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Europa Medicophysica 2003 December;39(4):171-9

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Does failed spine surgery affect the outcomes from rehabilitation of chronic low back pain?

Rainville J. 1, 2, Sobel J. 3, Hartigan C. 1, 2

1 The Spine Center New England Baptist Hospital, Boston, MA, USA 2 Department of Physical Medicine and Rehabilitation Medicine Harvard Medical School, Boston, MA, USA 3 Physiatry Medical Group, Menlo Park, CA, USA


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Aim. The pur­pose of ­this ­study ­was to deter­mine if a his­to­ry of ­failed sur­gery affect­ed phys­i­cal impair­ments, ­self-report­ed dis­abil­ity, ­mood dis­tur­bance ­and ­pain inten­sity meas­ured ­before ­and ­after spi­nal reha­bil­i­ta­tion.
Methods. This pros­pec­tive, obser­va­tion­al ­study com­par­ing mul­ti­ple char­ac­ter­is­tics ­and out­comes ­between sub­jects ­with ­and with­out ­spine sur­gery under­go­ing reha­bil­i­ta­tion in a hos­pi­tal affil­i­at­ed ­spine reha­bil­i­ta­tion cen­ter. Back ­and ­leg ­pain ­were meas­ured ­using vis­u­al ana­log ­scales, dis­abil­ity ­with ­the Oswestry dis­abil­ity ­scale ­and depres­sion ­with ­the Beck’s depres­sion inven­to­ry at eval­u­a­tion, ­and at 3 ­and 12 ­months ­using ­mailed ques­tion­naires. Physical meas­ures of ­trunk flex­ibil­ity, ­straight ­leg rais­ing, ­back ­strength, lift­ing abil­ity ­and low­er extrem­ity ­work per­for­mance ­were meas­ured ­prior to ­and fol­low­ing reha­bil­i­ta­tion. Aggressive quo­ta-­based exer­cis­es ­were ­used to ­address impair­ments in ­back func­tion ­and ­were deliv­ered in ­either ­group or indi­vid­u­al phys­i­cal ther­a­py set­tings. χ2 ­and “t”-­tests ­were ­used ­for sta­tis­ti­cal anal­y­ses. Attempts to con­trol ­for dif­fer­enc­es in char­ac­ter­is­tics ­between ­groups ­were ­done ­using anal­y­ses of var­i­ance mod­els.
Results. One-hun­dred ­and twen­ty-­two con­sec­u­tive chron­ic ­low ­back ­pain sub­jects com­plet­ing ­spine reha­bil­i­ta­tion. Eighty-­four sub­jects ­did ­not ­have a his­to­ry of ­prior ­spine sur­gery. They ­were com­pared to 38 ­with a ­prior sur­gi­cal his­to­ry includ­ing 15 ­with spi­nal ­fusions ­and 23 ­with decom­pres­sions. Prior sur­gery sub­jects pre­sent­ed ­with high­er ­leg ­pain inten­sity ­and ­more fre­quent­ly ­received ­workers’ com­pen­sa­tion ­when com­pared to sub­jects with­out ­prior sur­gery. Most oth­er char­ac­ter­is­tics ­were sim­i­lar. Following reha­bil­i­ta­tion, ­those ­with ­prior sur­gery dem­on­strat­ed slight­ly ­less ­trunk flex­ion, oth­er­wise sim­i­lar improve­ments in phys­i­cal meas­ures ­were not­ed. Subjects with­out ­prior sur­gery dem­on­strat­ed a reduc­tion of ­pain symp­toms at 3 ­and 12 ­month fol­low-up, ­but ­those ­with ­prior sur­gery ­did ­not. Depression ­improved equal­ly in ­both ­groups. Disability ­also ­improved in ­both ­groups ­but ­less so in ­those ­with ­prior sur­gery. This dif­fer­ence in dis­abil­ity result­ed ­from high­er ­back ­pain lev­els in ­the ­prior sur­gery ­group.
Conclusion. Aggressive reha­bil­i­ta­tion ­efforts ­improve impair­ments in ­back func­tion, depres­sion ­and dis­abil­ity in ­most sub­jects ­with chron­ic ­low ­back ­pain, ­but ­are ­less suc­cess­ful in reduc­ing ­pain symp­toms in ­those ­with ­failed ­prior ­spine sur­gery.

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