The annual meeting of the North American Spine Society was held from October 25 to 28 in Orlando, Florida, and attracted approximately 5,000 participants from around the world, including orthopedic surgeons, neurosurgeons, neurologists, radiologists, and anesthesiology specialists as well as researchers, physical therapy specialists, and other spine care professionals. The conference featured presentations focused on the latest advances in medical and surgical spine care.
In one study, Neil Manson, M.D., of the Canada East Spine Centre in New Brunswick, and colleagues found that half of patients who showed a high level of pain catastrophization before spine surgery experienced more pain and greater disability and were less likely to be back at work one year post-surgery.
“In our study, greater than one in three patients suffered from pain catastrophizing. While these patients did improve following spine surgery, they were more likely to report postoperative persistent pain, disability, surgical failure, and took longer to return to work. Thus, it is important to consider this component of a patient’s mental health so that we may intervene preoperatively to guide the patient in realizing success postoperatively,” said Manson.
According to Manson, surgeons can begin including pain catastrophizing as a baseline measure and take it under consideration when deciding whether a patient would benefit most from conservative or surgical intervention.
“Our research has the potential to encourage surgeons to consider aspects of psychological wellness in selecting patients most likely to succeed with surgical care,” said Manson. “This also provides an opportunity as surgeons to consider psychological interventions preoperatively for patients who require it.”
In another study, Owoicho Adogwa, M.D., M.P.H., of Rush University Medical Center in Chicago, and colleagues evaluated whether a 24-hour delay in ambulation for patients older than 65 years who underwent elective spinal surgery for the correction of adult degenerative scoliosis would lead to inferior outcomes.
“The results were staggering. Specifically, we found that patients who ambulated within 24 hours had lower rates of cardiopulmonary complications such as deep venous thrombosis and pulmonary embolism,” said Adogwa.
Patients who were considered “early ambulators” had improved outcomes and reduced length of hospital stays and were more likely to be discharged directly to home instead of a skilled nursing facility or rehabilitation facility.
“Hospitals should design processes/programs that encourage early ambulation, which could contribute to improved patient satisfaction and decreased health care resource utilization and costs,” said Adogwa.
Carol A. Mancuso, M.D., of the Hospital for Special Surgery in New York City, and colleagues found that 86 percent of patients who underwent lumbar spine surgery had greater expectations for their own improvement post-surgery than their surgeons had.
“While it is hardly surprising that spine surgeons are better able to accurately predict surgical outcomes, it is the degree to which the predictions diverged that is significant,” Mancuso said in a statement. “Evidently, surgeons and patients need to do a better job of working together to candidly communicate realistic expectations throughout the preoperative and postoperative processes.”
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