Surgical techniques for sciatica due to herniated disc, a systematic review. Jacobs WC, Arts MP, van...

96 Journal Reports / The Spine Journal 13 (2013) 95–97

PMID: 22878599 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/22878599].

Reprinted with permission from: Radcliff K, Hwang R, Hilibrand A,

et al. The effect of iliac crest autograft on the outcome of fusion in

the setting of degenerative spondylolisthesis: a subgroup analysis of

the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg

Am 2012;94(18):1685–92. Available at: http://jbjs.org/article.aspx?

articleid=1262703.

http://dx.doi.org/10.1016/j.spinee.2013.01.007

Comparison between patient and surgeon perception of outcomes of

operations for degenerative spine disease: a prospective blinded

database study. Thaci B, Roitberg BZ, Lam SK, Brown FD, Shen J.

Neurosurgery 2012;71(2):E555.

INTRODUCTION: Patient filled questionnaires, such as Oswestry Dis-

ability Index (ODI) or Neck Disability Index (NDI) have become the main-

stay in evaluation of treatment outcomes in degenerative spine disease

(DSD), replacing result reporting by surgeons. In this study we set to com-

pare patients’ and surgeons’ assessment of spine treatment outcome in

a prospective blinded patient-driven spine surgery outcomes registry.

METHODS: Patients referred to the neurosurgery clinic between 9/8/09

and 11/1/2011 filled out surveys at baseline, at recruitment preoperatively,

and at 3 and 6 months postoperatively. The surgeons were blinded to the

survey content. Pain was rated on a Visual Analog Scale (VAS) from

0–10, while NDI was scored for cervical spine patients and ODI for lumbar

patients. At 3 and 6 months postoperatively, outcome was rated indepen-

dently by patients and surgeons on a 7-point Likert-type scale

RESULTS: 337 patients prospectively enrolled in the database with inten-

tion to treat; 134 (40%) had cervical spine disease, 195 (58%) had lumbar

spine disease and 8 patients (2%) had both. 109 (32%) had outcome ratings

from both the patient and the surgeon in corresponding time frames. We

found that surgeons’ and patients’ ratings correlated strongly (Spearman

rho50.4, ***p!.0001); with 44.6% identical and 86.7% within 61 grade

of each other. Patient rating correlated better with most recent NDI/ODI

and pain score than with the incremental change from the baseline. In

a multivariate analysis, the age of the patient and identity of the surgeon

were the only variables that had significant impact on the ratings’ discrep-

ancy (*p5.02 and *p5.04, respectively).

CONCLUSIONS: We show that patients’ and surgeons’ global outcome

ratings for spinal disease correlate highly with each other. Also, patients’

ratings correlate better with their most recent functional scores rather than

the incremental change from their baseline.

Reprinted with permission from: Thaci B, Roitberg BZ, Lam SK, Brown

FD, Shen J. 137 Comparison between patient and surgeon perception of

outcomes of operations for degenerative spine disease: a prospective

blinded database study. Neurosurgery 2012;71(2):E555.


Is cauda equina syndrome linked with obesity? Venkatesan M,

Uzoigwe CE, Perianayagam G, Braybrooke JR, Newey ML. J Bone

Joint Surg Br 2012;94(11):1551–6.

No previous studies have examined the physical characteristics of patients

with cauda equina syndrome (CES). We compared the anthropometric fea-

tures of patients who developed CES after a disc prolapse with those who

did not but who had symptoms that required elective surgery. We recorded

the age, gender, height, weight and body mass index (BMI) of 92

consecutive patients who underwent elective lumbar discectomy and 40

consecutive patients who underwent discectomy for CES. On univariate

analysis, the mean BMI of the elective discectomy cohort (26.5 kg/m2

(16.6 to 41.7) was very similar to that of the age-matched national mean

(27.6 kg/m2, p51.0). However, the mean BMI of the CES cohort (31.1

kg/m2 (21.0 to 54.9)) was significantly higher than both that of the elective

group (p!.001) and the age-matched national mean (p!.001). A similar

pattern was seen with the weight of the groups. Multivariate logistic re-

gression analysis was performed, adjusted for age, gender, height, weight

and BMI. Increasing BMI and weight were strongly associated with an in-

creased risk of CES (odds ratio (OR) 1.17, p!.001; and OR 1.06, p!.001,

respectively). However, increasing height was linked with a reduced risk of

CES (OR 0.9, p!.01). The odds of developing CES were 3.7 times higher

(95% confidence interval (CI) 1.2 to 7.8, p5.016) in the overweight and

obese (as defined by the World Health Organization: BMI$25 kg/m2) than

in those of ideal weight. Those with very large discs (obstructingO75% of

the spinal canal) had a larger BMI than those with small discs (obstruct-

ing!25% of the canal; p!.01). We therefore conclude that increasing

BMI is associated with CES.

PMID: 23109638 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23109638].

Reproduced from: Venkatesan M, Uzoigwe CE, Perianayagam G, Bray-

brooke JR, Newey ML. Is cauda equina syndrome linked with obesity?

J Bone Joint Surg Br 2012;94(11):1551–6, with permission and copy-

right � of the British Editorial Society of Bone and Joint Surgery.


Surgical techniques for sciatica due to herniated disc, a systematic

review. Jacobs WC, Arts MP, van Tulder MW, et al. Eur Spine J

2012;21(11):2232–51. Epub 2012 Jul 20.

INTRODUCTION: Disc herniation with sciatica accounts for five percent

of low-back disorders but is one of the most common reasons for spine sur-

gery. The goal of this study was to update the Cochrane review on the ef-

fect of surgical techniques for sciatica due to disc herniation, which was

last updated in 2007.

MATERIALS AND METHODS: In April 2011, we conducted a compre-

hensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO,

ICL, and trial registries. We also checked the reference lists and citation

tracking results of each retrieved article. Only randomized controlled trials

(RCT) of the surgical management of sciatica due to disc herniation were

included. Comparisons including chemonucleolysis and prevention of scar

tissue or comparisons against conservative treatment were excluded. Two

review authors independently selected studies, assessed risk of bias of the

studies and extracted data. Quality of evidence was graded according to the

GRADE approach.

RESULTS: Seven studies from the original Cochrane review were in-

cluded and nine additional studies were found. In total, 16 studies were in-

cluded, of which four had a low risk of bias. Studies showed that

microscopic discectomy results in a significantly, but not clinically relevant

longer operation time of 12 min (95% CI 2–22) and shorter incision of 24

mm (95% CI 7–40) compared with open discectomy, but did not find any

clinically relevant superiority of either technique on clinical results. There

were conflicting results regarding the comparison of tubular discectomy

versus microscopic discectomy for back pain and surgical duration.

CONCLUSIONS: Due to the limited amount and quality of evidence, no

firm conclusions on effectiveness of the current surgical techniques being

open discectomy, microscopic discectomy, and tubular discectomy com-

pared with each other can be drawn. Those differences in leg or back pain

scores, operation time, and incision length that were found are clinically

insignificant. Large, high-quality studies are needed, which examine not

only effectiveness but cost-effectiveness as well.

http://www.ncbi.nlm.nih.gov/pubmed/22878599


http://jbjs.org/article.aspx?articleid=1262703

http://jbjs.org/article.aspx?articleid=1262703






97Journal Reports / The Spine Journal 13 (2013) 95–97



Reprinted with permission from: Jacobs WC, Arts MP, van Tulder MW,

et al. Surgical techniques for sciatica due to herniated disc, a systematic

review. Eur Spine J 2012;21(11):2232–51. Epub 2012 Jul 20. Available

at: http://link.springer.com/article/10.1007/s00586-012-2422-9.


The role of fusion in the management of burst fractures of the

thoracolumbar spine treated by short segment pedicle screw

fixation: a prospective randomised trial. Jindal N, Sankhala SS,

Bachhal V. J Bone Joint Surg Br 2012;94(8):1101–6.

The purpose of this study was to determine whether patients with a burst

fracture of the thoracolumbar spine treated by short segment pedicle screw

fixation fared better clinically and radiologically if the affected segment

was fused at the same time. A total of 50 patients were enrolled in a pro-

spective study and assigned to one of two groups. After the exclusion of

three patients, there were 23 patients in the fusion group and 24 in the

non-fusion group. Follow-up was at a mean of 23.9 months (18 to 30).

Functional outcome was evaluated using the Greenough Low Back Out-

come Score. Neurological function was graded using the American Spinal

Injury Association Impairment Scale. Radiological outcome was assessed

on the basis of the angle of kyphosis. Peri-operative blood transfusion re-

quirements and duration of surgery were significantly higher in the fusion

group (p5.029 and p!.001, respectively). There were no clinical or radio-

logical differences in outcome between the groups (all outcomes pO.05).

The results of this study suggest that adjunctive fusion is unnecessary

when managing patients with a burst fracture of the thoracolumbar spine

with short segment pedicle screw fixation.



Reproduced from: Jindal N, Sankhala SS, Bachhal V. The role of fusion in

the management of burst fractures of the thoracolumbar spine treated by

short segment pedicle screw fixation: a prospective randomised trial.

J Bone Joint Surg Br 2012;94(8):1101–6, with permission and copyright �of the British Editorial Society of Bone and Joint Surgery.


The relationship between pain and depressive symptoms after

lumbar spine surgery. Skolasky RL, Riley LH 3rd, Maggard AM,

Wegener ST. Pain 2012;153(10):2092–6. Epub 2012 Aug 3.

Although depressive symptoms are common among those living with back

pain, there is limited information on the relationship between postsurgical

pain reduction and changes in depressive symptoms. The objective of this

prospective cohort study was to examine the change in pain and depressive

symptoms and to characterize the relationship between pain and depressive

symptoms after lumbar spine surgery. We assessed 260 individuals undergo-

ing lumbar spine surgery preoperatively and postoperatively (3 and 6

months) using a pain intensity numeric rating scale and the Patient Health

Questionnaire depression scale. The relationship between change in pain

(a 2-point decrease or 30%reduction from the preoperative level) and depres-

sive symptoms was examined using standard regression methods. Preopera-

tively, the mean pain intensity was 5.2 (SD 2.4) points, and the mean

depressive symptom score was 5.03 (SD 2.44) points. At 3 months, individ-

uals who experienced a reduction in pain (63%)were nomore likely to expe-

rience a reduction in depressive symptoms (odds ratio 1.07, 95% confidence

interval [CI] 0.58 to 1.98) than individuals who experienced no change from

preoperative pain (34%).However, at 6months, individualswho experienced

a reduction in pain (63%) were nearly twice as likely to experience a reduc-

tion in depressive symptoms (odds ratio 1.93, 95% CI 1.15 to 3.25) as those

who experienced no change or an increase in pain (31%).We found thatmost

individuals experienced clinically important reductions in pain after surgery.

We concluded that thosewhosepain levelwas reduced at 6monthsweremore

likely to experience a reduction in depressive symptoms.

Copyright � 2012 International Association for the Study of Pain. Pub-

lished by Elsevier B.V. All rights reserved.



Reprinted from: Skolasky RL, Riley LH 3rd, Maggard AM, Wegener ST.

The relationship between pain and depressive symptoms after lumbar spine

surgery. Pain 2012;153(10):2092–6. Epub 2012 Aug 3. This abstract has

been reproduced with permission of the International Association for the

Study of Pain� (IASP�). The abstract may not be reproduced for any

other purpose without permission.


The sharp slowdown in growth of medical imaging: an early analysis

suggests combination of policies was the cause. Lee DW, Levy F.

Health Aff (Millwood) 2012;31(8):1876–84. Epub 2012 Jul 25.

The growth in the use of advanced imaging for Medicare beneficiaries decel-

erated in 2006 and 2007, ending a decade of growth that had exceeded 6 per-

cent annually. The slowdown raises three questions. Did the slowdown in

growth of imaging underMedicare persist and extend to the non-Medicare in-

sured?What factors caused the slowdown?Was the slowdowngood or bad for

patients?Using claims file data and interviewswith health care professionals,

we found that the growth of imaging use among both Medicare beneficiaries

and the non-Medicare insured slowed to 1–3 percent per year through 2009.

One by-product of this deceleration in imaging growth was a weaker market

for radiologists, who until recently could demand top salaries. The expansion

of prior authorization, increased cost sharing, and other policies appear to

have contributed to the slowdown. A meaningful fraction of the reduction

in use involved imaging studies previously identified as having unproven

medical value. What has occurred in the imaging field suggests incentive-

based cost control measures can be a useful complement to comparative ef-

fectiveness research when a procedure’s ultimate clinical benefit is uncertain.



Copyrighted and published by Project HOPE/Health Affairs as: Lee DW,

Levy F. The sharp slowdown in growth of medical imaging: an early anal-

ysis suggests combination of policies was the cause. Health Aff (Mill-

wood) 2012;31(8):1876–84. Epub 2012 Jul 25.




http://link.springer.com/article/10.1007/s00586-012-2422-9











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