Download - Jounal Review
-
8/2/2019 Jounal Review
1/21
Click to edit Master subtitle style
3/5/12
Jounal review
JBJS OCT 2011
Dr Kanthi Kiran G
-
8/2/2019 Jounal Review
2/21
Click to edit Master subtitle style
3/5/12
Duration of Symptoms
Resulting from LumbarDisc Herniation: Effect
on TreatmentOutcomes:
Analysis of the SpinePatient Outcomes
Research Trial (SPORT)
-
8/2/2019 Jounal Review
3/21
Click to edit Master subtitle style
3/5/12
Thomas Jefferson
University Hospital
One Medical CenterDrive, Lebanon
-
8/2/2019 Jounal Review
4/21
3/5/12
ARTICLE IS ACONTINUATION OF
SPORT study trial
Level I study
Done at 13 centres in USA
Compiled at 2 centres
-
8/2/2019 Jounal Review
5/21
3/5/12
Inclusion
>18yr age (no cut off age?)
6wk duration of
Radiculopathy
Deficit
Signs of nerve root tension
L2 level and below herniation
-
8/2/2019 Jounal Review
6/21
3/5/12
Exclusion
Previous surgery
Deformity
Deficit progressive
Cauda equina
Malignancy
Other spine diseases
-
8/2/2019 Jounal Review
7/213/5/12
Number
927 => >6months duration
2 groups
Randomised group
Observational group
-
8/2/2019 Jounal Review
8/213/5/12
Randomised group
Computer generated treatment
No biasSurgeon factor eliminated
-
8/2/2019 Jounal Review
9/213/5/12
Observational group
Pt and surgeon decide treatmentchoice
Cross over to treatment modalityhigh in this group
-
8/2/2019 Jounal Review
10/213/5/12
Treatment modalities
Opeartive
Discectomy
Post open approach
Non operative
Physical therapy
Home based exercises
NSAID
-
8/2/2019 Jounal Review
11/213/5/12
Analysis
SF 36
MODEMS (ODI)
SCIATICA BOTHERSOMENESS SCALE(0-24)
LBP BOTHERSOMENESS SCALE (0-6)
-
8/2/2019 Jounal Review
12/213/5/12
MAXIMUM OPERATIVE(181*/607/788)
Significant difference in sf36 scoresbetwn 2 groups with
-
8/2/2019 Jounal Review
13/213/5/12
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
-
8/2/2019 Jounal Review
14/213/5/12
Conlusion from article
Duration of symptoms hassignificant role in outcome of IVDPmanagement
The secondary measures like
SBC/LBPBI etc had also better resultsif symptoms
-
8/2/2019 Jounal Review
15/21
-
8/2/2019 Jounal Review
16/213/5/12
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
-
8/2/2019 Jounal Review
17/21
3/5/12
MLSS (1yr & 5yr followup studies) Level 1
Duration of symptoms hassignificant impact on outcome
Nonoperative methods include
Physical therapy
Home exercises
Opiods
NSAIDS
-
8/2/2019 Jounal Review
18/21
3/5/12
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).
-
8/2/2019 Jounal Review
19/21
3/5/12
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
-
8/2/2019 Jounal Review
20/21
3/5/12
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
-
8/2/2019 Jounal Review
21/21
3/5/12