Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade.

STUDY DESIGN: All patients aged 80 years or older, treated surgically for lumbar spine disorders from 1996 to 2001, were analyzed in a retrospective case series. The purpose of this study was to determine if higher than expected morbidity and mortality was observed for patients undergoing lumbar spine surgery in their ninth decade of life, and if any preoperative factors correlated with this outcome. OBJECTIVE: To determine how comorbidity affected surgical morbidity and mortality in patients older than 80 years. SUMMARY OF BACKGROUND DATA: Major complication rates for elderly patients approach 20% for spine surgeries, and mortality approaches 10% in some series. Chronic disease has been shown to impact mortality dramatically, with inpatient mortality 20 times higher if 3 comorbidities exist. In contrast, age is not a negative predictor for outcome after stenosis surgery; elderly patients fare as well as younger ones. METHODS: Twenty patients had complete medical records with an average follow-up of 2.57 years (range 0.42-8.77). Comorbidities, diagnoses, procedures, operative data, complications, and deaths were recorded. The diagnoses were stenosis (80%), spondylolisthesis (60%), scoliosis (30%), and instability (10%). A total of 95% of patients were treated with decompression. All patients underwent fusion, 75% with instrumentation. RESULTS: Four patients (20%) had a major complication as an inpatient, 4 as an outpatient (20%). There were no deaths. Comorbidity, hospital stay, and intensive care stay were the only factors that correlated significantly with the presence of an inpatient complication. No factors correlated with outpatient complications. The odds ratio for comorbidity, with regard to predicting a complication, was 9.20 (P = 0.04, 95% confidence interval 1.11- 72.4). Another strongly significant correlation occurred between levels fused, blood loss, operating time, and days spent in the intensive care unit. CONCLUSIONS: The negative effect of age on surgical morbidity and mortality has been established. However, the effect of comorbidity has not been linked to the occurrence of major complications. Comorbidity may predict major complications. Choosing patients with less preoperative comorbidity will help to minimize complications.

A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity.

BACKGROUND: The objective of this study was to determine the prevalence of lower back pain and associated leg pain/numbness in postmenopausal Caucasian women and the relationship of these symptoms to health status and function. METHODS: A convenience sample of 573 white women enrolled in the Observational Study of the Women's Health Initiative (WHI) in Pittsburgh completed a questionnaire on low back pain (LBP) and leg pain (LP) and its impact on their daily activity. For data analysis, this information was merged with that obtained under the standard WHI protocol. RESULTS: Almost half of the women (49%) reported having had LBP during the previous month: 8% had LBP only, while 41% had both LBP and LP. In 9% of women, the leg and back symptoms were alleviated by sitting. Among women with LBP during the previous month, those who also had leg pain were five times more likely to have had functional limitations, two to four times more likely to have consulted a clinician or taken medications, and more likely to have had prior spinal surgery or hospitalization than the women with no LP. Based on the Short Form-36, women with LBP/LP had significantly lower scores for physical function, physical role, and bodily pain than women with no LBP or with LBP alone. CONCLUSIONS: Low back pain that radiates into the hip, buttock, or leg is relatively common in postmenopausal Caucasian women living in the community and is associated with decreased physical health status and with physical limitations.

Spondylolisthesis in the athlete.

The diagnosis and appropriate management of spondylolysis and spondylolisthesis in the athlete can be challenging for the treating orthopaedic surgeon. With an increase in the number of skeletally immature athletes competing at more demanding levels of competition, an associated increase in the number of such cases may be seen. Management strategy is directed by the symptoms, the age of the patient, and the severity of the spondylolisthesis.

Influence of smoking on the health status of spinal patients: the National Spine Network database.

STUDY DESIGN: Multicenter, cross-sectional analysis of data from the National Spine Network. OBJECTIVES: Investigate the association between the smoking status of spinal patients, duration and severity of symptoms, and their self-reported health status. BACKGROUND: Although cigarette smoking was identified as a potential risk factor for lower back pain many years ago, more recent research is challenging this finding. METHODS: The National Spine Network database contains information on the initial visit of spinal patients visiting physicians at 23 health care institutions in the United States. All patients for whom data were available regarding smoking status are included in this study (n = 25,455). RESULTS: Data from a total of 25,455 patients (11,494 men and 13,961 women) were included in the study; 16.7% (n = 4249) were smokers. Smokers were younger than nonsmokers (44.2 vs. 48.7 years) and were more likely to report severe back symptoms (37 vs. 50%) and to report symptoms of depression (54 vs. 37%). Smokers of each gender scored 10-15 points lower than nonsmokers on each of the SF-36 subscales. These differences persisted when the absolute scores were compared with age- and sex-specific population norms and after adjustment for comorbid conditions, educational level, and depression. Similar results were obtained when the cohort was stratified by primary diagnosis or by surgical status. When postsurgical patients were grouped by time since surgery, those who were nonsmokers reported improved health status by time period; those who smoked did not. CONCLUSIONS: Smokers and nonsmokers had had spinal symptoms for similar duration, but the smokers reported more severe symptoms, which were present for a greater proportion of time each day. Also, the smokers had lower physical and mental health status scores (based on the SF-36) than did nonsmokers.