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Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

Publication ,  Journal Article
Adogwa, O; Elsamadicy, AA; Han, JL; Cheng, J; Karikari, I; Bagley, CA
Published in: Journal of neurosurgery. Spine
December 2016

OBJECTIVE With the recent passage of the Patient Protection and Affordable Care Act, there has been a dramatic shift toward critical analyses of quality and longitudinal assessment of subjective and objective outcomes after lumbar spine surgery. Accordingly, the emergence and routine use of real-world institutional registries have been vital to the longitudinal assessment of quality. However, prospectively obtaining longitudinal outcomes for patients at 24 months after spine surgery remains a challenge. The aim of this study was to assess if 12-month measures of treatment effectiveness accurately predict long-term outcomes (24 months). METHODS A nationwide, multiinstitutional, prospective spine outcomes registry was used for this study. Enrollment criteria included available demographic, surgical, and clinical outcomes data. All patients had prospectively collected outcomes measures and a minimum 2-year follow-up. Patient-reported outcomes instruments (Oswestry Disability Index [ODI], SF-36, and visual analog scale [VAS]-back pain/leg pain) were completed before surgery and then at 3, 6, 12, and 24 months after surgery. The Health Transition Index of the SF-36 was used to determine the 1- and 2-year minimum clinically important difference (MCID), and logistic regression modeling was performed to determine if achieving MCID at 1 year adequately predicted improvement and achievement of MCID at 24 months. RESULTS The study group included 969 patients: 300 patients underwent anterior lumbar interbody fusion (ALIF), 606 patients underwent transforaminal lumbar interbody fusion (TLIF), and 63 patients underwent lateral interbody fusion (LLIF). There was a significant correlation between the 12- and 24-month ODI (r = 0.82; p < 0.0001), SF-36 Physical Component Summary score (r = 0.89; p < 0.0001), VAS-back pain (r = 0.90; p < 0.0001), and VAS-leg pain (r = 0.85; p < 0.0001). For the ALIF cohort, patients achieving MCID thresholds for ODI at 12 months were 13-fold (p < 0.0001) more likely to achieve MCID at 24 months. Similarly, for the TLIF and LLIF cohorts, patients achieving MCID thresholds for ODI at 12 months were 13-fold and 14-fold (p < 0.0001) more likely to achieve MCID at 24 months. Outcome measures obtained at 12 months postoperatively are highly predictive of 24-month outcomes, independent of the surgical procedure. CONCLUSIONS In a multiinstitutional prospective study, patient-centered measures of surgical effectiveness obtained at 12 months adequately predict long-term (24-month) outcomes after lumbar spine surgery. Patients achieving MCID at 1 year were more likely to report meaningful and durable improvement at 24 months, suggesting that the 12-month time point is sufficient to identify effective versus ineffective patient care.

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Published In

Journal of neurosurgery. Spine

DOI

EISSN

1547-5646

ISSN

1547-5654

Publication Date

December 2016

Volume

25

Issue

6

Start / End Page

689 / 696

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Spondylolisthesis
  • Spinal Fusion
  • Registries
  • Radiculopathy
  • Prospective Studies
  • Prognosis
  • Pain Measurement
  • Orthopedics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Adogwa, O., Elsamadicy, A. A., Han, J. L., Cheng, J., Karikari, I., & Bagley, C. A. (2016). Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes? Journal of Neurosurgery. Spine, 25(6), 689–696. https://doi.org/10.3171/2015.8.spine15476
Adogwa, Owoicho, Aladine A. Elsamadicy, Jing L. Han, Joseph Cheng, Isaac Karikari, and Carlos A. Bagley. “Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?Journal of Neurosurgery. Spine 25, no. 6 (December 2016): 689–96. https://doi.org/10.3171/2015.8.spine15476.
Adogwa O, Elsamadicy AA, Han JL, Cheng J, Karikari I, Bagley CA. Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes? Journal of neurosurgery Spine. 2016 Dec;25(6):689–96.
Adogwa, Owoicho, et al. “Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?Journal of Neurosurgery. Spine, vol. 25, no. 6, Dec. 2016, pp. 689–96. Epmc, doi:10.3171/2015.8.spine15476.
Adogwa O, Elsamadicy AA, Han JL, Cheng J, Karikari I, Bagley CA. Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes? Journal of neurosurgery Spine. 2016 Dec;25(6):689–696.

Published In

Journal of neurosurgery. Spine

DOI

EISSN

1547-5646

ISSN

1547-5654

Publication Date

December 2016

Volume

25

Issue

6

Start / End Page

689 / 696

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Spondylolisthesis
  • Spinal Fusion
  • Registries
  • Radiculopathy
  • Prospective Studies
  • Prognosis
  • Pain Measurement
  • Orthopedics