Physical capability and patient-reported well-being after spinal surgery: a 20-year cohort from the Kuopio Osteoporosis Risk Factor and Prevention study combined with the Finnish Care Register for Health Care.

BACKGROUND AND PURPOSE: Studies investigating the effect of spinal surgery on both physical capability (PC) and subjective well-being (SW) are scarce. We aimed to investigate self-reported PC and SW up to 20 years after lumbar spine surgery. PATIENTS AND METHODS: 6,612 postmenopausal Finnish women (47-56 years at baseline [BL]), from the Osteoporosis Risk Factor and Prevention (OSTPRE) study, were followed-up (FU) for 20 years. The Finnish Care Register for Healthcare (CRFH) provided data on surgery in the OSTPRE population on lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). PC and SW of women with lumbar surgery was compared with that of women without lumbar surgery. A chi-square analysis was conducted to analyze the statistical differences in the distribution of PC and SW. A propensity score-matched control analysis was also performed in addition to analysis of the total populationbased control group. RESULTS: In women without lumbar surgery 94% reported good PC at BL, which decreased to 79% at the 20-year FU. For those with LSS/LDH surgery, 84%/(37/50) reported good PC at BL and 80%/(33/50) at 20-year FU, respectively. Good SW was reported by 48% of the control group at BL, 50% at 10-year FU, and 42% at 20-year FU. Women with LSS/LDH surgery before the 10-year FU reported good SW as follows: (6/50)/38% at BL, (12/48)/39% at 10-year FU, and (9/50)/37% at 20-year FU. CONCLUSION: Patients with LSS and LDH report lower PC and SW. Lumbar spinal surgery improves PC and SW in the short term, with early LDH surgery showing the greatest benefits whereas late surgery did not. Overall, PC and SW are lower both initially and during the 20-year FU when compared with the age-matched controls except for early LDH surgery.

Drug treatments associated with Achilles tendon rupture. A case-control study involving 1118 Achilles tendon ruptures.

The incidence of Achilles tendon (AT) rupture, especially nonsport-related rupture, is increasing, while the reasons for this increase are largely unknown. The association between the AT rupture and the use of various drug treatments was studied. We collected AT rupture patients from the Finnish Hospital Discharge Register. We also acquired information about all the doctor-prescribed drugs they had purchased within 1 year before the rupture. For comparison, we randomly selected age- and sex-matched controls from the Finnish Population Register. There were 1118 AT rupture patients. Several drug groups had a statistically significant association with the AT rupture. Our study confirmed an association between fluoroquinolone antibiotics and AT rupture (OR 2.20, P = 0.005). A statistically significant association of renin-angiotensin II receptor antagonists with tendon rupture (OR 7.59, P = 0.003) was a previously unreported finding. The increasing incidence of AT rupture, especially in middle-aged and elderly patients, might partially be a consequence of the increased use of certain drug treatments. Some associations are probably explained by the symptomatic treatment of the painful tendon before the rupture.

Life satisfaction and pain interference in spine surgery patients before and after surgery: comparison between on-opioid and opioid-naïve patients.

PURPOSE: Pain has a negative impact on life satisfaction (LS). Our primary aims were to compare LS in on-opioid and opioid-naïve spine surgery patients and to evaluate whether surgery affects LS during the first 3 weeks after surgery. METHODS: After informed consent 200 patients (99 on-opioid, 101 opioid-naïve; 112 male; aged 23-71 years) having elective spine surgery were enrolled. Their LS was evaluated using a four-item Life Satisfaction Scale (4-20, lower score more satisfied) and pain interference using Brief Pain Inventory (BPI)-questionnaire (0-10, lower score, less interference) before and 21 days after surgery. RESULTS: At baseline LS was lower in the ON-OPIOID-group, mean LS-score 10.6 (SD 3.9), than that in the OPIOID-NAÏVE-group, 9.3 (3.0) (p = .027). At 3 weeks after surgery LS had increased in both groups compared to baseline (p < .001). However, LS was still lower in the ON-OPIOID-group, 9.1 (3.7) than that in the OPIOID-NAÏVE-group, 7.6 (2.7) (p = .005). Patients with lower LS experienced more pain interference pre- and post-operatively (p < .001). At 3 weeks the pain interference had decreased in both groups, in the ON-OPIOID-group from mean BPI-score 5.1 (2.0) to 3.0 (2.0) (p < .001) and in the OPIOID-NAÏVE-group from 4.0 (2.1) to 2.4 (2.3) (p < .001), but BPI-score was still higher in the ON-OPIOID-group (p = .045). CONCLUSION: Life satisfaction increased and pain interference decreased in both groups after spine surgery. However, LS was lower and pain interference was more significant in on-opioid patients than that in opioid-naïve patients.

Opioid-Induced Bowel Dysfunction in Patients Undergoing Spine Surgery: Comparison of Oxycodone and Oxycodone-Naloxone Treatment.

INTRODUCTION: Opioids are needed for postoperative pain in spine surgery patients, but opioid-induced constipation is a harmful adverse event. The aim of this clinical trial was to compare the use of a controlled-release oxycodone-naloxone combination product with oxycodone controlled-release tablets in these patients. The main outcome measure was the prevalence of constipation at 7 days postoperatively assessed with a Bowel Function Index questionnaire. A follow-up assessment at 21 days after surgery was also included. METHODS: A total of 180 patients undergoing spine surgery, 91 having preoperative opioids in use and 89 opioid-naïve, were randomized to receive twice-daily oxycodone 10 mg or oxycodone-naloxone 10/5 mg controlled-release tablets for the first 7 postoperative days. Patients were followed-up for 21 days after surgery. RESULTS: At baseline, prevalence of constipation was common both in the opioid-naïve-25/87 (29%) and on-opioid groups 43/90 (48%) (P = 0.009). This increased at 7 days postoperatively with no difference between the groups, 54/89 with oxycodone and 54/88 with oxycodone-naloxone had constipation. At 21 days, constipation was less than in the baseline in both groups, in the opioid-naïve group the prevalence of constipation was 3/43 (7%) in patients with oxycodone-naloxone compared to 9/44 (21%) with oxycodone (effect size 0.68; P = 0.068). Both study compounds provided similar pain relief and were well tolerated. CONCLUSION: In patients presented for back surgery, the prevalence of constipation was significantly higher than that in the community. In opioid-naïve subjects, oxycodone-naloxone was beneficial concerning constipation; but this was not distinguishable in subjects with chronic opioid use. The analgesic efficacy of oxycodone and oxycodone-naloxone was similar. TRIAL REGISTRATION: European Clinical Trials Database (EudraCT no. 2012-001816-42) and ClinicalTrials.gov database (Identifier: NCT02573922).

Association of Modic changes with health-related quality of life among patients referred to spine surgery.

Background and purpose Modic changes (MC) are bone marrow and vertebral endplate lesions seen in magnetic resonance imaging (MRI) which have been found to be associated with low back pain (LBP), but the association between MC and health-related quality of life (HRQoL) is poorly understood. The aim of this study was to assess the relationship between MC and HRQoL among patients referred to spine surgery. Methods The study population consisted of 181 patients referred to lumbar spine surgery in Northern and Eastern Finland between June 2007 and January 2011. HRQoL was assessed using RAND-36 health survey. Lumbar MC were evaluated and classified into 'No MC', 'Type I' (Type I or I/II), and 'Type II' (Type II, II/III or III). Results In total, 84 patients (46%) had MC. Of these, 37% had 'Type I' and 63% 'Type II'. Patients with MC were older, more likely females, had longer duration of LBP and a higher degree of disc degeneration than patients without MC. The total physical component or physical dimensions did not differ significantly between the groups. The total mental component of RAND-36 (P = 0.010), and dimensions of energy (P = 0.023), emotional well-being (P = 0.012) and emotional role functioning (P = 0.016) differed significantly between the groups after adjustments for age and gender. In the mental dimension scores, a statistically significant difference was found between 'No MC' and 'Type II'. Conclusions Among patients referred to spine surgery, MC were not associated with physical dimensions of HRQoL including dimension of pain. However, 'Type II' MC were associated with lower mental status of HRQoL. Implications Our study would suggest that Type II MC were associated with a worse mental status. This may affect the outcome of surgery as it is well recognized that patients with depression, for instance, have smaller improvements in HRQoL and disability. Thus the value of operative treatment for these patients should be recognized and taken into consideration in treatment. Our study shows that MC may affect outcome and thus clinicians and researchers should be cognizant of this and take this into account when comparing outcomes of surgical treatment in the future. A longitudinal study would be needed to properly address the relationship of MC with surgical outcome.

Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11-13 years.

UNLABELLED: INTRODUCTION AND MATERIALS: We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; failed back syndrome after one to five discectomies; and failed back syndrome after one to three laminectomy operations (groups 1-4, respectively). METHODS: They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated. RESULTS: The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1%. The reoperation rate was 15.1% (7.5% due to adjacent segment disease). CONCLUSION: Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0%, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0%. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for >80% of patients, but varied among groups.

Missed Achilles tendon rupture due to oral levofloxacin: surgical treatment and result.

We describe a case of a 60-year-old male patient who was treated with oral levofloxacin. The patient sustained a total subcutaneous rupture of the left Achilles tendon which was not diagnosed for at least 5 months. Surgical treatment was successful.

Simple end-to-end suture versus augmented repair in acute Achilles tendon ruptures: a retrospective comparison in 98 patients.

We retrospectively compared the results in 98 patients with an acute Achilles tendon rupture treated with an augmented tendon repair (n = 59) to patients with an end-to-end suture (n = 39) after an average follow-up of 44 (22-69) months. 7 patients were operated on more than 2 weeks after the rupture, all with augmention. The complication rates in the augmention group were 0.1 and in the end-to-end suture group 0.2. We found no differences in subjective outcome or rerupture rate between the groups. In the augmentation group, the rate of complications was higher in those operated on after 2 weeks than in those operated on before. A simple end-to-end suture seems sufficient.