAD7, ODI, PHQ9, SF36, SRS, VAS pain, walking
Response to previous approaches, e.g., physiotherapy, facet joint injections, discogram, disc block
Pathology or degree of deformity
Number of levels predominant leg pain; more leg than back pain
Performance based outcome measures
Neurological examination
Imaging: CT scans, CT with 3D reconstruction, discography, MRI scans, X-ray
Evidence
Audit of data from past patients
Literature or empirical evidence
Experiential clinical experience
Other
Pathology: segmental instability, single level, spondylolisthesis, central disc protrusion
Pain mechanism: no features of chronic regional pain syndrome (allodynia, non-anatomical pain), stenosis
Table 2 Key indicators for performing spinal fusion (n = 29 responders)
Key indicator for surgerySurgeons n (%)
Instability25 (86)
Leg pain21 (72)
Back pain18 (62)
Failed conservative treatment17 (59)
Failed previous surgery16 (55)
Degenerative disc disease15 (52)
Neurological changes13 (48)
Other112 (41)
Table 3 Complications of lumbar spinal fusion surgery reported by surgeons (n = 29 surgeons)
Complications of lumbar spinal fusion surgerySurgeons n (%)
Persistent symptoms18 (62)
Dislodged instrumentation/implant failure14 (48)
Infection9 (31)
Failure of fusion7 (24)
Dural tear6 (21)
Nerve injury5 (17)
Failure at adjacent level4 (14)
No improvement3 (10)
Other18 (28)
Table 4 Pre-discharge advice on time (weeks post discharge) to return to functional activities
Functional activityNo. (%) of surgeons
Weeks1
Months1
123468369
Sitting22 (85)2 (8)1 (4)01 (4)0000
Driving04 (15)3 (12)10 (39)10 (39)2 (8)000
Sex2 (10)3 (15)2 (10)6 (30)9 (45)2 (10)1 (5)00
Work02 (8)3 (12)2 (8)13 (50)4 (15)9 (35)1 (4)0
Sport01 (4)01 (4)4 (17)010 (42)6 (25)2 (8)
Contact sports0000005 (21)8 (33)2 (8)
Jogging/running0001 (4)6 (25)1 (4)5 (21)10 (42)1 (4)
Weight training00001 (5)05 (21)9 (41)3 (14)
Heavy lifting00002 (8)05 (21)10 (42)1 (4)
Extreme range of lumbar movements01 (5)00008 (36)6 (27)2 (9)
Table 5 Post-operative outpatient use of patient reported outcome measures (n = 29 surgeons)
DomainQuestionnaireSurgeons n (%)
DisabilityODI17 (90)
PainVAS or NPRS14 (74)
MSP1 (5)
Pain drawing1 (5)
HealthSF-266 (32)
SF-121 (5)
PHQ-91 (5)
EQ-5D1 (5)
DepressionZung Depression Index2 (10)
Hospital Depression Scale1 (10)
AnxietyHospital Anxiety Scale1 (10)
GAD-71 (10)
Other12 (10)