Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant

Crawford, Rebecca J.; Malone, Quentin J.; Price, Roger I.

doi:10.21256/zhaw-4716

Please use this identifier to cite or link to this item: https://doi.org/10.21256/zhaw-4716

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DC Field	Value	Language
dc.contributor.author	Crawford, Rebecca J.	-
dc.contributor.author	Malone, Quentin J.	-
dc.contributor.author	Price, Roger I.	-
dc.date.accessioned	2018-10-08T13:20:54Z	-
dc.date.available	2018-10-08T13:20:54Z	-
dc.date.issued	2017	-
dc.identifier.issn	2397-1789	de_CH
dc.identifier.uri	https://digitalcollection.zhaw.ch/handle/11475/11499	-
dc.description.abstract	Background: Interspinous spacer/implants like the Device for Intervertebral Assisted Motion (DIAM™) are controversially yet commonly used in the surgical treatment of lumbar degenerative pathologies. Criticism is based on ill-defined indications, lack of superiority over decompression, and a poorly understood mechanical effect. Yet, continued use by surgeons implies their perceived clinical merit. We examined radiographic spinal alignment for 12 months, and pain and function for 24 months, after DIAM-augmented surgery to improve the understanding of the mechanical effect relating to clinical outcomes in patients. Methods: We undertook a single-surgeon prospective, longitudinal study of 40 patients (20 F, 20 M) who received DIAM-augmented surgery in treatment of their symptomatic lumbar degenerative condition. Outcomes measured included sagittal spinal alignment (lumbar lordosis, sacral inclination, primary (PDA), supradjacent (SDA) disc angles, and regional sagittal balance (RSB; standing lateral radiographs), and back and leg pain (visual analogue scale; VAS) and function (Oswestry Disability Index; ODI). Responders were identified as those with clinically meaningful improvement to pain (>20%) and function (>15%) at 24 months postoperatively; features of sagittal spinal alignment between responders and non-responders were examined. Results: Sagittal alignment was unchanged at 12 months. At 6 weeks postoperatively, PDA (mean (SD)) reduced by 2.2° (4.0°; p < 0.01) and more-so in back pain non-responders (3.8° (3.2°)) than responders (0.7° (4.4°); p < 0.05). Positive preoperative RSB in responders (26.7Rmm (42.3Rmm); Rmm is a system-relative measure) decreased at 6 weeks (by 3.1Rmm (9.1Rmm)). Non-responders had a negative RSB preoperatively (−1.0Rmm (32.0Rmm)) and increased at 6 weeks (11.2Rmm (15.5Rmm); p < 0.05). Clinically meaningful improvement for the whole cohort for back pain and function were observed to 24 months (back pain: 25.0% (28.0); function: 15.4% (17.6); both p < 0.0001). Conclusions: Unaltered sagittal alignment at 12 months was not related to symptoms after DIAM-augmented lumbar surgery. Subtle early flattening at the index disc angle was not maintained. Preoperative and early post-operative sagittal alignment may indicate response after DIAM-augmented surgery for mixed lumbar pathologies. Further investigation toward defining indications and patient suitability is warranted.	de_CH
dc.language.iso	en	de_CH
dc.publisher	BioMed Central	de_CH
dc.relation.ispartof	Scoliosis and Spinal Disorders	de_CH
dc.rights	Licence according to publishing contract	de_CH
dc.subject	Clinical outcomes	de_CH
dc.subject	DIAM	de_CH
dc.subject	Interspinous implant	de_CH
dc.subject	Low back pain	de_CH
dc.subject	Radiological outcomes	de_CH
dc.subject	Spinal alignment	de_CH
dc.subject.ddc	617.5: Orthopädische Chirurgie	de_CH
dc.title	Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant	de_CH
dc.type	Beitrag in wissenschaftlicher Zeitschrift	de_CH
dcterms.type	Text	de_CH
zhaw.departement	Gesundheit	de_CH
zhaw.organisationalunit	Institut für Public Health (IPH)	de_CH
dc.identifier.doi	10.21256/zhaw-4716	-
dc.identifier.doi	10.1186/s13013-017-0109-z	de_CH
dc.identifier.pmid	28164163	de_CH
zhaw.funding.eu	No	de_CH
zhaw.issue	2	de_CH
zhaw.originated.zhaw	Yes	de_CH
zhaw.publication.status	publishedVersion	de_CH
zhaw.volume	12	de_CH
zhaw.publication.review	Peer review (Publikation)	de_CH
Appears in collections:	Publikationen Gesundheit

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Crawford, R. J., Malone, Q. J., & Price, R. I. (2017). Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant. Scoliosis and Spinal Disorders, 12(2). https://doi.org/10.21256/zhaw-4716

Crawford, R.J., Malone, Q.J. and Price, R.I. (2017) ‘Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant’, Scoliosis and Spinal Disorders, 12(2). Available at: https://doi.org/10.21256/zhaw-4716.

R. J. Crawford, Q. J. Malone, and R. I. Price, “Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant,” Scoliosis and Spinal Disorders, vol. 12, no. 2, 2017, doi: 10.21256/zhaw-4716.

CRAWFORD, Rebecca J., Quentin J. MALONE und Roger I. PRICE, 2017. Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant. Scoliosis and Spinal Disorders. 2017. Bd. 12, Nr. 2. DOI 10.21256/zhaw-4716

Crawford, Rebecca J., Quentin J. Malone, and Roger I. Price. 2017. “Change of Sagittal Spinal Alignment and Its Association with Pain and Function after Lumbar Surgery Augmented with an Interspinous Implant.” Scoliosis and Spinal Disorders 12 (2). https://doi.org/10.21256/zhaw-4716.

Crawford, Rebecca J., et al. “Change of Sagittal Spinal Alignment and Its Association with Pain and Function after Lumbar Surgery Augmented with an Interspinous Implant.” Scoliosis and Spinal Disorders, vol. 12, no. 2, 2017, https://doi.org/10.21256/zhaw-4716.