Radiculopathy with motor deficit: a cross-sectional study of the impact of the surgeon's experience on the indication and timing of surgical treatment.

PURPOSE: The optimal management of patients with compressive radiculopathy with motor deficit (CRMD) is controversial. Our goal was to provide evidence on the impact of the spine surgeons' experience on surgical planning and timing. METHODS: Spine surgeons were invited to participate in a 5-item online survey. A literature review was carried out. RESULTS: Of the 94 spine surgeons who responded to the survey, 70% would operate early on a patient with acute CRMD, but only 48% would do so if the radicular pain had resolved. Surgeons with more than 15 years of experience chose more conservative options. Twenty published studies were selected in the literature review. CONCLUSION: The optimal management of patients with compressive radiculopathy associated with a non-progressive motor loss remains unknown. The results of our survey show that surgeons with extensive surgical experience take a more conservative and cautious approach.

Elective Lumbar Spine Surgery in Depressed Patients: Is it Worth it?

BACKGROUND: The objective of this study is to compare surgical results (pain, function, and satisfaction) between a group of depressed patients and a nondepressed group who had been operated on for a degenerative lumbar condition. METHODS: Prospective observational study. Preoperative pain (lumbar and radicular visual analog scale [VAS]), function (Oswestry Disability Index [ODI]), and depression (Zung depression scale) data were collected in patients listed to be operated on for a lumbar degenerative condition. One year postoperatively, ODI and VAS data were collected again as well as a satisfaction question (are you satisfied with the surgical results? Yes/no). RESULTS: Ninety-seven patients were included in the study, 78 nondepressed patients (80.4%) and 19 depressed patients (19.6%). Preoperatively, depressed patients had more lumbar pain (P = .00) and more functional limitation (P = .01) than nondepressed patients. One year postoperatively, depressed patients had more radicular pain (P = .029) and more functional limitation (P = .03) than non-depressed patients. The overall improvement of pain and function was similar between both groups (not significant). Seventy percent of depressed patients and 80% of nondepressed patients were satisfied with the surgical outcome (P = .52) 1 year postoperatively. CONCLUSION: Depressed patients experience the same overall level of improvement as nondepressed patients, despite having more pain and functional limitation preoperatively and 1 year after elective lumbar spine surgery than nondepressed patients. The level of satisfaction does not differ significantly between the two groups. LEVEL OF EVIDENCE: 2.

Síndrome de la espalda inclinada: Presentación de cuatro casos y revisión de la bibliografía / Bent spine syndrome. Presentation of four cases and literature review

El síndrome de la espalda inclinada o camptocormia es una causa de desequilibrio sagital del tronco no estructurada de difícil manejo médico y quirúrgico. Puede ser secundario a enfermedades del sistema nervioso central o periférico, o de origen primario muscular, como la atrofia aislada de la musculatura paravertebral espinal. El diagnóstico se basa en la evaluación clínica, los estudios por imágenes, la electromiografía y la biopsia muscular. El síndrome de la espalda inclinada, cualquiera fuera su causa, tiene un pronóstico pobre, los síntomas suelen progresar hasta afectar la bipedestación de manera irreversible. Presentamos un análisis retrospectivo de cuatro casos de síndrome de la espalda inclinada tratados en nuestro centro y una revisión de la bibliografía. Nivel de Evidencia: IV

Objectives: Bent spine syndrome (BSS) or camptocormia is a cause of unstructured sagittal imbalance of difficult medical and surgical management. The purpose of this paper is to describe the causes of BSS and how to approach its treatment. Materials and Methods: Retrospective analysis of 4 cases of BSS treated at our center and review of the literature. Results: The 4 patients were women between 60 and 82 years of age. In 3 of them, BSS was due to an isolated atrophy of the paravertebral erector spinae muscles, and in 1 of them, it was due to an inflammatory myopathy. Conclusions: The prognosis of BSS is poor in all cases, so symptoms usually progress to an irreversible difficulty to stand upright. Level of Evidence: IV