Jounal review JBJS OCT 2011

Dr Kanthi Kiran G
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Duration of Symptoms Resulting from Lumbar Click to edit Master subtitle style Disc Herniation: Effect on Treatment Outcomes: Analysis of the Spine Patient Outcomes Research Trial (SPORT)

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Thomas Jefferson University Hospital

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One Medical Center Drive, Lebanon

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ARTICLE IS A CONTINUATION OF

SPORT study trial I study at 13 centres in USA at 2 centres

Level

Done

Compiled
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Inclusion
>18yr

age (no cut off age?)

6wk

duration of

Radiculopathy Deficit Signs of nerve root tension L2 level and below herniation
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Exclusion
Previous

surgery

Deformity Deficit Cauda

progressive equina

Malignancy 3/5/12

Other spine diseases

Number
927 265

=> <6months duration => >6months duration

groups group group

Randomised

Observational
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Randomised group
Computer

generated treatment

No

bias factor eliminated

Surgeon

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Observational group
Pt

and surgeon decide treatment choice over to treatment modality high in this group

Cross

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Treatment modalities
Opeartive
Discectomy Post open approach

Non

operative

Physical therapy Home based exercises NSAID

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Analysis
SF

36 (ODI) BOTHERSOMENESS SCALE

MODEMS

SCIATICA

(0-24)
LBP

BOTHERSOMENESS SCALE (0-6)

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MAXIMUM

OPERATIVE (181*/607/788) difference in sf36 scores betwn 2 groups with <6mths having 1yr outcomes better (both operated/non operated) 4YR outcomes also show difference

Significant

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Confusing

staistics

But

tables show that significant difference in out comes between operated groups and non operative groups

measures like SF36 & ODI provide objective analysis of results 3/5/12

Primary

Conlusion from article

Duration

of symptoms has significant role in outcome of IVDP management secondary measures like SBC/LBPBI etc had also better results if symptoms <6months

The

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drawbacks
Significant

cross over to operative group during trial period level disk pts???

Multiple

Level/site/type

of herniation ===== scope for varied symptoms

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Previous SPORT trials

Surg

v/s non operative: 4YR OUTCOME

MANY CONFOUNDING FACTORS

Duration Type Intent to treat

But it concluded operative has better

outcome

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Used same parameters to assess

MLSS (1yr & 5yr follow up studies) Level 1

Duration

of symptoms has significant impact on outcome methods include

Nonoperative

Physical therapy Home exercises Opiods NSAIDS

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Sciatica bothersome index

leg

pain; or tingling in leg, foot, or in leg or foot;

numbness

groin;
weakness back

or leg pain while sitting (pain while walking for patients with stenosis).

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LBP BOTHERSOMENESS SCALE

bothersomeness

(0 = not bothersome to 6 = extremely bothersome) of back and leg symptoms.

The Maine Lumbar Spine Study, Part II: 1-Year Outcomes of Surgical and Nonsurgical Management of Sciatica

SPINE 1996
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What can we learn from this study?

Use

the bothersomeness indices to assess pts need for treatment a cut off for surgical intervention

Formulate

pt about importance of exercises, and the need for surgery if symptoms persist 3/5/12

Counsel

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