Archive for month: June, 2017

Spine Jun 2017 Jazini E et al

RESULTS:

Of 1187 eligible cases, 843 (71%) had complete data, with 477 Never, 250 Former, and 116 Current smokers. Among patients who had a fusion, baseline and 12-month post-op PROs were significantly different between cohorts, with Former smokers having intermediate scores between Current and Never smokers. In the decompression only group, 12-month ODI was worse in the Current smokers, but overall the effects were much less pronounced. There was a significant negative correlation between smoke-free days prior to surgery and baseline back pain, ODI, 12-month leg pain and ODI and improvement in ODI. However, the correlation coefficients were small.

CONCLUSION:

Former smokers have distinct baseline and 12-month post-op PROs that are intermediate between those of never smokers and current smokers. Smoking cessation does not entirely mitigate the negative effects of smoking on baseline and postoperative PROs for patients undergoing lumbar fusion surgery. This effect is less pronounced in patients undergoing decompression alone.

Spine April 2014. Menke M.

STUDY DESIGN:

Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain.

RESULTS:

Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham’s effectiveness. Most acute results were within 95% confidence that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not.

CONCLUSION:

Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations–-features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.

Tye, Erik Y. BA*,†; Anderson, Joshua MD‡ et al Spine July 2017

Objective. The aim of this study was to compare outcomes in Workers’ compensation (WC) subjects receiving decompression alone versus decompression and fusion for the indication of degenerative spinal stenosis (DLS) without deformity or instability.

Summary of Background Data. The use of a fusion procedure during lumbar decompression for DLS alone remains controversial. We hypothesize that WC subjects receiving fusion and decompression will return to work less and incur greater medical costs than subjects receiving decompression alone.

Methods. Three hundred sixty-four Ohio WC subjects were identified  subjects who received an adjunctive fusion cost of the Ohio BWC on average, $46,115 more in costs accrued over 3 years after their index surgery compared with subjects who received a decompression alone.

Conclusion. Overall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for DLS without instability in the WC population.