tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 22

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 22. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Predictors of Surgical Outcome Chapter 7 187 Health Behavioral and Lifestyle Factors Few studies have examined health behavioral or lifestyle factors as predictors of outcome although it is conceivable that these could be important in determining an individual s response to major surgery. Intuitively one might imagine that a higher level of pre-surgical physical fitness would allow a more rapid return to normal functioning after surgery. To the authors knowledge fitness or the participation in regular exercise has been examined in only one retrospective study 4 and was not found to be associated with outcome after percutaneous lumbar discectomy. Results from the authors own studies suggest that the regular participation in exercise physical activity for many years prior to the operation but not necessarily exercise habits at the time of the intervention - . exercise as a lifetime habit - is associated with a more positive outcome after decompression surgery unpublished observations . Smoking is a relatively frequently examined predictor factor especially in relation to the outcome after spinal fusion. In some studies it has been shown to have a negative impact on outcome whereas in many others it has had no effect Table 1 . It has been suggested that tobacco use must be examined as a doseresponse relationship in order to reveal associations that can be obscured by expressing it as a dichotomous variable yes no to a smoking habit 51 . While the inhibitory effects of nicotine on fusion itself have been established 2 26 it is also possible that smoking may simply reflect other factors - such as negative health behavior low physical activity levels alcohol use lower educa-tion social level manual job - and thereby act as a marker for these in determining outcome. Interestingly even in a subgroup of patients with no signs of pseudarthrosis smoking still predicted clinical outcome and return to work in patients undergoing fusion 26 . Health behavioral and lifestyle .