Change in Patient-Reported Outcome Measures as Predictors of Revision Lumbar Decompression Procedures

Abstract

Objective: To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).Methods: Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.Results: The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).Conclusion: LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.

Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study

“…In addition, the medical costs associated with secondary surgery were higher than the medical costs of the initial surgery. While many factors are known to be associated with the risk of secondary surgery for DLSD, there are no financial indicators for predicting secondary surgery 33 , 38 , 41 , 49 . In this study, interim costs after initial surgery showed promise in predicting the occurrence of secondary surgery in DLSD.…”

Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

“…Our study offers the advantage of a long-term follow-up and a relatively large population; however, due to the de-identified nature of the dataset, we were unable to assess patient-reported outcome measures. To gain insights into factors that mediate the risk of lumbar spine reoperation, it is necessary to conduct a longitudinal prospective study incorporating standardized assessments of pain, low back-related disability, quality of life, and pain medication utilization [ 55 , 56 ].…”