Jounal Review

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Jounal review

JBJS OCT 2011

Dr Kanthi Kiran G


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Duration of Symptoms

Resulting from LumbarDisc Herniation: Effect

on TreatmentOutcomes:

Analysis of the SpinePatient Outcomes

Research Trial (SPORT)


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Thomas Jefferson

University Hospital

One Medical CenterDrive, Lebanon


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ARTICLE IS ACONTINUATION OF

SPORT study trial

Level I study

Done at 13 centres in USA

Compiled at 2 centres


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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 progressive

Cauda equina

Malignancy

Other spine diseases


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Number

927 => >6months duration

2 groups

Randomised group

Observational group


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Randomised group

Computer generated treatment

No biasSurgeon factor eliminated


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Observational group

Pt and surgeon decide treatmentchoice

Cross over to treatment modalityhigh in this group


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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

MODEMS (ODI)

SCIATICA BOTHERSOMENESS SCALE(0-24)

LBP BOTHERSOMENESS SCALE (0-6)


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MAXIMUM OPERATIVE(181*/607/788)

Significant difference in sf36 scoresbetwn 2 groups with


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Confusing staistics

But tables show that significantdifference in out comes betweenoperated groups and non operative

groups

Primary measures like SF36 & ODI

provide objective analysis of results


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Conlusion from article

Duration of symptoms hassignificant role in outcome of IVDPmanagement

The secondary measures like

SBC/LBPBI etc had also better resultsif symptoms


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Previous SPORT trials

Surg v/s non operative: 4YROUTCOME

MANY CONFOUNDING FACTORS Duration

Type

Intent to treat

But it concluded operative has betteroutcome

Used same parameters to assess


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MLSS (1yr & 5yr followup studies) Level 1

Duration of symptoms hassignificant impact on outcome

Nonoperative methods include

Physical therapy

Home exercises

Opiods

NSAIDS


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Sciatica bothersomeindex

leg pain;

numbness or tingling in leg, foot, or

groin;weakness in leg or foot;

back or leg pain while sitting (pain

while walking for patients withstenosis).


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LBP BOTHERSOMENESSSCALE

bothersomeness (0 = notbothersome to 6 = extremelybothersome) of back and legsymptoms.

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 fromthis study?

Use the bothersomeness indices toassess pts need for treatment

Formulate a cut off for surgicalintervention

Counsel pt about importance ofexercises, and the need for surgery if

symptoms persist


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