Time course and correlates of psychological distress post spinal surgery: A longitudinal study.

Background: Psychological distress post lumbar spine surgery is associated with poorer outcomes. There is a scarcity of studies devoted to analyzing the risk factors associated with psychological distress in patients who have undergone lumbar fusion surgery. The purpose of this study was to (1) describe the time course and severity of psychological distress using the STarT Back Tool (SBT) and (2) determine the demographic and clinical predictors of SBT score post lumbar spine fusion surgery. Methods: This retrospective longitudinal study analyzed 227 subjects with 1- and 2-level lumbar fusion surgery who underwent standardized assessment preoperatively and at 4 and 12 weeks postoperatively. Preoperative variables collected were demographic, clinical, and psychological variables. Postoperative psychological distress was measured by self-reported SBT. Risk factors for SBT over time were identified using ordinal and mixed-effects modelling. Results: Although the trajectory of SBT levels declined postoperatively over time, at week-12, 20% of patients had moderate to high SBT. Postoperative SBT scores at week-4 time point was significantly greater than SBT scores at week-8 (OR = 2.7, 95% credible interval [CrI]; 1.8-3.9). Greater SBT scores at week-4 were strongly associated with greater SBT scores throughout 12 weeks of follow-up (OR = 7.3, [95% CrI; 1.2-31.4]). Greater postoperative SBT levels over time were associated with being male (OR = 2.2, 95% CrI; 1.0-3.9), greater preoperative back or leg pain intensity (OR = 2.2; 95% CrI: 1.0-4.4), greater preoperative leg weakness (OR = 4.2, 95% CrI: 1.7-7.5) and higher preoperative depression levels (OR = 4.8; 95% CrI: 1.6-10.4). Conclusion: Postoperative SBT levels declined nonlinearly over time. However, a sizable proportion of patients had moderate to high psychological distress at week-12 postsurgery. Greater preoperative back or leg pain intensity, leg weakness and depression levels, and male gender were risk factors of greater psychological distress postsurgery. Although requiring validation, our study has identified potential modifiable risk factors which may give an opportunity to provide early (preoperative) and targeted strategies to optimize postoperative psychosocial outcomes in patients undergoing lumbar fusion surgeries.

Factors Associated with Pain Intensity and Walking Disability After Lumbar Fusion: A Longitudinal Study.

STUDY DESIGN: Retrospective longitudinal study. OBJECTIVE: To identify the preoperative factors associated with postoperative lumbar fusion recovery in back or leg pain, self-reported walking time, and gait speed over a 6-month period. SUMMARY OF BACKGROUND DATA: The demand for lumbar fusion surgeries has significantly increased over the years. Yet, some patients report persistent postsurgical pain and poor functional outcomes. Unfortunately, the associated risk factors are not well understood. METHODS: The study analyzed 232 subjects with mono- or bisegmental lumbar fusion surgery who underwent standardized assessment preoperatively and at 4, 12, and 24weeks postoperatively. Preoperative variables collected were demographic, clinical, and psychological variables. Back or leg pain was measured by the Numeric Pain Rating Scale. Walking disability was measured by self-reported walking time and performance-based fast gait speed. Risk factors of pain and walking disability over time were identified using ordinal and linear mixed-effects modeling. RESULTS: At 6 months post-surgery, 17% of patients reported having moderate or severe back/leg pain and 24% were unable to walk longer than 30 minutes. Greater preoperative self-reported leg weakness frequency and body-mass-index (BMI) were strongly associated with greater pain and walking disability. Additionally, greater preoperative depression symptoms were associated with greater back/leg pain (adjusted odds ratio = 4.0) and shorter walking time (adjusted odds ratio = 2.7)-but not with slower gait speed (difference = 0.01 m/s). Old age and female gender were strongly associated with gait speed but not with self-reported walking time. CONCLUSION: A sizable proportion of patients had poor pain and walking outcomes even at 6 months post-surgery. Preoperative leg weakness and BMI were consistent risk factors and patients with greater depression symptoms may have poorer self-reported outcomes. Although requiring validation, our study has identified potentially modifiable risk factors which may give clinicians an opportunity to provide early (preoperative) and targeted intervention strategies to optimize postoperative outcomes.Level of Evidence: NA.

The influence of cervical spine flexion-rotation range-of-motion asymmetry on postural stability in older adults.

STUDY DESIGN: Cross-sectional design. OBJECTIVE: The purpose of this study was to isolate the contribution of cervical spine range-of-motion (ROM) asymmetry to postural control in a group of older adults with neck pain. SUMMARY OF BACKGROUND DATA: Previous research has suggested that the upper cervical spine plays an important role in postural stability. However, it remains unclear whether the upper cervical spine rotation ROM asymmetry is associated with postural stability. METHODS: Using the cervical range-of-motion device to assess upper cervical spine ROM via the cervical flexion-rotation test, we classified 54 older adults with neck pain (30 females; mean [standard deviation] age, 66 [5] yr) into the (1) symmetrical group (SYM; n = 20; ≤5° side-to-side difference) or (2) asymmetrical group (ASYM; n = 34; >5° difference). Standing postural control was characterized by the center-of-pressure (CoP) movements measured using a Balance Board. Other measures included habitual, fast-paced gait speed and neck pain. Both groups were compared on the various measures using Welch t tests. RESULTS: Although the ASYM group had 26% greater anteroposterior postural sway than the SYM (P < 0.01), both groups did not differ on postural sway velocity, gait speed, and neck pain intensity. Analyzing the frequency content of the postural sway using wavelet analysis (a modern, nonlinear signal processing method) shed further light: the standing postural sway in the ASYM group was skewed toward lower frequency movement (ultralow [< 0.10Hz] frequency content, anteroposterior: 6.7% in ASYM, 4.7% in SYM, P = 0.01; medial-lateral: 4.2% in ASYM, 3.4% in SYM, P = 0.045). CONCLUSION: The ASYM group seemed to have compensated for their altered somatosensory input to achieve similar functional levels as the SYM group. Given what is known about the association between ultralow frequency postural sway and visual input, we speculated that the postural strategy adopted by the ASYM group was adaptive and that this group may be relying on the visual system to achieve these compensations.