Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.

BACKGROUND: Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. PURPOSE: To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. STUDY DESIGN: A single-center, two-arm, randomized controlled trial PATIENT SAMPLE: One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. OUTCOME MEASURES: Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2 days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2 days and 3 and 6 months after surgery. METHOD: Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen.

Purpose To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. Methods A multidisciplinary working group formulated recommendations based on the GRADE approach. Results Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general beneficial effects of training on general health, even though there was no evidence on an effect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the beneficial effect. Conclusion The recommendations are based on low to very low quality of evidence or professional consensus as well as patient preferences and positive or harmful effects of the intervention. The true treatment effect may therefore be different from the estimated effects, which is why the results should be interpreted with caution. The working group recommends intensified research in relation to all aspects of management of lumbar spinal stenosis. Graphical abstractThese slides can be retrieved under Electronic Supplementary Material. Key points 1. A multidisciplinary work group developed a Danish national clinical guideline for non-surgical and surgical treatment in patients over 65 years of age with lumbar spinal stenosis 2. The recommendations were all based on either weak evidence or professional consensus. 3. High-quality RCTs on all aspects of treatment of lumbar spinal stenosis are needed to move the field of research forward. Rousing R, Krüger Jensen R, Fruensgaard S, Strøm J, Brøgger HA, Degn JDM, Andersen MO (2019) Danish National Clinical Guidelines for surgical and non-surgical treatment of patients with lumbar spinal stenosis. Eur Spine J; PICO questionsShould patients with lumbar spinal stenosis be: 1. advised to supervised exercise rather than usual care? 2. offered spinal manual therapy as compared to usual care? 3. be offered paracetamol rather than no treatment with pain medication? 4. offered non-steroidal anti-inflammatory medicine (NSAID) rather than no pain medication? 5. offered opioids in addition to treatment with non-opioid pain medication? 6. offered muscle relaxants in addition to treatment with weak pain medication? 7. offered medication for neurogenic pain in addition to treatment with weak pain medication? 8. offered surgical decompression in case of insufficient effect of non-surgical treatment? 9. offered stabilization procedure (with or without instrumentation) in addition to decompression? 10. offered supervised exercise following surgery for lumbar spinal stenosis rather than no supervision?Rousing R, Krüger Jens...