Clinical outcome analysis in surgical patients enrolled in a Second Opinion Program in spine surgery

ABSTRACT Objective To analyze pain, functional capacity, quality of life, anxiety and depression outcomes in patients undergoing lumbar spine surgery following use of the Second Opinion Program, and to present disagreements regarding diagnoses and therapeutic indications between the first and second opinions. Methods A prospective, observational cohort study with 100 patients enrolled in the Second Opinion Program who underwent lumbar spine surgery. Questionnaires addressing pain intensity, level of disability, quality of life, anxiety and depression were applied prior to and within 1, 3, 6 and 12 months of surgery. Descriptive and comparative statistical analyses were performed. The following clinical outcomes were analyzed: pain intensity, level of disability, quality of life, anxiety, and depression. Results In this sample, 88% and 12% out of 100 patients were submitted to lumbar decompression and arthrodesis, respectively. Patients reported improvements in function, pain intensity, and quality of life factors following surgery and were able to attain the minimal clinically important difference relative to the preoperative period. Agreement between the first and second opinions was observed in 44% of diagnoses, and in 27% of therapeutic indications. Conclusion Patients had favorable postoperative outcomes regarding pain, disability, and quality of life. These findings and the high rates of diagnostic and therapeutic indication disagreements corroborate the need of a second opinion in cases of spine disease with surgical indications.

Síndrome adyacente / Síndrome adjacente / Adjacent segment disease

OBJETIVO: Estudiamos la incidencia de SDA quirúrgico de localización lumbar y los factores relacionados con el mismo. MÉTODO: Estudio retrospectivo de corte transversal. RESULTADOS: Encontramos 50 casos operados por SDA en 1662 cirugías realizadas, 530 en columna lumbar; incidencia 9,4%. Edad promedio 62 años. Síntoma principal: claudicación radicular (80%). Las Rx previas a la primera cirugía del nivel que sufrirá SDA: UCLA 1 (45%) y 2 (27%); lordosis prerrevisión: 36° promedio y pos 44°. Prerrevisión: IP55°, VP26°, PS29° y posoperatoria IP56°, VP22° y PS34°. Desequilibrio sagital prerrevisión 60% y posoperatorio 27%, equilibrio coronal recuperado en los 2 casos. IRM previa a la primera intervención mostró 83% con Pfirmann IV. Tipos de SDA: estenosis lumbar monosegmentaria agravada por antelistesis en 20 y por retrolistesis en 14; estenosis multisegmentaria 4, hernia discal 4, fractura por aplastamiento 4, estenosis sin listesis 4. Período entre las 2 cirugías: 6 años promedio. CONCLUSIÓN: Una incidencia de 9,4% de reintervenciones a causa de un Síndrome Adyacente, hace de esta patología un importante problema a largo plazo, lo que obligaría al cirujano a tomar las medidas que sean posibles para evitarlo. Con los resultados de este estudio retrospectivo solo podríamos decir que tendrían más posibilidades de desarrollar un SDA los segmentos con Pfirmann IV en la IRM y que se debería tener en cuenta las relaciones VP (20%) y PS (80%) pre y pos operatorias para devolver las condiciones mecánicas ideales al raquis. Se necesitarían estudios clínicos prospectivos para tener conclusiones más firmes.

OBJETIVO: Estudamos a incidência de SA de localização lombar tratada por cirurgia e fatores associados. MÉTODO: Estudo transversal retrospectivo. RESULTADOS: Foram encontrados 50 casos de SA em 1.662 casos operados, 530 na coluna lombar, incidência de 9,4%. A média de idade foi 62 anos. Principais sintomas: claudicação radicular (80%). Radiografias antes do primeiro nível que sofrerá SA: UCLA 1 (45%) e 2 (27%), lordose pré-revisão: 36° média 44° e pós-revisão. Pré-revisão: IP55°, VP26° PS 29º e pós-operatória IP56°, VP22° e PS34°. Desequilíbrio sagital pré-revisão 60% e pós-operatório 27%, equilíbrio, coronal recuperado nos 2 casos. A RM antes da primeira intervenção mostrou 83% com Pfirmann IV. Nível da SA: 38% L3-L4, L5-S1: 26%. Tipos de SA: estenose lombar agravada pela ântero-listese monossegmentar em 20 casos e por retro-listese em 14, estenose multissegmentar 4, hérnias de disco 4, fraturas por esmagamento 4, estenoses sem listese 4. Período entre as 2 cirurgias: em média 6 anos. CONCLUSÃO: A incidência de 9,4% de re-operação em cirurgias decorrentes de síndrome adjacente torna esta doença um problema importante a longo prazo, obrigando o cirurgião a tomar todas as medidas possíveis para evitar esta situação. Com os resultados deste estudo retrospectivo só poderíamos dizer que os segmentos mais propensos a desenvolver SA são os com Pfirmann IV na ressonância magnética e que se deve levar em conta a relação VP (20%) e PS (80%) pré e pós-operatória para voltar à condição mecânica perfeita da coluna vertebral. Estudos clínicos prospectivos são necessários para que se obtenham resultados mais conclusivos.

OBJECTIVE: We studied the incidence of lombar AS surgically treated and the factors associated with it. METHOD: Retrospective cross sectional study. RESULTS: We found 50 surgeries for AS performed in 1662 cases, 530 in the lumbar spine, incidence: 9.4%. Average age: 62 years. Main symptoms: radicular claudication (80%). Radiographs prior to the first surgery level that will suffer AS: UCLA 1 (45%) and 2 (27%), lordosis pre-revision: 36° average and 44° post-revision. Pre-revision: IP 55°, VP 26° and PS 29° and postoperative IP 56°, VP 22° and PS 34°. Sagittal imbalance pre-revision 60% and postoperative 27%, coronal balance recovered in both cases. MRI before the first intervention was 83% with Pfirmann IV. AS level: 38% L3-L4, L5-S1: 26%. AS types: lumbar stenosis worsened by monosegmental antero-listhesis in 20 and retro-listhesis in 14; multisegmental stenosis 4, disc herniation 4, crush fracture 4, stenosis without listhesis 4. Period between the 2 surgeries: on average 6 years. CONCLUSION: An incidence of 9.4% of reoperation due to adjacent syndrome makes this disease an important long-term problem, forcing the surgeon to take all the possible steps to avoid this. With the results of this retrospective study we could only say that the segments more likely to develop AS are those with Pfirmann IV on MRI and that the relation VP (20%) and PS (80%) pre and post-operative should be taken into account to return to the spinal column perfect mechanical condition. Prospective clinical studies are needed for more conclusive results.