The effect of previous low back surgery on general health status: results from the National Spine Network initial visit survey of patients with low back pain.

STUDY DESIGN: A cross-sectional study on 18,325 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 to April 2000. OBJECTIVES: To examine whether patients who had previous low back surgeries had poorer general health status than patients with no surgery. SUMMARY OF BACKGROUND DATA: Several studies have described the role of psychological abnormalities in patients with chronic low back pain. Some of these patients have had previous spinal surgeries performed. No study has examined the effects of previous low back surgery on the general health status. METHODS: The Short Form Health Survey 36 was administered to the initial visit NSN patients. Of the 18,325 patients enrolled, 3,632 had previous low back surgeries. RESULTS: Patients who had previous lumbar surgeries fared significantly poorly in all 10 scores of the SF-36 health survey, even after adjustment for confounding factors. Among these patients, decompression achieved significantly higher scores for General Health, Role-Physical, and Mental Component Summary scales. Patients who had decompression as their most recent surgery had higher scores for General Health, Role-Physical, Role-Emotional, and Mental Component Summary scales, when compared to those who had other surgeries. Patients who had instrumentation as their most recent surgery had higher scores for Bodily Pain and Physical Component Summary scores. There is a positive correlation between time since last surgery and the SF-36 outcomes. CONCLUSIONS: Previous back surgery is associated with significantly worse general health status than those without surgery. Among patients who had previous surgeries, decompression seems to exert better effects on SF-36 health status. There is a positive correlation between time since last surgery and the SF-36 outcomes, although the SF-36 scores are significantly lower than those without previous surgery.

Induction of bone ingrowth from acetabular defects to a porous surface with OP-1.

Reliable ingrowth of bone into porous-coated cementless total hip components can be expected in primary surgery. In the revision scenario, however, bone deficiency frequently is encountered and the remaining bone may have less ingrowth potential. Allograft bone and bone graft substitutes may be successful in healing bone defects, but have virtually no capacity to induce bone growth from the defect into the porous surface. To evaluate the role osteoinductive bone proteins may play in enhancing bone ingrowth, six canines had bilateral total hip arthroplasties with a cementless press-fit porous-coated acetabular component. A defect 8 mm in diameter and 5 mm in depth was created in the superior weightbearing area of each acetabulum. One defect in each animal was filled with recombinant human osteogenic protein-1. Each contralateral defect was filled with allograft bone, left empty (defect healing control), or no defect was created (intact) to serve as a control for ideal conditions for bone ingrowth. The osteogenic protein-treated defects healed more completely than allograft bone-treated or empty defects and achieved a bone density equivalent to the intact acetabulum. Bone ingrowth also occurred to a significantly higher degree in the osteogenic protein group compared with the allograft or empty defects achieving a degree of ingrowth equivalent to the intact acetabulum controls. The osteogenic bone protein was successful in achieving complete defect healing and inducing extensive ingrowth from the defect into the adjacent porous coating.

Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating.

The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.

Do worker's compensation patients with neck pain have lower SF-36 scores?

Poorer outcomes of treatment are reported in patients with spinal disorders who receive worker's compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between worker's compensation and SF-36 health status of patients with neck pain. The aim of our study was to compare the self-perceived health status of patients with neck pain receiving worker's compensation, with that of patients not receiving worker's compensation. A cross-sectional study was conducted on 2356 patients with neck pain who were evaluated at the 27 centers comprising the National Spine Network, between January 1998 and April 2000. The outcome measures used were the eight individual and two component scores of the SF-36 health survey. Of the 2356 patients, 171 (7%) were receiving worker's compensation. Bivariate analyses revealed seven individual scores (except General Health) and two summary scores of the SF-36 were significantly lower in patients receiving worker's compensation. After controlling for confounding covariates, worker's compensation status was a significant predictor of lower SF-36 scores for Physical Functioning ( P<0.05). The results of this study indicate that worker's compensation status is associated with poorer Physical Functioning in patients presenting with neck pain. Another significant finding of the study is that confounding factors can exert major effects on the SF-36 scores obtained on normal validated instruments.