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  • Central Sensitization Inventory as a Predictor of Worse Quality of Life Measures Following Cervical and Lumbar Spinal Fusion

    Final Number:

    Elizabeth Emily Bennett MD MS; Kevin M Walsh MD; Ajit A. Krishnaney MD, FAANS; Nicholas Thompson

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: Central sensitization (CS) is an abnormal and intense enhancement of pain mechanism by the central nervous system. Patients with CS may be at higher risk of poor outcomes following spinal fusion. The Central Sensitivity Inventory or Index (CSI) was developed to identify and quantify key symptoms related to central sensitization. The goal of this study is to evaluate pretreatment CSI as a predictor of post-operative quality of life (QOL) measures in patients who underwent spinal fusion.

    Methods: Retrospective cohort study evaluating all patients who underwent cervical or lumbar spinal fusion at the Cleveland Clinic between 2010 and 2014. Data was obtained from a prospective maintained database. Inclusion criteria included: CSI completion pre-operatively, age 18 or greater, and QOL values pre- and post-operatively. Linear regression modeling was used to evaluate pre-operative CSI as a predictor of post-operative QOL outcomes.

    Results: There were no significant differences in demographic or clinical characteristics including preoperative CSI value between those included and excluded in the analysis (p > 0.05 for all). Of the included patients, 576 scored 40 or higher on the CSI and 449 scored less than 40. Patients who scored 40 or higher on the CSI were, on average, more likely to be female, less likely to be married, more likely to be a current smoker, lived in zip codes with lower median household income, had worse pre-operative scores for the PDQ, EQ-5D, and PHQ-9, and were more likely to not be working due to medical reasons and receiving worker’s compensation. Pre-operative CSI score was significantly associated with worse post-operative scores for the PDQ total (P = 0.0254), PHQ-9 score (P = 0.0014), and EQ-5D index (P < 0.0001).

    Conclusions: CSI may be an additional measure to use in evaluating patients pre-operatively to better predict successful outcomes following cervical and lumbar fusion.

    Patient Care: The rates of spinal fusions are increasing. Multiple clinical, psychological, and socioeconomic factors have been correlated with outcomes following spinal fusion. Our data show that CSI may be an additional measure to use in evaluating patients pre-operatively to better predict successful outcomes following cervical and lumbar fusion.

    Learning Objectives: 1) Describe central sensitization. 2) Understand Central Sensitivity Inventory as a way for identifying patients with central sensitization. 3) Discuss the Central Sensitivity Inventory as a predictor of quality of life measures following spinal fusion.

    References: 1. Yunus MB: Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. 36(6):339-56. 2007 2. Kindler LL, Bennett RM, Jones KD: Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs. 12(1):15-24. 2011 3. Neblett R, Cohen H, Choi Y, Hartzell MM, Williams M, Mayer TG, Gatchel RJ. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain. 14(5):438-45. 2013 4. Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ: The development and psychometric validation of the central sensitization inventory. Pain Pract. 12(4):276-85. 2012  5. Yunus MB: Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. 37(6):339-52. 2008 6. Neblett R, Hartzell MM, Cohen H, Mayer TG, Williams M, Choi Y Gatchel RJ. Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample. Clin J Pain. 31(4):323-32. 2015 7. Deyo RA, Gray DT, Kreuter W, et al: United States trends in lumbar fusion surgery for degenerative conditions, Spine (Phila Pa 1976) 30(12):1441–1445, 2005:discussion 6–7. 8. Soriano JC, Revulenta SD, Fuente MF, Diaz IC, Urena PM, Meneses RD. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. Eur Spine J 19:1841-1848. 2010 9. Derby R, Lettice JJ, Kula TA, Lee SH, Seo KS, Kim BJ. Single-level lumbar fusion in chronic discogenic low-back pain: psychological and emotional status as predictor of outcome measured using the 36-item short form. J Neurosurg Spine 3:255-61. 2005

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