An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

McGirt, Matthew J.; Bydon, Mohamad; Archer, Kristin R.; Devin, Clinton J.; Chotai, Silky; Parker, Scott L.; Nian, Hui; Harrell, Frank E.; Speroff, Theodore; Dittus, Robert S.; Philips, Sharon; Shaffrey, Christopher I.; Foley, Kevin T.; Asher, Anthony L.

doi:10.3171/2016.11.spine16526

Cited by 142 publications

(162 citation statements)

References 61 publications

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“…In other studies where preoperative ODI scores were assessed, some reports included higher scores than the ones reported here 24,26,27 , whereas other reports were closer to our results 12,14 . Some authors described the improvement in disability based on the percentage of the patients reaching the MCID for ODI 6,13 , while others took into consideration the average variation of the disability score 12,28,8,27 .The percentage improvement for our Table 3. Comparison between the satisfied and dissatisfied groups using the scores of the Oswestry Disability Index (ODI), and physical component summary (PCS), mental component summary (MCS) and Pain constructs of the SF-36.…”

Section: Discussionsupporting

confidence: 79%

“…As the study developed, however, overlapping of different pathologic subtypes in the same patient became so frequent as to justify studying the group as a whole. A tendency to combine data for the different types of DLD for such analyses has also been observed in other recent publications [12][13][14] .…”

Section: Evaluated Scalessupporting

confidence: 57%

“…The MCID for the SF-36 pain component was reached by 73.2% of the patients in the satisfaction group 5, and by 63.7% of the patients in the group 4+5. It should be noted that the use of the SF-36 pain component to evaluate treatment results is not widespread in the literature; most often, the reported scores are based on the visual analogue scale (VAS) 21,22,9,23,8 and numerical rating scale (NRS) 13,24,7,10,12 . However, a few authors have recently been opting for the SF-36 pain component 25 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the patients often present different clinical conditions at the same time, including disc herniation and stenosis, stenosis in one level and spondylolisthesis in another, and so on. Recently, studies evaluating the results of surgery for DDL analyzing all patients as a single set have been published, an approach that seems realistic 12,13,14 .…”

mentioning

confidence: 99%

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Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data

Rohrmoser¹,

Brasil²,

Gago

et al. 2019

Arq. Neuro-Psiquiatr.

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Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 – 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

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Section: Discussionsupporting

confidence: 79%

Section: Evaluated Scalessupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data

Rohrmoser¹,

Brasil²,

Gago

et al. 2019

Arq. Neuro-Psiquiatr.

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“…The intimate relationship between baseline and followup PRO scores has been reported previously. 24 Here, it is a reflection of our outcome metric reflecting a change score as opposed to absolute score. Namely, patients with worse ODI, back pain, leg pain, and EQ-5D at baseline will have the opportunity to achieve the greatest improvement from baseline, as those with less severe baseline disease will be susceptible to floor and ceiling effects.…”

Section: Baseline Prosmentioning

confidence: 99%

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Chan

Bisson

Bydon

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe optimal minimally invasive surgery (MIS) approach for grade 1 lumbar spondylolisthesis is not clearly elucidated. In this study, the authors compared the 24-month patient-reported outcomes (PROs) after MIS transforaminal lumbar interbody fusion (TLIF) and MIS decompression for degenerative lumbar spondylolisthesis.METHODSA total of 608 patients from 12 high-enrolling sites participating in the Quality Outcomes Database (QOD) lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis, of whom 143 underwent MIS (72 MIS TLIF [50.3%] and 71 MIS decompression [49.7%]). Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse plane MIS intervertebral body graft (MIS TLIF) or if there was a tubular decompression (MIS decompression). Parameters obtained at baseline through at least 24 months of follow-up were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain, NRS for leg pain, EuroQol-5D (EQ-5D) questionnaire, and North American Spine Society (NASS) satisfaction questionnaire. Multivariate models were constructed to adjust for patient characteristics, surgical variables, and baseline PRO values.RESULTSThe mean age of the MIS cohort was 67.1 ± 11.3 years (MIS TLIF 62.1 years vs MIS decompression 72.3 years) and consisted of 79 (55.2%) women (MIS TLIF 55.6% vs MIS decompression 54.9%). The proportion in each cohort reaching the 24-month follow-up did not differ significantly between the cohorts (MIS TLIF 83.3% and MIS decompression 84.5%, p = 0.85). MIS TLIF was associated with greater blood loss (mean 108.8 vs 33.0 ml, p < 0.001), longer operative time (mean 228.2 vs 101.8 minutes, p < 0.001), and longer length of hospitalization (mean 2.9 vs 0.7 days, p < 0.001). MIS TLIF was associated with a significantly lower reoperation rate (14.1% vs 1.4%, p = 0.004). Both cohorts demonstrated significant improvements in ODI, NRS back pain, NRS leg pain, and EQ-5D at 24 months (p < 0.001, all comparisons relative to baseline). In multivariate analyses, MIS TLIF—as opposed to MIS decompression alone—was associated with superior ODI change (β = −7.59, 95% CI −14.96 to −0.23; p = 0.04), NRS back pain change (β = −1.54, 95% CI −2.78 to −0.30; p = 0.02), and NASS satisfaction (OR 0.32, 95% CI 0.12–0.82; p = 0.02).CONCLUSIONSFor symptomatic, single-level degenerative spondylolisthesis, MIS TLIF was associated with a lower reoperation rate and superior outcomes for disability, back pain, and patient satisfaction compared with posterior MIS decompression alone. This finding may aid surgical decision-making when considering MIS for degenerative lumbar spondylolisthesis.

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Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery

Berg,

Gorosito,

Fjeld

et al. 2024

JAMA Netw Open

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ImportanceLumber disc herniation surgery can reduce pain and disability. However, a sizable minority of individuals experience minimal benefit, necessitating the development of accurate prediction models.ObjectiveTo develop and validate prediction models for disability and pain 12 months after lumbar disc herniation surgery.Design, Setting, and ParticipantsA prospective, multicenter, registry-based prognostic study was conducted on a cohort of individuals undergoing lumbar disc herniation surgery from January 1, 2007, to May 31, 2021. Patients in the Norwegian Registry for Spine Surgery from all public and private hospitals in Norway performing spine surgery were included. Data analysis was performed from January to June 2023.ExposuresMicrodiscectomy or open discectomy.Main Outcomes and MeasuresTreatment success at 12 months, defined as improvement in Oswestry Disability Index (ODI) of 22 points or more; Numeric Rating Scale (NRS) back pain improvement of 2 or more points, and NRS leg pain improvement of 4 or more points. Machine learning models were trained for model development and internal-external cross-validation applied over geographic regions to validate the models. Model performance was assessed through discrimination (C statistic) and calibration (slope and intercept).ResultsAnalysis included 22 707 surgical cases (21 161 patients) (ODI model) (mean [SD] age, 47.0 [14.0] years; 12 952 [57.0%] males). Treatment nonsuccess was experienced by 33% (ODI), 27% (NRS back pain), and 31% (NRS leg pain) of the patients. In internal-external cross-validation, the selected machine learning models showed consistent discrimination and calibration across all 5 regions. The C statistic ranged from 0.81 to 0.84 (pooled random-effects meta-analysis estimate, 0.82; 95% CI, 0.81-0.84) for the ODI model. Calibration slopes (point estimates, 0.94-1.03; pooled estimate, 0.99; 95% CI, 0.93-1.06) and calibration intercepts (point estimates, −0.05 to 0.11; pooled estimate, 0.01; 95% CI, −0.07 to 0.10) were also consistent across regions. For NRS back pain, the C statistic ranged from 0.75 to 0.80 (pooled estimate, 0.77; 95% CI, 0.75-0.79); for NRS leg pain, the C statistic ranged from 0.74 to 0.77 (pooled estimate, 0.75; 95% CI, 0.74-0.76). Only minor heterogeneity was found in calibration slopes and intercepts.ConclusionThe findings of this study suggest that the models developed can inform patients and clinicians about individual prognosis and aid in surgical decision-making.

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An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

Cited by 142 publications

References 61 publications

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery

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