Patient perceived outcome after central corpectomy for cervical spondylotic myelopathy.

BACKGROUND: Patient perception of outcome after decompressive surgery for CSM is infrequently reported. We evaluated a simple, quantitative patient-reported assessment of outcome after CC for CSM by comparing it with the NGRR. METHODS: In a prospective study between 1994 and 2004, patients who underwent CC for CSM were asked to quantify the outcome (relative to their preoperative status) on a scale of 0 to 100. Patient perceived outcome score was compared with the NGRR (preoperative grade - postoperative grade / preoperative grade x 100) at the same follow-up. RESULTS: A total of 208 patients with a follow-up ranging from 6 to 72 months (mean, 16.3 months) were evaluated. There was a good positive correlation between PPOS and NGRR for the whole group (Pearson correlation coefficient, 0.62; P < .001), good-grade patients (preoperative Nurick grade of 1-3) (Pearson correlation coefficient, 0.52; P < .001), and poor-grade patients (Pearson correlation coefficient, 0.79; P < .001); the correlation was strongest in the poor-grade group of patients. kappa statistic revealed moderate agreement between the 2 scores in the whole group (kappa = 0.45), substantial agreement in the poor-grade patients (kappa = 0.61), and fair agreement in the good-grade patients (kappa = 0.34). In 28 of the 208 patients (13.5%), there was no agreement between the 2 scores with a significantly greater proportion (24/28), reporting an improvement in spite of no change in their Nurick grade (McNemar chi(2) test, P = .0002). CONCLUSIONS: Although there was good agreement and a positive correlation between PPOS and NGRR, the disagreement in 13.5% of patients suggests that the 2 scores are evaluating some dissimilar functional domains; therefore, PPOS provides additional independent data in the assessment of the results of decompressive surgery for CSM. Patient-reported outcome should be included in reporting outcome of decompressive surgery for CSM.

Immune function, pain, and psychological stress in patients undergoing spinal surgery.

STUDY DESIGN: This study was an exploratory repeated measures design comparing patients undergoing two magnitudes of surgery in the lumbar spine: lumbar herniated disc repair and posterior lumbar fusion. OBJECTIVE: The present study evaluated and compared the effect of perceived pain, perceived stress, anxiety, and mood on natural killer cell activity (NKCA) and IL-6 production among adult patients undergoing lumbar surgery. SUMMARY OF BACKGROUND DATA: Presurgical stress and anxiety can lead to detrimental patient outcomes after surgery, such as increased infection rates. It has been hypothesized that such outcomes are due to stress-immune alterations, which may be further exacerbated by the extent of surgery. However, psychologic stress, anxiety, and mood have not been previously characterized in patients undergoing spinal surgery. METHODS: Pain, stress, anxiety, and mood were measured using self-report instruments at T1 (1 week before surgery), T2 (the day of surgery), T3 (the day after surgery), and T4 (6 weeks after surgery). Blood (30 mL) was collected for immune assessments at each time point. RESULTS: Pain, stress, anxiety, and mood state were elevated at baseline in both surgical groups and were associated with significant reduction in NKCA compared with the nonsurgical control group. A further decrease in NKCA was observed 24 hours after surgery in both surgical groups with a significant rise in stimulated IL-6 production, regardless of the magnitude of surgery. In the recovery period, NKCA increased to or above baseline values, which correlated with decreased levels of reported pain, perceived stress, anxiety, and mood state. CONCLUSIONS: This study demonstrated that patients undergoing elective spinal surgery are highly stressed and anxious, regardless of the magnitude of surgery and that such psychologic factors may mediate a reduction in NKCA.

Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36.

STUDY DESIGN: Clinical outcome study comparing the Short Form-36 (SF-36) and Short Form-12 (SF-12) assessment scales in patients with cervical spondylotic myelopathy (CSM). OBJECTIVES: To compare the validity, reliability, and sensitivity to change of the SF-12 and SF-36 scales in CSM patients undergoing decompressive surgery. SUMMARY OF BACKGROUND DATA: The SF-36 is a generic Health Related Quality of Life (HRQoL) questionnaire, consisting of 36 questions that can be reported as a Physical (PCS) and Mental Component Summary (MCS). Recently, an abbreviated version of SF-36, the SF-12, which uses only 12 questions drawn from the SF-36, has been described. METHODS: In this prospective study, patients with CSM undergoing decompressive surgery, self-completed the SF-36 questionnaire before surgery and at 6 months after surgery. SF-12 item responses were abstracted from the responses given to the SF-36 questionnaire. The validity, reliability, and sensitivity to change of the PCS and MCS components of SF-12 and SF-36 scales were compared. RESULTS: Overall, 105 patients underwent anterior (N = 58) or posterior (N = 47) decompressive surgery. After surgery, there were improvements in the PCS components of both the SF-36 (40 +/- 2 to 54 +/- 2) and SF-12 (34 +/- 2 to 48 +/- 3), as well as in the MCS component of the SF-36 (48 +/- 2 to 63 +/- 2) and SF-12 (43 +/- 2 to 59 +/- 2) (P < 0.001). The sensitivity to change and absolute sensitivity for both SF-12 and SF-36 were comparable, but the reliability of SF-36 was marginally greater. There were close and linear correlations between the SF-36 and SF-12 scores for both the PCS and MCS components, before and after surgery (R = 0.86 to 0.93; P < 0.0001). CONCLUSIONS: Both the SF-12 and SF-36 scales are valid and sensitive to changes in physical and mental health status in CSM patients, undergoing decompressive surgery. Despite its abbreviated nature, the SF-12 appears to be an adequate substitute for SF-36, and its brevity should increase its attractiveness to both clinicians and patients.

[Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain]. / Fear Avoidance Beliefs und Funktion bei älteren Personen mit chronischem Rückenschmerz.

Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain This analysis assessed how fear avoidance beliefs (FABs) affected subjective and objective functional parameters as well as pain in elderly individuals. The study comprised 152 elderly patients with low back pain, which was attributed to spondylosis in almost half of the cases. Their average age was 70.1 years (SD=4.3, range 65-84). All of the patients participated in a physiotherapeutic program including data acquisition before treatment (t1), immediately after its completion (t2), and 6 months later (t3). FABs were assessed by a five-item scale with satisfying psychometric properties. The primary outcome criterion was function, which was evaluated as a subjective measure using the Hannover functional disability scale and as an objective measure based on the anteflexion determined by ultrasound topometry. Secondary outcome criteria were pain parameters. At the time o the first measurement (t1), the patients were classified into three groups with strong, intermediate, or weak FABs. Analyses of variance reveal an improvement of subjective functional capacity in every FAB group between t1 and t2. At t3, there is a decline of these values only in the group of the high fear avoiders. High fear avoiders also show lower values in the objective measure at all three measurement points. No influence of the FABs on the pain parameters could be determined. It would be expected that the efficacy of physiotherapy could be improved if the patients' FABs are taken into consideration when planning the treatment regimen.

Cervical spondylotic myelopathy, depression, and anxiety: a cohort analysis of 89 patients.

OBJECTIVE: To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM. METHODS: We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales. RESULTS: According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety. CONCLUSION: More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.

Quality of life assessment with the medical outcomes study short form-36 among patients with cervical spondylotic myelopathy.

OBJECTIVE: Cervical spondylotic myelopathy (CSM) is a chronic degenerative condition of the cervical spine that produces narrowing of the spinal canal and disruption of spinal cord function. We used Medical Outcomes Study Short Form-36 (SF-36), a generic quality of life outcome-assessment instrument, to assess the quality of life among patients with CSM. METHODS: A cohort of 88 Veterans Administration neurosurgery clinic patients with CSM underwent structured interviews for collection of data on demographic features, symptoms, operations, and comorbid diseases. Patients also completed the SF-36. Symptoms and examination findings were used to assign each patient scores on the Nurick, Cooper, and Harsh myelopathy scales and a Western modification of the Japanese Orthopaedic Association scale. SF-36 scores were compared with age-adjusted Veterans Administration population normative values by using Student's t test with unequal variances. Cuzick's nonparametric test for trend was used to explore the relationship between the SF-36 physical component summary scores and the myelopathy scale scores. RESULTS: Patients with CSM exhibited decreased quality of life in all eight SF-36 domains, as well as with the physical and mental component summary scores, compared with Veterans Administration population normative values (for all, P

Validity and reliability of the Short Form-36 in cervical spondylotic myelopathy.

OBJECT: Validity (the extent to which a test measures what it is intended to measure) and reliability (the stability and reproducibility of measures of the same concept over time or across methods of gathering data) are important characteristics of any outcomes instrument. Generic outcomes instruments are designed for use in any population; however, their validity and reliability in particular diseases should be verified to ensure their appropriateness for use in that disease. In this study the authors assessed the validity and reliability of the Medical Outcomes Study Short Form-36 (SF-36), a generic outcomes instrument, in a population of patients with cervical spondylotic myelopathy (CSM). METHODS: The SF-36 was administered to a cohort of patients with CSM on an outpatient basis. Symptom-related data derived from a structured interview and physical examination findings were used to classify cases according to the myelopathy scales of Nurick, Cooper, Harsh, and a Western modification of the Japanese Orthopaedic Association (JOA). Construct validity was assessed by determining whether SF-36 scores varied in accordance with predefined hypotheses relating to the myelopathy scores by using the Cuzick nonparametric test for trend. The reliability of the SF-36 scores was assessed using Cronbach alpha. Eighty-eight patients with CSM completed the SF-36 and interview. Construct validity was demonstrated by confirming the hypothesized relationship between SF-36 scales and the myelopathy scales of Nurick (p < or = 0.003), Cooper leg subscale (p < or = 0.012, except the general health perceptions domain [p = 0.091]), Harsh (p < or = 0.016), and the motor component of the modified JOA (p < or = 0.006). Reliability was demonstrated for all eight SF-36 domain scales and the physical component and mental component summary scales, in which Cronbach alpha satisfied the Nunnally criterion of 0.7. CONCLUSIONS: The SF-36 provides valid and reliable data on patients with CSM.

Measurement of outcome in patients with cervical spondylotic myelopathy treated surgically.

The objective was to establish the role of the Short Form 36 (SF 36) as an objective measure of clinical outcome in cervical spondylotic myelopathy (CSM), and took the form of a prospective observational study. Seventy patients with symptomatic CSM were treated by surgical decompression. Health status was measured pre- and 3 months postoperation using objective, validated patient completed measures. These were the SF 36, neck disability index, myelopathy disability index and analogue scores for neck pain and arm symptoms. SF 36 scores were compared with age matched control data. Twelve-month postoperative data are available in a proportion of the cohort. CSM patients have lower preoperative SF 36 scores than age-matched population controls. Comparing pre- and postoperative SF36 scores for the physical functioning domain 64% of patients improve, 23% show no change and 14% of patients continue to deteriorate (Wilcoxon P< 0.0001). These changes are replicated in other domains of the SF36 and by the other measures of outcome. The SF36 is responsive, valid, and practical. Its use for determining outcome in the surgical treatment of CSM is recommended.

[Aging effect on frontal lobe function-evaluation by the new modified Wisconsin Card Sorting Test].

New Modified Wisconsin Card Sorting Test (WCST) was administered to ninety-five individuals to assess the effects of age on frontal lobe functions. The correlations between ages and scores were evaluated in the following five subgroups which were classified into whole subjects (TOL, n = 95), normals and patients who were neurologically diagnosed as only having cervical spondylosis (NOR, n = 20), individuals whose age-corrected total intelligence quotients (TIQ) by the Wechsler Adult Intelligence Scale were higher than or equal to 100 (HIQ, n = 30), individuals whose TIQ were less than 100 (LIQ, n = 27), and individuals whose Mini-Mental State Examination scores were full (MMS, n = 28). Scores of the WCST including Categories Achieved, Total Errors, Difficulty of Maintaining Set and Perseveration were significantly correlated to ages in four groups such as TOL, NOR, HIQ, and MMS. The correlation of WCST's scores of the four groups indicated almost the same tendency. Some subcategories of the WCST, indicating perservation which were characteristic signs of the frontal lobe dysfunction correlated with ages in these four groups. The groups indicating NOR, HIQ, and MMS were thought to be regarded as being normal controls. And, the scores of Mini-Mental State Examination were not correlated with ages. So, the WCST scores of the MMS group were no thought to be effected by the age-related decline of intelligence. The results might suggest that the age-related decline of the frontal lobe function precedes that of intelligence.

Psychiatric morbidity and illness behaviour in female neurological in-patients.

Ninety three female neurological in-patients were assessed in a collaborative neurological and psychiatric study. An overall prevalence of definite psychiatric disorder of 34% was found, depression being the most common diagnosis. Psychiatric morbidity was most common when the neurologist felt that the presentation could not be explained by a neurological disorder. The majority of such patients had symptoms which could be explained by the psychiatric disorder but a substantial number could not be given a definite diagnosis. The General Health Questionnaire was not found to be a useful screening instrument in this setting.

Personality in torticollis: a controlled study.

The Eysenck Personality Questionnaire, the trait scales of the Leyton Obsessional Inventory, the Spielberger State Trait Anxiety Inventory, and a questionnaire assessing marital status and harmony were completed by 100 torticollis patients and a control group of 49 cervical spondylosis sufferers. Information regarding employment status, and events preceding onset of their complaint was also obtained. The two groups did not differ in terms of any of the personality dimensions evaluated, or in their self-reports of events prior to onset of their illness. The groups differed significantly with regards to marital status (a higher proportion of the torticollis patients were single) but not marital harmony. A significantly higher proportion of the torticollis patients were in the permanently sick category of employment status. Findings of previous studies evaluating personality in torticollis and in sufferers of other disabling physical conditions are considered, and the results are discussed in terms of the effects of disabling chronic physical disorders.