Abstract
Eighty-five patients were followed up for more than 5 years after an anterior low-back fusion which was performed for a chronically painful low-back condition. The mean age of the patients at the time of the index operation was 35 years, the mean duration of their symptoms was 8 years, and 50 (59%) had undergone previous low-back surgery. Preoperatively the patients were on average severely disabled according to the Oswestry scale, and the self-rated improvement at the follow-up on average 7.4 years after surgery was significant, the mean index being 24%. In 29 (34%) patients, the Oswestry index was 10% or below, reflecting none or very little discomfort as a result of the surgery. In all age groups, women had better results than men. The best outcome was found in patients with no previous low-back surgery. Half of the patients returned to work. Thirteen patients needed new surgery because of nonunion. The use of transpedicular fixation did not produce better results. The sense of coherence scale assessing the patient's successful coping capability had a very good predictive value in the whole series, and this predictive value was especially good in patients between 35 and 50 years of age. Also, the shorter duration of symptoms was an important predictor of a successful outcome, and the end results in patients who had a longer duration of preoperative low-back symptoms tended to be poor.
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References
Alaranta H (1985) Factors defining impairment, disability and hancicap in a population of patients examined one year following surgery for lumbar disc herniation. Publications of the Social Insurance Institution, Finland 25:1–161
Allan DB, Waddell G (1989) An historical perspective on low back pain and disability. Acta Orthop Scand Suppl 60 (234):1–23
Antonovsky A (1987) Unravelling the mystery of health. Jossey-Bass, San Francisco
Antonovsky A (1993) The structure and properties of the sense of coherence scale. Soc Sci Med 36:725–733
Antonovsky A (1993) Complexity, conflict, chaos, coherence, coercion and civility. Soc Sci Med 37:969–981
Antonovsky H, Sagy S (1986) The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol 126:213–225
Blumenthal SL, Baker J, Dossett A, Selby DK (1988) The role of anterior lumbar fusion for internal disc disruption. Spine 13:566–569
Cameron AJR, Shepel LF (1983) Psychological assessment. In: Kirkaldy-Willis WH (ed) Managing low back pain. Churchill Livingstone, New York, pp 63–73
Chow SP, Leong JCY, Ma A, Yau ACM (1980) Anterior spinal fusion for deranged lumbar intervertebral disc. A review of 97 cases. Spine 5:452–458
Estlander AM (1991) Assessment and treatment of chronic low back pain patients. Research Reports of the Rehabilitation Foundation, Helsinki 25:1–57
Fairbanks JCT, Couper J, Davies JB, O'Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Flynn JC, Hoque MA (1979) Anterior fusion of the lumbar spine. J Bone Joint Surg [Am] 61:1143–1149
Gallon RL (1989) Perception of disability in chronic back pain patients: a long-term follow up. Pain 37:67–75
Gaskin ME, Greene AF, Robinson ME, Geisser ME (1992) Negative affect and the experience of chronic pain. J Psychosom Res 36:707–713
Grönblad M, Weinstein A, Santavirta S (1991) Immunohistochemical observations on spinal tissue innervation. A review of hypothetical mechanisms of back pain. Acta Orthop Scand 62:614–622
Härkäpää K, Järvikoski A, Mellin G, Hurri H, Luoma J (1991) Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study. Pain 46:35–41
Heliövaara M (1988) Epidemiologicy of sciatica and herniated lumbar intervertebral disc. Publications of The Social Insurance Institution, Finland 76:1–115
Jensen I (1993) Non-specific spinal pain. Multidisciplinary intervention, a cognitive-behavioural approach. Ph D thesis, Stockholm
Jensen I, Nygren Å, Gamberale F, Goldie I, Westerholm P (1994) Coping with long-term musculoskeletal pain and its consequences: is gender a factor? Pain 57:167–172
Keefe FC, Brown GK, Wallston KA, Caldwell DS (1989) Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy. Pain 37:51–56
Keefe FJ, Beckham JC, Fillingim RB (1991) The psychology of chronic back pain. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, New York, pp 185–197
Langius A, Björvell H, Antonowsky A (1992) The sense of coherence concept and its relation to personality traits in Swedish samples. Scand J Caring Sci 6:165–171
Loguidice VA, Johnson RG, Guyer RD, Stith WJ, Ohnmeiss DD, Hochschuler SH, Rashbaum RF (1988) Anterior lumbar interbody fusion. Spine 13:366–369
Manniche C, Asmussen K, Lauritzen B, Vinterberg H, Kreiner S, Jordan A (1994) Low back pain rating scale: validation of a tool for assessment of low back pain. Pain 57:317–326
Nachemson AL (1991) Spinal disorders. Overall impact on society and the need for orthopedic resources. Acta Orthop Scand Suppl 62 (241):17–22
Nachemson AL (1992) Newest knowledge of low-back pain. Clin Orthop 279:8–20
O'Brien JP, Dawson MHO, Heard CW, Momberger G, Speck G, Weatherly CR (1986) Simultaneous combined anterior and posterior fusion. A surgical solution for failed spinal surgery with a brief review of the first 150 patients. Clin Orthop 203:191–195
O'Farrell V, Tate N, Aitken C (1993) Attitudes and prognosis in chronic low back pain. J Psychosom Res 37:415–422
Pearce S (1983) A review of cognitive-behavioural methods for the treatment of chronic pain. J Psychosom Res 27:431–440
Santavirta S, Konttinen YT (1991) Lumbar spine: studies on pathobiology, clinical examination and surgical treatment. Curr Opin Orthop 2:206–211
Santavirta S, Tallroth K, Konttinen YT (1992) Spinal anomalies and developmental disturbances. Curr Opin Orthop 3:199–203
Sievers K, Klaukka T (1991) Back pain and arthrosis in Finland. How many patients by the years 2000? Acta Orthop Scand Suppl 62 (241):3–5
Stratford P, Solomon P, Binkley J, Finch E, Gill C (1993) Sensitivity of sickness impact profile items to measure change over time in a low-back pain patient group. Spine 18:1723–1727
Viikari-Juntura E, Vuori J, Silverstein BA, Kalimo R, Kuosma E, Videman T (1991) A life-long prospective study on the role of psychooocial factors in neck-shoulder and low-back pain. Spine 16:1056–1061
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Santavirta, N., Björvell, H., Konttinen, Y.T. et al. Sense of coherence and outcome of anterior low-back fusion A 5- to 13-year follow-up of 85 patients. Arch Orthop Trauma Surg 115, 280–285 (1996). https://doi.org/10.1007/BF00439054
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DOI: https://doi.org/10.1007/BF00439054