Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy

Willems, Stijn J; Coppieters, Michel W.; Rooker, Servan; Heymans, Martijn W.; Scholten-Peeters, Gwendolyne G M

doi:10.1097/brs.0000000000003448

Cited by 9 publications

(9 citation statements)

References 31 publications

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“…The derivation and internal validation of the prognostic models revealed that the explained variance scored poorly, and the discriminative ability was poor to acceptable. This is in line with previous research on prediction models for lumbar microdiscectomy [8,10,26,38]. The role of potentially important biomedical factors (e.g., degeneration, type of disc herniation) and psychosocial factors (e.g., distress, depression, or fear-avoidance) should be further explored [3,5,9,10,40].…”

Section: Discussionsupporting

confidence: 85%

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

Willems

Coppieters

Rooker

et al. 2023

Clinical Neurology and Neurosurgery

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Section: Discussionsupporting

confidence: 85%

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

Willems

Coppieters

Rooker

et al. 2023

Clinical Neurology and Neurosurgery

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“…Other social factors known to be associated with musculoskeletal disorders including income and place of residence were not available in the QOD [ 60 , 61 ]. These data are especially important in light of recent work indicating that outcomes following microdiscectomy could not be accurately predicted by commonly captured sociodemographic variables [ 62 ]. It is unknown how including additional SDoH would affect the present results.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

et al. 2020

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Objectives Our objective was to analyze the collective effect of social determinants of health (SDoH) on lumbar spine surgery outcomes utilizing two different statistical methods of combining variables. Methods This observational study analyzed data from the Quality Outcomes Database, a nationwide United States spine registry. Race/ethnicity, educational attainment, employment status, insurance payer, and gender were predictors of interest. We built two models to assess the collective influence of SDoH on outcomes following lumbar spine surgery—a stepwise model using each number of SDoH conditions present (0 of 5, 1 of 5, 2 of 5, etc) and a clustered subgroup model. Logistic regression analyses adjusted for age, multimorbidity, surgical indication, type of lumbar spine surgery, and surgical approach were performed to identify the odds of failing to demonstrate clinically meaningful improvements in disability, back pain, leg pain, quality of life, and patient satisfaction at 3- and 12-months following lumbar spine surgery. Results Stepwise modeling outperformed individual SDoH when 4 of 5 SDoH were present. Cluster modeling revealed 4 distinct subgroups. Disparities between the younger, minority, lower socioeconomic status and the younger, white, higher socioeconomic status subgroups were substantially wider compared to individual SDoH. Discussion Collective and cluster modeling of SDoH better predicted failure to demonstrate clinically meaningful improvements than individual SDoH in this cohort. Viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDoH on outcomes.

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“…Fourteen studies [35,38,39,43,45,46,48,49,55,57,59,63,64,66] did not adjust their final models for age, gender, or baseline pain severity (Table 2). showed a small association between the female sex and persistent leg pain after lumbar microdiscectomy (OR = 1.15, 95% CI = 0.63 to 2.08) (Figure 2).…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Two of these factors, opioid use before surgery and legal representation at the time of surgery, met our criteria as promising for future investigations (Table 6). [53] Udby et al [66] En'Wezoh et al [38] Willems et al [63] Two out of six studies showed that higher One study out of the two studies showed a significant association between passive coping with functional limitations/disability [49] Than et al [55] One out of three studies showed that higher preoperative quality was associated with a higher probability of sustaining RTW which we could not perform a meta-analysis. Another limiting factor that precluded us from a meta-analysis of most variables was incomplete data reporting, such as many studies only reported p-values [38,46,57] or SE [36] or OR without 95% CI [44] or only beta-coefficient [49,53].…”

Section: Rtw = Return To Workmentioning

confidence: 99%

Predictors of Recovery Following Lumbar Microdiscectomy for Sciatica: A Systematic Review and Meta-Analysis of Observational Studies

Rehman¹,

Bała²,

Rehman³

et al. 2023

Cureus

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Chronic post-surgical pain is reported by up to 40% of patients after lumbar microdiscectomy for sciatica, a complaint associated with disability and loss of productivity.We conducted a systematic review of observational studies to explore factors associated with persistent leg pain and impairments after microdiscectomy for sciatica. We searched eligible studies in MEDLINE, Embase, and CINAHL that explored, in an adjusted model, predictors of persistent leg pain, physical impairment, or failure to return to work after microdiscectomy for sciatica. When possible, we pooled estimates of association using random-effects models using the Grading of Recommendations Assessment, Development, and Evaluation approach.Moderate-certainty evidence showed that the female sex probably has a small association with persistent post-surgical leg pain (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 0.63 to 2.08; absolute risk increase (ARI) = 1.8%, 95% CI = -4.7% to 11.3%), large association with failure to return to work (OR = 2.79, 95% CI = 1.27 to 6.17; ARI = 10.6%, 95% CI = 1.8% to 25.2%), and older age is probably associated with greater postoperative disability (β = 1.47 points on the 100-point Oswestry Disability Index for every 10-year increase from age (>/=18 years), 95% CI = -4.14 to 7.28). Among factors that were not possible to pool, two factors showed promise for future study, namely, legal representation and preoperative opioid use, which showed large associations with worse outcomes after surgery.The moderate-certainty evidence showed female sex is probably associated with persistent leg pain and failure to return to work and that older age is probably associated with greater post-surgical impairment after a microdiscectomy. Future research should explore the association between legal representation and preoperative opioid use with persistent pain and impairment after microdiscectomy for sciatica.

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Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy

Cited by 9 publications

References 31 publications

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

Predictors of Recovery Following Lumbar Microdiscectomy for Sciatica: A Systematic Review and Meta-Analysis of Observational Studies

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