The spine journal : official journal of the North American Spine Society
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Of the three broad outcome domains of body functions and structures, activities, and participation (eg, engaging in valued social roles) outlined in the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), it has been argued that participation is the most important to individuals, particularly those with chronic health problems. Yet, participation is not commonly measured in back pain research. ⋯ It is important that outcome measures of participation are included in back pain research to gauge the effects of painful spinal conditions and interventions on maintaining valued social roles. A simple, concise measure would be very useful for this purpose in clinical and research settings. The results of this study support the construct validity of the 5-Item PDI as a brief measure of participation in people with chronic back pain. These findings are likely most applicable to those with chronic back pain attending pain clinics and other tertiary centers for care.
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Neoplastic spinal instability is movement-related pain or neurologic compromise under physiologic loads with the Spinal Instability Neoplastic Score (SINS) developed to facilitate diagnosis. There is a paucity of evidence that mechanical instability correlates with patient-reported symptoms and that surgical stabilization significantly improves these patient-reported outcomes (PROs). ⋯ Patient-related outcome-based validation of SINS confirms this scoring system for diagnosing neoplastic spinal instability and provides surgeons with a tool to determine which patients will benefit from stabilization. Surgical stabilization of cancer patients with SINS consistent with mechanical instability provides significant reduction in pain and improves patient mobility independent of neurologic status and stabilization technique.
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Because of the limited and confidential nature of most legal data, scarce literature is available to physicians about reasons for litigation in spine surgery. To optimally compensate patients while protecting physicians, further understanding of the medicolegal landscape is needed for high-risk procedures such as spine surgery. Based on these, surgeons can explore ways to better protect both their patients and themselves. ⋯ Spine surgeons successfully defended themselves in 75% of lawsuits, although the cases won by physicians lingered significantly longer than those settled. Better understanding of these cases may help surgeons to minimize litigation. More than one third of cases involved a claim of insufficient informed consent. Surgeons can protect themselves and optimize care of patients through clear and documented patient communication, education, and intraoperative vigilance to avoid preventable complications.
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Although many risk factors are known to contribute to the development of a postoperative surgical site infection (SSI) following spinal surgery, little is known regarding the costs associated with the management of this complication, or the predictors for which patients will require increased resources for the management of SSI. ⋯ Preoperative nutritional status assessment and MRSA colonization screening with targeted prophylaxis represent potentially modifiable risk factors in the treatment of SSI. Further study is needed to investigate the relationship between poor nutrition status and increased length of stay and total costs in the treatment of SSI following spine surgery.
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Even though catastrophizing can negatively moderate the outcome of surgery for lumbar spinal stenosis (LSS), it is still unclear whether pain catastrophizing is an enduring stable or a dynamic structure related to pain intensity after spine surgery. ⋯ The present study shows that pain catastrophizing can change in association with the improvement in pain intensity after spine surgery. Therefore, catastrophizing may not be an enduring stable construct, but a dynamic construct.