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Master Thesis

Intérêt d'une réunion de concertation pluridisciplinaire (RCP) sur l'évolution à 2 ans après chirurgie dans les pathologies lombaires communes : étude cas-témoins

Abstract : Objectives. The main objective of our study was to assess the impact of a multidisciplinary consultation meeting (MCM) on lumbar and radi cular pain, 2 years after lumbar spinal surgery. The secondary objectives were to assess activity limitations and quality of life, 2 years after lumbar spinal surgery. Methods. We conducted a prospective observational bicentric case-control study. All the patients who had lumbar spinal surgery in the orthopedics department of the Georges Pompidou European Hospital from 1/1/2018 to 9/30/2018 were screened consecutively. Patients meeting the inclusion criteria (i .e. herniated disc, lumbar spinal stenosis, spondylolisthesis, active discopathy) were contacted by mail from 04/16/2020 to 06/21/2020 then, in the absence of a response, by email and telephone, in order to collect outcomes at 2 years. The cases were participants whose case was discussed in the MCM and controls were participants for whom the case was not discussed. Lower back and radicular pain were assessed using a self-administered numerical rating scale, spine-specific activity limitations using the Oswestry Disability Index (ODI), and health -related quality of life using the 12 -Item Short Form Health Survey (SF-12). Quantitative variables were compared between cases and controls by a t test in the case of normal distribution and by a Mann-Whitney test in the case of non-normal distribution. We conducted a multivariate analysis to identify variables at the time of surgery as sociated with an acceptable symptom state for lumbar pain (i.e. lumbar pain < 40/100) 2 years after lumbar spinal surgery. Results. A total of 107 patients met the inclusion criteria and were contacted: 44/107 (41.1%) responded to the questionnaire (11 cas es and 33 controls). The mean age of the participants at the time of surgery was 57.4 (15.4) years, 26/44 (59.1%) were female and 8/32 (25.0%) were working. At the time of surgery, the mean intensity of lumbar pain was 51.3 (18.2)/100, that of radicular pain was 53.4 (18.6)/100 and the duration of symptoms was 14.8 (15.3) months. Two years of lumbar spinal surgery, lumbar pain was 35.5 (24.5)/100 and 26.7 (26.4)/ 100, p=0.222, and radicular pain was 27.3 (27.6)/100 and 33.9 (27.6)/100, p=0.449, in cases and controls, respectively. The ODI was 20.2 (16.2)/100 and 24.9 (19.3)/100, p=0.541, the SF-12 (PCS) was 47.5 (20.4)/70.0 and 45.0 (14.9)/71.9, p=0.419, and the SF-12 (MCS) was 41.5 (6.4)/70.0 and 40.8 (5.2)/71.9, p=0.754, in cases and controls, respectively. A total of 7/11 (63.6%) cases and 22/32 (68.8%) controls had an acceptable symptom state for lumbar pain, 2 years after lumbar spinal surgery. In multivariate analysis, none of the 3 variables tested (i.e. lumbar pain at the time of surgery, being in MCM and being on sick leave at the time of surgery) was significantly associated with an acceptable symptom state for lumbar pain, 2 years after lumbar spinal surgery. Discussion. We did not observe any statistically significant difference 2 years after lumbar spinal surgery between cases and controls. However, we noted a numerically higher decrease in pain scores and activity limitations among the cases. The lack of statistical significance could be explained by the lack of difference between the 2 strategies but also, in part, by the lack of power of our study. Conclusion. We did not observe any statistically significant difference between patients undergoing MCM and those who did not, in terms o f lower back and radicular pain, activity limitations and quality of life, 2 years of lumbar spinal surgery. However, the lack of power of our study does not allow us to conclude that MCM is not useful.
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Master Thesis
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Submitted on : Wednesday, March 17, 2021 - 11:04:16 AM
Last modification on : Tuesday, October 19, 2021 - 11:34:51 PM
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Sébastien Troussier. Intérêt d'une réunion de concertation pluridisciplinaire (RCP) sur l'évolution à 2 ans après chirurgie dans les pathologies lombaires communes : étude cas-témoins. Médecine humaine et pathologie. 2020. ⟨dumas-03171772⟩

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