Frailty status as a predictor of 3-month cognitive and functional recovery following spinal surgery: a prospective pilot study

Rothrock, Robert J.; Steinberger, Jeremy; Badgery, Henry; Hecht, Andrew C.; Cho, Samuel K.; Caridi, John M.; Deiner, Stacie

doi:10.1016/j.spinee.2018.05.026

Cited by 33 publications

(45 citation statements)

References 27 publications

(31 reference statements)

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“…* * Surgeries were all ACDF confirmed during the study by operative report and postsurgical radiographs. 6 Rehabilitation Research and Practice lumbar spinal stabilizer training combined with behavior or cognitive therapy) was included in several of these studies as behavioral or cognitive training has been shown to help improve recovery from spine surgery [12,37,38]. Given recent motor control studies specify 8 or more weeks necessary to integrate strength changes with spine stabilizers, so that 12 weeks may have not been a long enough follow-up time to see differences between groups [5,10,18].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion

McFarland

Wang-Price

Gordon

et al. 2020

Rehabilitation Research and Practice

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Study Design. Randomized clinical trial. Objectives. Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population. Methods. Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants. Results. There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests. Conclusions. Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion

McFarland

Wang-Price

Gordon

et al. 2020

Rehabilitation Research and Practice

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“…Zudem konnte bei älteren Patienten eine geringere Schmerzlinderung nach lumbaler Wirbelsäulendegeneration festgestellt werden. Interessanterweise zeigte sich in einer Pilotstudie bei gebrechlichen Patienten, die unter dem Begriff "Frailty" zusammengefasst werden, dass sich diese Patienten von der Operation unbefriedigend erholen und über einen Zeitraum von über 3 Monaten relevante mentale und funktionelle Einschränkungen aufweisen [3].…”

Section: Alterunclassified

“…Rothrock et al [3] Schlechtere kognitive Erholung auch über einen Zeitraum von 3 Monaten nach elektiver WS-Operation bei "Frailty".…”

Section: Studie Kernaussageunclassified

Outcome-relevante Faktoren in der Wirbelsäulenchirurgie

Spiegl¹,

Josten²,

Heyde³

2020

Die Wirbelsäule

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Several parameters might influence the outcome after vertebral spine surgeries. In order to find these a systematic literature search was performed. Thereby, a total of 62 articles were selected. All outcome-relevant parameters were categorized into patient-specific, course-specific, and radiologic parameters. Furthermore, scores were included which help to estimate the risk of adverse events and outcome for certain pathologies and/or surgeries. Patient-specific parameters were predominantly the patient age and several specific secondary diagnoses such as diabetes, adipositas, depression, anxiety disorders, and nicotine abuse. Additionally, the patient expectation plays an important role in the subjective outcome assessment. Course-specific parameters are mainly perioperative factors such as surgical experience, particularly in highly demanding vertebral spine surgeries. Furthermore, modern intraoperative equipment such as intraoperative CT and neuromonitoring helps to increase patient safety. The most outcome-relevant radiologic parameters are those which define the sagittal balance. Thereby, a correct sagittal balance is associated with superior clinical outcomes.

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“…While advanced age (>65 years) has been consistently identified as a risk factor for POCD (8, 14), the evidence is less convincing with other potential risk factors due to differences in populations and neurocognitive testing modalities (4, 7). For example, it has long been thought that preexisting frailty in general (15–20), and neurocognitive frailty in particular (9, 21, 22) may be a risk factor for POCD as these patients may be vulnerable to cognitive insults at baseline. Indeed, observational studies have shown that surgery may precipitate further cognitive decline in patients with neurodegenerative disorders such as Alzheimer's disease (AD) (23), and biomarkers of AD such as the apolipoprotein E4 (APOE-4) genotype have also been associated with development of POCD in elderly patients (24, 25).…”

Section: Introductionmentioning

confidence: 99%

The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving From Hypothesis to Treatment

2019

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Postoperative cognitive dysfunction (POCD) is a common complication of the surgical experience and is common in the elderly and patients with preexisting neurocognitive disorders. Animal and human studies suggest that neuroinflammation from either surgery or anesthesia is a major contributor to the development of POCD. Moreover, a large and growing body of literature has focused on identifying potential risk factors for the development of POCD, as well as identifying candidate treatments based on the neuroinflammatory hypothesis. However, variability in animal models and clinical cohorts makes it difficult to interpret the results of such studies, and represents a barrier for the development of treatment options for POCD. Here, we present a broad topical review of the literature supporting the role of neuroinflammation in POCD. We provide an overview of the cellular and molecular mechanisms underlying the pathogenesis of POCD from pre-clinical and human studies. We offer a brief discussion of the ongoing debate on the root cause of POCD. We conclude with a list of current and hypothesized treatments for POCD, with a focus on recent and current human randomized clinical trials.

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Frailty status as a predictor of 3-month cognitive and functional recovery following spinal surgery: a prospective pilot study

Abstract: This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery.

Cited by 33 publications

References 27 publications

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion

Outcome-relevante Faktoren in der Wirbelsäulenchirurgie

The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving From Hypothesis to Treatment

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