Osteoporosis and Endplate Damage Correlation Using a Combined Approach of Hounsfield Unit Values and Total Endplate Scores: A Retrospective Cross-Sectional Study.

PURPOSE: Osteoporosis and endplate damage, two primary orthopedic disorders that have adverse effects on the quality of life of older adults, may have some previously unknown relationship. The purpose of this study was to determine the potential association between osteoporosis and endplate damage with two specific imaging scoring systems and analyze the underlying mechanisms. PATIENTS AND METHODS: A cross-sectional study including 156 patients with degenerative disc disease (DDD) who visited our department in 2018 was performed. Data including age, sex, body mass index, Hounsfield unit (HU) values utilizing computed tomography (CT), and total endplate scores (TEPSs) using magnetic resonance imaging (MRI) of all patients were retrospectively collected and analyzed. The average HU value and TEPS of L1-L4 were used to represent the degrees of bone mineral density (BMD) and endplate damage, respectively. Patients with an HU value < 110 were defined as having osteoporosis and placed in the low-BMD group; otherwise, they were placed in the normal-BMD group. Multivariate logistic regression models were used to determine the independent factors of endplate damage. RESULTS: The TEPSs in the low-BMD group were significantly higher (6.4 ± 1.6 vs 5.0 ± 0.9, p < 0.001) overall and in every segment of L1-L4 (p < 0.01). A significant negative correlation was found between TEPS and HU values (p < 0.001). The HU value (odds ratio [OR] 0.221; 95% confidence interval [CI], 0.148-0.295, p < 0.001), age (OR 0.047; 95% CI, 0.029-0.224, p < 0.001), and BMD (OR 3.796; 95% CI, 2.11-7.382, p < 0.05) were independent factors influencing endplate damage. CONCLUSION: A significantly positive correlation was observed between osteoporosis and endplate damage, indicating the requirement for a more comprehensive therapeutic regimen for treating patients with DDD complicated with osteoporosis.

The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation.

PURPOSE: This study was conducted to determine the impact of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk hernia. DESIGN AND METHODS: The study was a nonrandomized pretest-posttest controlled quasi-experimental research and carried out in a total of 64 patients. A personal information form, the Depression Anxiety Stress Scale, the Psychological Well-Being Scale, and the Pain Beliefs Scale were used for data collection. FINDINGS: We observed a statistically significant difference between the intervention and control groups in terms of the posttest mean scores of the psychiatric symptoms, psychological well-being, and pain beliefs. PRACTICE IMPLICATIONS: The results revealed that mindfulness-based therapy has a positive impact on pain beliefs and psychological well-being.

Impact of knowledge, attitude, and practice (KAP)-based rehabilitation education on the KAP of patients with intervertebral disc herniation.

BACKGROUND: This study aims to quantify the effectiveness of knowledge, attitude, and practice (KAP)-based rehabilitation education on the KAP of patients with intervertebral disc herniation (IDH). METHODS: Seventy IDH patients undergoing conservative treatment in our center from February 2018 to December 2018 were randomly divided into the KAP group and control group by using a table of random numbers. The control group was given traditional health education, while the KAP group was offered with KAP-based rehabilitation education. Both groups were followed up for 3 months after their discharge from the hospital. A self-designed questionnaire form was used to evaluate the KAP quantities of patients. RESULTS: Before health education, the scores of knowledge in the control group and the KAP group were (15.12±3.12) and (15.20±3.28), respectively, showing no significant difference (P>0.05). After the health education, the total score of knowledge, the score of disease knowledge, the score of attitude, and the score of practice were (25.42±3.16), (7.66±0.73), (7.80±0.36), and (7.85±0.68), respectively, in the KAP group, which were significantly higher than those in the control group [(20.31±3.43), (6.83±0.92), (6.41±1.05), and (7.10±1.11), P<0.05]. After health education, the awareness rates of the disease, attitude, and behavior were significantly higher in the KAP group than in the control group (P<0.05). CONCLUSIONS: Rehabilitation education based on the KAP theory can effectively enhance the patients' awareness of the disease, increase their rehabilitation consciousness, and promote them to adopt positive rehabilitation behavior, thus achieving the goal of changing the patients' KAP.

Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life.

STUDY DESIGN: A prospective cross-sectional study. OBJECTIVE: To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. SUMMARY OF BACKGROUND DATA: Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. METHODS: Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. RESULTS: 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ±â€Š11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). CONCLUSION: Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. LEVEL OF EVIDENCE: 2.

How I Thought Myself into Illness, Then Thought My Way Out.

When doctors couldn't find an explanation for my mysterious symptoms, including back pain, aching joints, and tingling limbs, I went on a quest to uncover the root causes. My journey took me from the West Coast to the East Coast, from physical therapists to psychiatrists, from the body to the mind, chronic pain to repressed emotions, existential crisis to posttraumatic growth.

Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting.

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. RESULTS: Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. LEVEL OF EVIDENCE: 3.

A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial.

BACKGROUND: Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. PURPOSE: To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. STUDY DESIGN: A single-center, two-arm, randomized controlled trial PATIENT SAMPLE: One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. OUTCOME MEASURES: Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2days and 3 and 6 months after surgery. METHOD: Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen. The independent charity Helsefonden contributed $45,000, the Health Research Fund of the Regional Hospital Central Jutland contributed $10,000, and the Toyota foundation contributed $10,000 to remunerate a dedicated investigator. The authors have no conflict of interest to declare. RESULTS: There was no statistically significant difference within the w-SPIINA group and the control group regarding changes in HADS at 3-month follow-up (p≥.37). Approximately 40% reached minimum clinically important difference (MCID) in the w-SPIINA group on the HADS at 3 months. In the control group 50% reached MCID on anxiety subscale and 35% on the depression subscale at 3 months. No statistically significant differences were found between groups with regard to the overall outcomes at any of the predefined time points. CONCLUSION: Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1day before, 2days, 3 or 6 months after surgery. However, a high compliance and degree of interaction with w-SPIINA indicates that this mode of web-based support could be applicable in this group of patients.

The impact of health literacy on health status and resource utilization in lumbar degenerative disease.

BACKGROUND CONTEXT: Health literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE: To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN: Cross sectional. PATIENT SAMPLE: Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES: Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0-10) for back and leg pain. METHODS: The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS: Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p = .017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS: Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.

Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.

OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (ß = -0.349; P < 0.001) and self-efficacy for exercise (ß = 0.176; P = 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (ß = -0.790; P < 0.001), self-efficacy for exercise (ß = 0.152; P = 0.024), and pain catastrophizing (ß = 0.383; P = 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.

A Novel Non-invasive Effective Method for Potential Treatment of Degenerative Disc Disease: A Hypothesis.

The pathophysiology of the intervertebral discs plays a significant role in the people's life quality. There is not adequate research done in the pathogenesis and treatment of intervertebral disc degeneration. Alternately, self-educated physiology offers a novel and noninvasive method to reverse the degenerated discs. In this single case study, report attempts have been made to highlight the effect of the self-educative physiology, on magnetic resonance imaging investigations, of progressive healing, on the degenerated intervertebral discs. Based on this novel method, an effort has been made to review literature on the degeneration of intervertebral discs and available mode of treatments and then to propose a hypothesis for the biochemical mechanisms of healing. The idea is that transforming growth factor-ß1 from seminal plasma secretions may contribute to releasing the osteogenic protein- 1 which induces nucleus pulposus and annulus fibrosus cells in intervertebral discs for repairs. In addition, the patient's medical history is presented with background information.

The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study.

BACKGROUND: Prescription opioid medications negatively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid-using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease. METHODS: The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. Prescription opioid use during hospital admission and at 30 days postoperatively were compared with preoperative use. Thirty-day postoperative patient-reported outcomes for pain, disability, and quality of life were compared with preoperative patient-reported outcomes. Dose-response effect of mindfulness courses was assessed using Mindful Attention Awareness Scale scores. RESULTS: In this pilot study, 24 participants were included in each group. Most intervention patients (70.83%) completed 1 session, and the mean Mindful Attention Awareness Scale score was 4.28 ± 0.71 during hospital admission. At 30 days, mean visual analog scale back pain score was lower in the intervention group (P = 0.004) but other patient-reported outcomes did not differ. CONCLUSIONS: During hospital admission, no significant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.

Decisional Conflict Among Patients Considering Treatment Options for Lumbar Herniated Disc.

BACKGROUND: Lumbar herniated disc is a "preference-sensitive" condition, in which the optimal treatment choice is crucially dependent on an informed patient's goals and values. Little is known about decisional conflict, defined as an individual's level of uncertainty regarding a decision, in patients considering treatment for lumbar herniated discs. Our work aims to identify factors associated with decisional conflict and areas for improved shared decision making. METHODS: We prospectively surveyed patients seeking treatment for a lumbar herniated disc at L4-L5 and/or L5-S1 with a physician at the UCLA Spine Center. Decisional conflict was measured using the validated SURE questionnaire. We performed univariate and multivariate logistic analysis to identify predictors of decisional conflict. RESULTS: Among the 174 participants surveyed, 47% reported experiencing decisional conflict and 44% changed their treatment preference after the visit, with 61% of these opting for more invasive treatment. Participants with decisional conflict were less satisfied with their treatment decision (P < 0.001) and less willing to recommend their physician (P = 0.003) and physician's medical group to others (P = 0.003). Multivariate analysis revealed that participants were more likely to experience decisional conflict if they consulted with a physiatrist compared with a surgeon (odds ratio [OR], 2.6; P = 0.019) and if they did not feel able to discuss the various treatment options with the doctor during the visit (OR, 8.5; P < 0.001). CONCLUSIONS: Many patients with a lumbar herniated disc experience decisional conflict when choosing a treatment option. Our results highlight the need to implement tools and strategies to improve decisional quality, such as decision aids before consultation.

Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis.

OBJECTIVE Previous studies have demonstrated that among patients with adult spinal deformity (ASD), sagittal plane malalignment is poorly tolerated and correlates with suboptimal patient-reported health-related quality of life (HRQOL). These studies included a broad range of radiographic abnormalities and various types of ASD. However, the clinical and radiographic characteristics of de novo degenerative lumbar scoliosis (DNDLS), a subtype of ASD, may influence previously reported correlation strengths. The aim of this study was to correlate sagittal radiographic parameters with pretreatment HRQOL in patients with symptomatic DNDLS. METHODS In this multicenter retrospective study of prospectively collected data, 74 patients with symptomatic DNDLS were enrolled based on anteroposterior and lateral 36-inch standing radiographs. Measurements included Cobb angle, coronal imbalance, pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis (PI-LL), T1-pelvic angle, and global tilt. HRQOL questionnaires included the Oswestry Disability Index (ODI), Scoliosis Research Society (SRS-22r), 36-item Short-Form Health Survey, and numeric rating scale (NRS) for back and leg pain. Correlations between radiographic parameters and HRQOL were assessed. Finally, HRQOL and increasing severity of sagittal modifiers (SVA, PI-LL, and PT) were evaluated. RESULTS Weak correlations were found between SVA and ODI (r = 0.296, p < 0.05) and PT with NRS back pain and the SRS pain domain (r = -0.260, p < 0.05, and r = 0.282, p < 0.05, respectively). Other sagittal radiographic parameters did not show any significant correlation with HRQOL. No significant differences in HRQOL were found concerning the increasing severity of PT, PI-LL, and SVA. CONCLUSIONS While DNDLS is a severe disabling condition, no noteworthy association between clinical and sagittal radiographic parameters was found through this study, demonstrating that sagittal radiographic parameters should not be considered the unique predictor of pretreatment suboptimal health status in this specific group of patients. Future studies addressing classification and treatment algorithms will have to take into account the existing subgroups of ASD.

The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation.

PURPOSE: To explore the role of physical status versus mental status in predicting the quality of life (QOL) of patients with lumbar disk herniation (LDH). METHOD: In this correlative study 51 patients with LDH were recruited in their conservative stage of treatment. After profiling their physical status, all participants reported about pain level (according to VAS), pain perception using the Pain Catastrophizing Scale (PCS), and disability level (according to Oswestry Low Back Pain Disability Questionnaire). Their mental status was evaluated using the Spielberger's State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II). Their QOL was evaluated by the World Health Organization Quality of Life Questionnaire, brief version (WHOQOL-BREF). RESULTS: Physical status/disability level correlated with anxiety and depression. While Physical status predicted physical QOL, mental status, and mainly anxiety and depression were the significant predictors of psychological, social, and environmental QOL. CONCLUSIONS: Mental status may play a significant role in reducing most QOL domains among patients with LDH. The evaluation and intervention process should consider both physical and mental status and their relation to the person's QOL. Since QOL is a major parameter in determining intervention type and success this elaborated perspective may contribute to the intervention planning and outcomes. Implications for rehabilitaion A significant mental distress may accompany the physical disability of patients with LDH. The role of this mental distress in reducing the QOL of patients with LDH may be greater than that of their physical disability. The evaluation and intervention for patients with LDH should refer to both physical and mental status and explore their impacts on quality of life in order to elevate intervention success.

Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions.

OBJECTIVE Patient-reported outcomes (PROs) such as the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) are widely used to evaluate treatment outcomes following spine surgery for degenerative conditions. The goal of this study was to use the Charlson Comorbidity Index (CCMI) as a measure of general health status, for comparison with standard PROs. METHODS The authors examined serial CCMI scores, complications, and PROs in 371 patients treated surgically for degenerative lumbar spine conditions who were enrolled in the Quality and Outcomes Database from a single center. The cohort included 152 males (41%) with a mean age of 58.7 years. Patients with no, minor, or major complications were compared at baseline and at 1 year postoperatively. RESULTS Minor complications were observed in 177 patients (48%), and major complications in 34 (9%). There were no significant differences in preoperative ODI, EQ-5D, or CCMI among the 3 groups. At 1 year, there was a significantly greater deterioration in CCMI in the major complication group (1.03) compared with the minor (0.66) and no complication groups (0.44, p < 0.006), but no significant difference in ODI or EQ-5D. CONCLUSIONS Despite equivalent improvements in PROs, patients with major complications actually had greater deterioration in their general health status, as evidenced by worse CCMI scores. Because CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including subsequent spine surgery. Although PRO scores are a key metric, they fail to adequately reflect the potential long-term impact of major perioperative complications.

Anxiety and depression affect pain drawings in cervical degenerative disc disease.

INTRODUCTION: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. METHODS: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS. RESULTS: Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm. CONCLUSIONS: Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients' pain in correlation to psychological impairment and pain location.

Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease.

BACKGROUND CONTEXT: The Timed Up and Go (TUG) test has recently been proposed as a simple and standardized measure for objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). PURPOSE: The study aimed to explore the relationship between a patient's mental health status and both patient-reported outcome measures (PROMs) and TUG test results. STUDY DESIGN/SETTING: This is a prospective institutional review board-approved two-center study. PATIENT SAMPLE: The sample was composed of 375 consecutive patients scheduled for lumbar spine surgery and a healthy cohort of 110 control subjects. OUTCOME MEASURES: Patients and control subjects were assessed with the TUG test and a comprehensive panel of subjective PROMs of pain intensity (visual analog scale [VAS]), functional impairment (Roland-Morris Disability Index [RMDI]), Oswestry Disability Index [ODI]), as well as health-related quality of life (hrQoL; Euro-Qol [EQ]-5D). METHODS: Standardized age- and sex-adjusted TUG test T-scores were calculated. The dependent variable was the short-form (SF)-12 mental component summary (MCS) quartiles, and the independent variables were the TUG T-scores and PROMs. Direct and adjusted analyses of covariance were performed to estimate the interaction between the SF-12 MCS quartiles and the independent variables. RESULTS: In patients, there was a significant decrease in the subjective PROMs, notably the VAS back pain (p=.001) and VAS leg pain (p=.035), as well as significant increase in the RMDI (p<.001), ODI (p<.001), and the EQ-5D index (p<.001) with every increase in the quartile of the SF-12 MCS. There were no significant group differences of OFI as measured by the TUG T-scores across the SF-12 MCS quartiles (p=.462). In the healthy control group, a significant decrease in VAS leg pain (p=.028), RMDI (p=.013), and ODI (p<.001), as well as a significant increase in the EQ-5D index (p<.001), was seen across the SF-12 MCS quartiles, whereas TUG T-scores remained stable (p=.897). CONCLUSIONS: There are significant influences of mental hrQoL on subjective measures of pain, functional impairment, and hrQoL that might lead to bias when evaluating patients with lumbar DDD who suffer from reduced mental hrQoL. The TUG test appears to be a stable instrument and especially helpful in the evaluation of patients with lumbar DDD and mental health problems.

How does back muscle strength change after posterior lumbar interbody fusion?

OBJECTIVE There is a lack of evidence of how back muscle strength changes after lumbar fusion surgery and how exercise influences these changes. The aim of this study was to evaluate changes in back muscle strength after posterior lumbar interbody fusion (PLIF) and to measure the effects of a postoperative exercise program on muscle strength and physical and mental health outcomes. METHODS This prospective study enrolled 59 women (mean age 58 years) who underwent PLIF at 1 or 2 spinal levels. To assess the effects of a supervised lumbar stabilization exercise (LSE), the authors allocated the patients to an LSE (n = 26) or a control (n = 33) group. The patients in the LSE group performed the LSEs between 3 and 6 months postoperatively. Back extensor strength, visual analog scale (VAS) scores in back pain, and physical component summary (PCS) and mental component summary (MCS) scores on the 36-Item Short Form Health Survey were determined for the both groups. RESULTS Mean strength of the back muscles tended to slightly decrease by 7.5% from preoperatively to 3 months after PLIF (p = 0.145), but it significantly increased thereafter and was sustained until the last follow-up (38.1%, p < 0.001). The mean back muscle strength was similar in the LSE and control groups preoperatively, but it increased significantly more in the LSE group (64.2%) than in the control group (21.7%) at the last follow-up 12 months after PLIF (p = 0.012). At the last follow-up, decreases in back pain VAS scores were more significant among LSE group patients, who had a pain reduction on average of 58.2%, than among control group patients (reduction of 26.1%) (p = 0.013). The patients in the LSE group also had greater improvement in both PCS (39.9% improvement) and MCS (20.7% improvement) scores than the patients in the control group (improvement of 18.0% and 1.1%, p = 0.042 and p = 0.035, respectively). CONCLUSIONS After PLIF, strength in back muscles decreased until 3 months postoperatively but significantly increased after that period. The patients who regularly underwent postoperative LSE had significantly improved back strength, less pain, and less functional disability at 12 months postoperatively.

Effects of Smoking on Subjective and Objective Measures of Pain Intensity, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disk Disease.

BACKGROUND: Numerous studies assessed the effects of smoking on lumbar degenerative disk disease (DDD); they focused on patient-reported outcome measures (PROMs) and yielded conflicting results. METHODS: In this 2-center study on consecutive patients receiving surgical treatment for lumbar DDD, subjective functional impairment (SFI) in terms of PROMs including visual analog scale back and leg pain, Roland-Morris, Oswestry Disability Index, Euro-Qol-5D, and a Short-Form 12 physical component summary was determined at baseline, 3 days, 6 weeks, 6 months, and 1 year postoperatively. Age- and sex-adjusted T-scores of objective functional impairment (OFI) were determined using the Timed Up and Go test up to 6 weeks postoperatively. The responder status was defined by the minimal clinically important difference. RESULTS: We analyzed 375 patients (n = 96 [25.6%] smokers and n = 279 [74.4%] nonsmokers). SFI on any of the PROMs before treatment was similar in smokers and nonsmokers. Smokers were more likely to have OFI in univariate logistic regression analysis (95% confidence interval 1.31-3.37, P = 0.002). In multivariate analysis, however, this relationship became insignificant (95% confidence interval 0.85-2.38, P = 0.184). The smoking status had no predictive capacity on the 6-week SFI or OFI responder status, and there were no differences in any of the PROMs until the 1-year follow-up. CONCLUSIONS: PROMs measuring SFI for pain intensity, functional impairment, and health-related quality of life were similar in smokers and nonsmokers before surgery for lumbar DDD, as well as postoperatively. The smoking status has negligible impact on the Timed Up and Go test, which appears to be a robust assessment tool for OFI.

Influence of Body Mass Index on Subjective and Objective Measures of Pain, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disc Disease.

OBJECTIVE: To analyze the influence of body mass index (BMI) on subjective and objective measures of pain, functional impairment, and health-related quality of life in patients with lumbar degenerative disc disease undergoing surgery. METHODS: Prospective institutional review board-approved 2-center study, measuring visual analog scale (VAS) back and leg pain, Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), EuroQol 5D questionnaire, and Short Form-12 at baseline, 6 weeks, 6 months, and 1 year postoperatively. T-scores of objective functional impairment (OFI) were determined using the Timed Up and Go (TUG) test. RESULTS: A total of 375 patients with a median BMI of 26.6 kg/m2 (94 obese patients [BMI ≥30 kg/m2]) were included. Obese patients presented more VAS back pain (mean, 4.7 vs. 3.6; P = 0.001) and greater disability on the RMDI (mean, 12.6 vs. 11.3; P = 0.045). The prevalence and severity of OFI were similar in obese and nonobese patients. There was a weak positive correlation between BMI and VAS back pain (r = 0.1552; P = 0.0026), on both RMDI (r = 0.1138; P = 0.0276) and ODI (r = 0.1075; P = 0.0374). There was no correlation between BMI and TUG T-scores (r = 0.0475; P = 0.3585). Obese patients were as likely as nonobese patients to show a positive 6-week treatment response, and the outcome up to 1 year was similar. CONCLUSIONS: BMI positively correlates with VAS back pain, RMDI, and ODI. Standardized TUG T scores reflect the patient's degree of OFI well, irrespective of BMI. The TUG test appears to be a good means to estimate functional impairment in populations with a high prevalence of obesity.