Background: No spine-specific educational tool has been developed using input from all relevant stakeholders, including patients. Purpose: The objective of this study was to determine the information needs of lumbar microdiscectomy patients. Methods: Qualitative methods with thematic analysis was used. Focus groups were conducted with: 1) preoperative microdiscectomy patients; 2) postoperative microdiscectomy patients; 3) spine surgeons; 4) spine fellows; 5) orthopaedic surgery residents; 6) anesthesiologists; 7) surgeons’ administrative assistants; and, 8) preoperative assessment team. Results: Major information needs were related to: anesthesia, surgical procedure details and postoperative course. Patients desire information on postoperative course much more than surgeons perceive. Desired attributes of information tools as well as patient factors that influence the extent of information shared by surgeons were determined. Information resources should be given to patients as soon as they are deemed surgical candidates. Conclusions: Microdiscectomy patients desire more information than currently provided to them – in particular postoperative-related information.

Background: No spine-specific educational tool has been developed using input from all relevant stakeholders, including patients. Purpose: The objective of this study was to determine the information needs of lumbar microdiscectomy patients. Methods: Qualitative methods with thematic analysis was used. Focus groups were conducted with: 1) preoperative microdiscectomy patients; 2) postoperative microdiscectomy patients; 3) spine surgeons; 4) spine fellows; 5) orthopaedic surgery residents; 6) anesthesiologists; 7) surgeons’ administrative assistants; and, 8) preoperative assessment team. Results: Major information needs were related to: anesthesia, surgical procedure details and postoperative course. Patients desire information on postoperative course much more than surgeons perceive. Desired attributes of information tools as well as patient factors that influence the extent of information shared by surgeons were determined. Information resources should be given to patients as soon as they are deemed surgical candidates. Conclusions: Microdiscectomy patients desire more information than currently provided to them – in particular postoperative-related information.

<p>Uvod: Mikrodiskektomija je jedan od savremenih hirur&scaron;kih metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 mu&scaron;karaca i 104 žene), različitih profesija, prosečne životne dobi 50.20 &plusmn; 10.26 godina (raspon 29&ndash;69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, preme&scaron;teni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvr&scaron;ena prema njihovim biolo&scaron;ko-demografskim, socio-ekonomskim, psiholo&scaron;kim i funkcionalnim obeležjima, uz kori&scaron;ćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Kori&scaron;ćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholo&scaron;kih karakteristika Spilbergerovi testovi za trenutnu i op&scaron;tu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću &Scaron;oberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod mu&scaron;karaca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p&lt;0.01) kod mu&scaron;karaca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lo&scaron;iji kod starijih osoba. Navika pu&scaron;enja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pu&scaron;ača nego kod nepu&scaron;ača (p&lt;0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psiholo&scaron;ki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno če&scaron;će prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pu&scaron;enja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psiholo&scaron;ki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.</p> / <p>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 &plusmn; 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober&#39;s and Thomayer&#39;s tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p&lt;0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p&lt;0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.</p>

[Truncated abstract] There have been few studies into the effects of rehabilitation following lumbar microdiscectomy and consequently little evidence of its effect, if any, on outcome. Most studies cited fall into one of two categories: research involving a spinal surgery procedure without rehabilitation, or research involving spinal surgery with a nonspecific generic 'rehabilitation' or 'physical therapy'. In an era of evidence based medicine the efficacy of specific rehabilitation protocols following defined lumbar spine surgical procedures needs to be established for surgeons, therapists and patients to have confidence that the rehabilitation is appropriate and effective. The study was proposed to investigate the outcome of a specific and novel rehabilitation protocol commenced immediately after lumbar microdiscectomy. Data collected from the research cohort were compared to data collected from a contrast group who underwent standard rehabilitation at a distant site. A retrospective study (Phase One) was carried out with a cohort of post-operative microdiscectomy patients between February 2000 and December 2002. The outcome of surgery followed by the rehabilitation protocol was assessed using validated outcome instruments. A contrast or control group was not included. After reviewing the data limitations with the design and implementation of the study were identified. A prospective study (Phase Two) was proposed and changes made in the principal outcome measure used, in the demographic data to be retrieved, the addition of pain scales, and in the exclusion of compensable patients. A contrast group was included for the prospective study. ... The study group commenced exercise and posture correction the day following surgery. There were restrictions placed on activity involving bending. The contrast group followed the advice of the surgeon in Queensland and attended rehabilitation at local physiotherapy facilities. Both groups were followed for 12 months using outcome instruments. Strict comparison between WA and QLD cohorts were limited due to sample size, however trends were observed. Data of the prospective study showed that there was greater reduction in back pain with the early rehabilitation protocol (P<.0001) compared to standard rehabilitation (P=.09), while there was no difference between groups in leg pain. There was a significant improvement in the level of functional disability between time-points for the WA cohort, and overall change from pre-operative RMQ measures to 12 months in both groups were statistically significant. The WA group was less reliant on pain medication and was more satisfied with the results of their surgery. The primary hypothesis of this study that there would be a difference in outcome following lumbar microdiscectomy in patients who receive early specific rehabilitation compared to those who receive standard rehabilitation at another centre, was supported in both primary and secondary outcome data. The key finding of this study was that commencing the early exercise protocol resulted in significantly less back pain over the 12 month time period of the study. Other major findings were that the WA cohort demonstrated significant improvement in function at all time-points and between all time-points except six to 12 months, took less pain medication and were more satisfied with the outcome of their surgery than the QLD cohort.

Title: Physical activity of patients after surgical treatment of the lumbar spine. Aim: Main aim of the diploma thesis is to investigate which physiotherapeutic intervention for patients after spinal surgery is the most effective one and offer optimal activity immediately after the surgery and in a long term phase. Investigate questions: 1. Which physiotherapeutic intervention is the most effective one? 2. Which type of physical activity is the most optimal one? Methods: A systematic review on the topic. Results: The review answers the questions about physiotherapy after lumbar surgery in acute and long term phase after surgery and shows current trends and unique approaches in this study area. Keywords: Lumbar spine, intervertebral disc herniation, microdiscectomy, physiotherapy, physical activity.

Title: Analysis of plantar pressures distribution at patients after microdiscectomy L5/S1 Author: Petra Végsöová Objective: The topic of the thesis is to analyze distribution of plantar pressure at "broken" and "healthy" foot. The work is based on comparison of plantar pressure distribution on "broken and healthy" footprint in static position before and after intensive daily rehabilitation. Method of solution: Twelve 40-65 years-old individuals were chosen for the study. They were treated for L5/S1 microdiscectomy and rehabilitated daily at Rehabilitation clinic Malvazinky in Prague. This group of individuals was examined in two ways; by a physiotherapist, who analysed their state of health using kinesiology analysis, and by Plantograph V07, which is used for examination of state of pressure between sole of foot and miniature pressure sensors shaped in a grid. Three weeks of rehabilitation was ended by the same ways of examination used at the beginning of therapy. The results were processed and compared by a computer. Key words: back pain, radicular syndrome, microdiscectomy, radicular pain, analysis of plantar pressures, plantograph