Study Design.
Retrospective cohort study.
Objective.
The decision to pursue operative intervention for patients with isthmic spondylolisthesis is complex. Although steroid injections are a well-accepted therapeutic modality that may delay or obviate surgery, little is known regarding their ability to predict surgical outcomes.
Summary of Background Data.
Here, we examine whether improvement after preoperative steroid injections can accurately predict clinical outcomes after surgery.
Methods.
A retrospective cohort analysis was performed on adult patients undergoing primary posterolateral lumbar fusion for isthmic spondylolisthesis between 2013 and 2021. Data were stratified into a control (no preoperative injection) group and an injection group (received a preoperative diagnostic and therapeutic injection). We collected demographic data, peri-injection visual analog pain scores (VAS) pain scores, PROMIS pain interference and physical function scores, Oswestry Disability Index, and VAS pain (back and leg). Student t test was utilized to compare baseline group characteristics. Linear regression was performed comparing changes in peri-injection VAS pain scores and postoperative measures.
Results.
Seventy-three patients did not receive a preoperative injection and were included in the control group. Fifty-nine patients were included in the injection group. Of patients who received an injection, 73% had >50% relief of their preinjection VAS pain score. Linear regression revealed a positive interaction between the injection efficacy and postoperative pain relief as measured by VAS leg scores (P<0.05). There was also an association between injection efficacy and back pain relief, though this did not achieve statistical significance (P=0.068). No association was found between injection efficacy and improvement in Oswestry Disability Index or PROMIS measures.
Conclusions.
Steroid injections are often utilized in the nonoperative therapeutic management of patients with lumbar spine disease. Here, we demonstrate the diagnostic value of steroid injections in predicting postoperative leg pain relief in patients undergoing posterolateral fusion for isthmic spondylolisthesis.
Study Design.
Prospective cohort study.
Objective.
This study determined (1) the surgeon accuracy of psychological assessment in patients in spine clinic, (2) the impact of psychological distress on surgical recommendation, and (3) the correlation between patient-reported disability and psychological distress.
Summary of Background Data.
Psychological distress is common among patients presenting for spine surgery. Surgeon estimations of patients? distress may influence treatment recommendations, but little is known as to whether these assessments accurately mirror patient-perceived psychological distress.
Materials and Methods.
A sample of new patients was recruited from an academic spine center. Prior to their initial consultation, patients completed the Modified Somatic Perception Questionnaire and Zung Depression Index to assess mental and physical manifestations of distress, which generated a Distress and Risk Assessment Method (DRAM) score of N (normal), R (at risk), or D (distressed). The Oswestry Disability Index and Neck Disability Index scores were also collected. Surgeons provided their estimates of the DRAM score after the visit and indicated their surgery recommendation.
Results.
Of 296 patients, 40.5% reported some level of psychological distress (DRAM=R) and 15.9% had a high level of distress (DRAM=D). All three surgeons? ability to accurately assess the participant DRAM score was poor, with an overall kappa of 0.13 (0.08?0.18), biased toward underestimating the patient?s true level of psychological distress. Patients rated as normal (N) by the surgeon were 3.78 times more likely to be recommended for surgery compared to those assessed as distressed (D) (P=0.007). Patients with higher DRAM scores had higher Oswestry Disability Index (P=0.008) and Neck Disability Index (P=0.005) scores compared to those with lower DRAM scores.
Conclusions.
Spine surgeons have limited ability to detect psychological profiles in patients, with a tendency to underestimate levels of distress. The finding that these inaccurate assessments influence surgical recommendations underscores the importance of limiting surgeon bias in the decision-making process.
Level of Evidence.
Diagnostic Level 2.
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