Citation

Lewkonia P, Dipaola C, Schouten R, Noonan V, Dvorak M, Fisher C. Spine 2012; 37(18): E1140-7.

Affiliation

Division of Orthopaedics, Department of Surgery, University of Calgary, Calgary, Canada 2Spine Division, Department of Orthopedics, University of Massachusetts Medical Centre, Worcester, Massachusetts, U.S.A. 3Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e31825b2c10

PMID

22565383

Abstract

Study Design. A systematic review of the available medical literature from 1980 to 2010 was conducted, and combined with expert opinion from a recent survey of experts regarding cervical spine fractures. Using an objective, hierarchical approach, the best available evidence is presented for health-related quality of life outcomes for these injuries.Objective. To provide an evidence-based set of guidelines for cervical spine injuries in order to reduce variability in the information given to patients and their families.Summary of Background Data. Patients' expectations regarding quality-of-life outcomes are highly dependent on the information provided by surgeons early in the treatment course. Our previous work has demonstrated that there is substantial variability in what surgeons tell patients regarding outcomes cervical spine injuries, thus patient expectations will differ and outcomes vary.Methods. Four common cervical spine injuries (C1 burst, Hangman's fracture, odontoid fracture, and unilateral facet fracture) treated both surgically and non-surgically were considered. We assessed the evidence regarding five health-related quality of life outcomes: time to return to work, activity level, hospital stay, and the proportion of patients who are pain free and have regained full range of motion at one year after the injury.Results. Published outcome data was available for most injuries. Using consensus expert opinion and the literature, answers to each question were achieved. Overall, expert opinion was relatively homogeneous across injury types, suggesting that experts do not distinguish between specific injuries when advising patients of expected outcomes such as pain.Conclusion. By overcoming gaps in the literature with consensus expert opinion, our study provides surgeons and others with evidence based medicine guidelines for patient-centred outcomes after cervical spine injury. This information can be presented to patients to frame expectations of typical outcomes during and after treatment to optimize patient care and quality of life.

Language: en