Work Status as a Predictor of Surgical Outcome of Discogenic Low Back Pain

Anderson, Paul A.; Schwaegler, Paul; Cizek, Deborah; Leverson, Glen

doi:10.1097/01.brs.0000239180.14933.b7

Cited by 57 publications

(73 citation statements)

References 30 publications

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“…Actually, relief of low back pain and recovery of function after treatment are dependent on various factors such as psychological state, worker's education and age, job satisfaction, economic statement, worker's compensation, and the employer-employee relationship. 2) In our study, high resumption rate was proven by TLIF even in patients who could not work at the time of operation. Various factors are thought to influence this result.…”

Section: Discussionsupporting

confidence: 48%

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

Takahashi

Hanakita

Minami

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The clinical outcome and resumption of work were investigated in 21 patients with lumbar discogenic pain (15 males and 6 females, mean age 37.2 years), who failed to respond to intensive conservative therapy, treated by transforaminal lumbar interbody fusion (TLIF) augmented with the pedicle screw system from January 2005 to December 2007. Perioperative assessment was performed using the modified Japanese Orthopaedic Association (mJOA) score, the Oswestry Disability Index, and the visual analogue scale (VAS). Type of occupation and work status of the patients were also assessed before and after surgery. Preoperative occupation was divided into two groups according to the work content (heavy labor vs. light labor). Follow-up period was mean 26.1 months, and greater than 1 year in all patients. Perioperative assessment showed postoperative improvement with statistical significance. Recovery rates at final follow-up examination were 53% of the mJOA score and 65% of the VAS. This study showed that postoperative overall resumption rate was 90%. However, only 23% of the heavy labor group returned to the previous work compared with 71% of the light labor group. TLIF is thought to be a safe and effective technique in patients with intractable chronic lumbar discogenic pain with an acceptable overall work resumption rate, whereas complete return to previous jobs was limited in the heavy labor group.

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Section: Discussionsupporting

confidence: 48%

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

Takahashi

Hanakita

Minami

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…1,3,8,10,11,25 Some of these factors characterized smokers in our study. Furthermore, consistent with other studies, our previous analysis has demonstrated that being a smoker is associated with poor disability outcomes following lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 58%

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

Asher

Devin

McCutcheon

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEIn this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration.METHODSA total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present.RESULTSIn total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients’ smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients’ propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers.CONCLUSIONSUsing a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

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“…Presurgical screening have been successful in establishing the relationship between particular psychological (12)(13)(14)(15)(16) and social (4,10,(17)(18)(19) issues with clinical outcomes and patient satisfaction. Different risk factors were identified to independently impact surgical outcomes: work compensation (10,17,18,20), lifestyle factors (21), expectations (22)(23)(24), depression (13,16,25), anxiety (26), substance use and abuse (27,28), and preoperative education (29,30).…”

Section: Original Studymentioning

confidence: 99%

Influence of Psychosocial Distress in the Results of Elective Lumbar Spine Surgery

Amaral

Marchi

Martim³

et al. 2017

The Spine Journal

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Work Status as a Predictor of Surgical Outcome of Discogenic Low Back Pain

Abstract: These results show that patients with chronic low back pain should be encouraged to continue working up until surgery.

Cited by 57 publications

References 30 publications

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

Surgical Outcome and Postoperative Work Status of Lumbar Discogenic Pain Following Transforaminal Interbody Fusion

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

Influence of Psychosocial Distress in the Results of Elective Lumbar Spine Surgery

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