Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS).

BACKGROUND: Previous studies indicated that about 20% of the individuals undergoing back surgery are unable to return to work 3 months to 1 year after surgery. The specific factors that predict individual trajectories in postoperative pain, recovery, and work resumption are largely unknown. The aim of this study is to identify modifiable predictors of work resumption after back surgery. METHODS: In this multisite, prospective, longitudinal study, 300 individuals with radicular pain undergoing a lumbar decompression will be followed until 1-year post-surgery. Prior to surgery, participants will perform a computer task to assess fear of movement-related pain, avoidance behavior, and their generalization to novel situations. Before and immediately after surgery, participants will additionally complete questionnaires to assess fear of movement-related pain, avoidance behavior, optimism, expectancies towards recovery and work resumption, and the duration and severity of the pain. Six weeks, 3 months, 6 months, and 12 months after surgery, they will again complete questionnaires to assess sustainable work resumption, pain severity, disability, and quality of life. The primary hypothesis is that (generalization of) fear of movement-related pain and avoidance behavior will negatively affect sustainable work resumption after back surgery. Second, we hypothesize that (generalization of) fear of movement-related pain and avoidance behavior, negative expectancies towards recovery and work resumption, longer pain duration, and more severe pain before the surgery will negatively affect work resumption, pain severity, disability, and quality of life after back surgery. In contrast, optimism and positive expectancies towards recovery and work resumption are expected to predict more favorable work resumption, better quality of life, and lower levels of pain severity and disability after back surgery. DISCUSSION: With the results of this research, we hope to contribute to the development of strategies for early identification of risk factors and appropriate guidance and interventions before and after back surgery. Trial registration The study was preregistered on ClinicalTrials.gov: NCT04747860 on February 9, 2021.

The importance of being a spinal neurosurgeon: evaluation of spinal surgery in Belgium between 2000 and 2005 and the creation of the Belgian Neurosurgical Spine Society.

BACKGROUND: As the scope of neurosurgical spinal operations has broadened widely, spinal neurosurgery is certainly the one of the fields of neurosurgery where the most changes are observed. Increasing health costs and an aging population will make this issue even more crucial in the future. METHODS: We reviewed the number of spinal procedures performed by neurosurgeons in Belgium between 2000 and 2005. During this period, the number of lumbar spinal operations for degenerative spinal diseases has increased by 20%, reaching more than 23,000 operations per year, among which 77% were decompressive surgeries, 43% posterior fusions, and 50% anterior fusions, all done by neurosurgeons. The neurosurgical prevalence is even more striking in cervical or intradural procedures. CONCLUSION: As a result we created a neurosurgical spine society to represent neurosurgeons who were otherwise almost absent from the political decision-making processes. These observations, not unique to Belgium, should encourage colleagues to play a pivotal role in all spine-related discussions with healthcare providers, state or private, to get involved in teaching spinal surgery, and to participate in clinical and laboratory research leading to the publications that are essential to put forward the contribution of neurosurgeons in spinal surgery.

Translumbar thrombin embolization of an aortic pseudoaneurysm complicating lumbar disk surgery.

We report a case of translumbar embolization of an aortic pseudoaneurysm complicating lumbar disk surgery. The iatrogenic pseudoaneurysm was initially treated by open repair, but due to failure of this treatment, we opted for direct translumbar thrombin injection under computed tomography (CT) guidance. The patient recovered completely, and follow-up CT scans showed progressive shrinkage of the residual retroperitoneal hematoma. This minimally invasive treatment should be considered in selected cases as a valuable treatment option for pseudoaneurysms that arise from the aorta.