The spine journal : official journal of the North American Spine Society
-
Randomized Controlled Trial Multicenter Study
Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function.
The presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5-S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. ⋯ Although retrolisthesis in patients with L5-S1 disc herniation did not affect the baseline pain or function, postoperative outcomes appeared to be somewhat worse. It is possible that the contribution of pain or dysfunction related to retrolisthesis became more evident after removal of the disc herniation.
-
Randomized Controlled Trial
Psychometric properties of selected tests in patients with lumbar spinal stenosis.
The psychometric properties of many outcome tools commonly used with patients with lumbar spinal stenosis have yet to be examined. ⋯ The results of our study indicate that the Oswestry Disability Index, SSS, and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain.
-
Randomized Controlled Trial Multicenter Study
Epidural fentanyl for postoperative analgesia after lumbar canal decompression: a randomized controlled trial.
Postoperative back pain is common after decompression surgery for lumbar stenosis and often delays discharge from hospital. Achieving regional analgesia by intraoperative delivery of epidural opiates after lumbar canal decompression is a promising approach to reduce postoperative pain and enhance early mobilization. However, there have been concerns about opiate-related complications, such as respiratory depression and urinary retention in what is generally an elderly population of patients. ⋯ Bolus epidural fentanyl provides effective short-term postoperative analgesia after lumbar canal decompression and may be a useful adjunct to pain management in patients undergoing lumbar spine surgery.
-
Randomized Controlled Trial
Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases.
Transforaminal lumbar interbody fusion (TLIF) has become a well-established technique that is traditionally performed with bilateral pedicle screw (PS) fixation. There are only a small number of case reports of unilateral instrumented TLIF. To our knowledge, there have been few well-designed studies comparing unilateral versus bilateral instrumentation with TLIF. ⋯ Unilateral PS instrumented TLIF is a viable treatment option generating better results, especially in terms of operative time, blood loss, and hospital time for single-level disease and implant costs. No decrease in the fusion rate or increase in the complication rate was observed in this group. Further improved study design and a longer period of follow-up are needed to confirm this effect.
-
Randomized Controlled Trial Multicenter Study
The development of a model for translation of the Neck Disability Index to utility scores for cost-utility analysis in cervical disorders.
The Neck Disability Index (NDI) is a commonly used disease-specific instrument for cervical spine disorders with good responsiveness and psychometric properties compared with general health status measures. However, NDI scores are unitless and do not have an intrinsic value that is comparable to other health status measures, and these scores have limited value in cost-utility analysis. The translation of disease-specific measures to Short Form-6 Dimensions (SF-6D) utility scores may be useful in cost-utility analysis. ⋯ Correlations between NDI and SF-6D utility scores are strong and statistically significant. The model has a large R(2) and small RMSE. The prediction models produce a small mean prediction error, but the SD of the prediction errors is large. High correlations between NDI and SF-6D permit these models to be used to calculate overall utilities, changes in utilities, and quality-adjusted life-years for large data samples. However, the relatively large observed prediction error SDs may limit the accuracy of translation of individual data points or small sample sizes.