Our Summary

The research paper discusses a study on patients with multiple sclerosis (MS) who undergo a specific type of back surgery called posterior lumbar fusion (PLF). The researchers wanted to know if these patients had more complications after surgery and if their surgeries cost more than those of similar patients without MS.

They looked at data from Medicare, the US government healthcare program for older people, for the years 2006 to 2013. They only included patients who had PLF surgery and didn’t have other health conditions that could affect the results.

The research found that patients with MS were more likely to have complications after surgery. These included blood infections (sepsis), urinary tract infections, blood clots in the veins (deep vein thrombosis), and needing to visit the emergency room or be readmitted to the hospital within 90 days after surgery.

In terms of cost, the study found that the total hospital charge for MS patients was on average $4379 more than for patients without MS. The cost of the hospital stay itself was on average $1679 more for MS patients, and they tended to stay in the hospital longer.

The researchers concluded that having MS does increase the risk of complications and costs after PLF surgery. They suggest that doctors need to be aware of these risks when discussing the procedure with their MS patients.

FAQs

  1. Does having multiple sclerosis increase the risk of complications after posterior lumbar fusion surgery?
  2. Is the cost of posterior lumbar fusion surgery higher for patients with multiple sclerosis than those without?
  3. What types of complications are more likely to occur after posterior lumbar fusion surgery in patients with multiple sclerosis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to follow post-operative care instructions carefully to reduce the risk of complications and promote healing. This may include avoiding heavy lifting, following a prescribed physical therapy plan, and taking prescribed medications as directed. Additionally, maintaining a healthy lifestyle with regular exercise and proper nutrition can help support the healing process.

Suitable For

Patients who are typically recommended lumbar fusion are those who have chronic back pain, instability in the spine, degenerative disc disease, herniated discs, spinal stenosis, scoliosis, spondylolisthesis, or other spinal conditions that have not responded to conservative treatments such as physical therapy, medications, injections, or activity modification. These patients may have symptoms such as severe back pain, leg pain, numbness or weakness in the legs, difficulty walking, or loss of bladder or bowel control. Lumbar fusion may be recommended when other treatments have not provided relief or when the spinal condition is causing progressive neurological symptoms or spinal instability.

Timeline

Before lumbar fusion surgery, a patient typically experiences chronic back pain, weakness or numbness in the legs, difficulty walking or standing for long periods, and limited mobility. They may have tried conservative treatments such as physical therapy, medication, and injections without success.

After lumbar fusion surgery, a patient may experience pain and discomfort at the surgical site, limited mobility and range of motion, fatigue, and difficulty performing daily activities. Physical therapy and rehabilitation are typically recommended to help regain strength and function. Over time, the patient may experience improved pain relief, increased stability in the spine, and better overall quality of life.

What to Ask Your Doctor

Some questions a patient with MS should ask their doctor about lumbar fusion surgery include:

  1. What specific complications am I at a higher risk for due to my MS?
  2. How will my MS impact my recovery time and overall outcome after surgery?
  3. Are there any alternative treatments or surgical approaches that may be safer or more effective for me given my MS diagnosis?
  4. How experienced are you in performing lumbar fusion surgery on patients with MS?
  5. What steps will be taken to minimize my risk of complications during and after surgery?
  6. Can you provide me with information on the potential costs associated with the surgery, including any additional expenses related to my MS?
  7. What support or resources are available to help me manage my MS symptoms during the recovery process?
  8. Are there any specific post-operative rehabilitation or physical therapy programs that may be beneficial for me as a patient with MS?
  9. Can you connect me with other patients who have undergone lumbar fusion surgery with MS, so I can hear about their experiences and outcomes?
  10. What is your overall recommendation for me as a patient with MS considering lumbar fusion surgery?

Reference

Authors: Kamalapathy PN, Bell J, Puvanesarajah V, Hassanzadeh H. Journal: Clin Spine Surg. 2022 Feb 1;35(1):E211-E215. doi: 10.1097/BSD.0000000000001212. PMID: 34081657