Predictors of multidimensional outcome after spinal surgery

Mannion, Anne F.; Elfering, Achim; Staerkle, Ralph F.; Junge, Astrid; Grob, Dieter; Dvořák, Jiří; Jacobshagen, Nicola; Semmer, Norbert K.; Boos, Norbert

doi:10.1007/s00586-006-0255-0

Cited by 112 publications

(87 citation statements)

References 32 publications

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“…The COMI is a multidimensional index consisting of validated questions covering the domains of pain (leg/buttock and back pain intensity, each measured separately on a 0-10 graphic rating scale), function, symptomspecific well-being, general quality of life, and social and work disability. The COMI was originally developed based on the recommendations for a short series of Core Outcome questions by an Expert Group in the field of Low Back Pain Outcome measurement [2] and subsequently validated as an outcome instrument by three research groups [3,8,9,18]. In addition to the COMI questions, at the 3-month follow-up there were further questions inquiring about overall satisfaction with treatment of the back problem in the hospital (5 categories from ''very satisfied'' to ''very dissatisfied''), the global outcome of surgery (''how much did the operation help your back problem?…”

Section: Patient-orientated Questionnairesmentioning

confidence: 99%

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

et al. 2009

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Section: Patient-orientated Questionnairesmentioning

confidence: 99%

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

et al. 2009

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“…The COMI is a multidimensional index consisting of validated questions covering the domains of pain (neck and arm pain intensity, each measured separately on a 0-10 graphic rating scale), function, symptom-specific well-being, general quality of life, and social and work disability. The COMI was originally developed based on the recommendations for a short series of Core Outcome questions by an expert group in the field of spine outcome measurement [15] and subsequently validated as an outcome instrument by three research groups [17,31,32,49]. In addition to the COMI questions, at the 12-month and 24-month FUs, there were further questions with 5-point Likert scales inquiring about satisfaction (''over the course of treatment for your neck problem how satisfied were you with the medical care in our hospital?…”

Section: Patient-orientated Questionnairesmentioning

confidence: 99%

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

et al. 2009

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Randomised controlled trials (RCTs) of cervical disc arthroplasty vs fusion generally show slightly more favourable results for arthroplasty. However, RCTs in surgery often have limited external validity, since they involve a select group of patients who fit very rigid admission criteria and who are prepared to subject themselves to randomisation. The aim of this study was to examine whether the findings of RCTs are verified by observational data recorded in our Spine Center in association with the Spine Society of Europe Spine Tango surgical registry. Patients undergoing fusion/stabilisation or disc arthroplasty for degenerative cervical spinal disease were selected for inclusion. They completed a questionnaire pre-operatively and at 12 and 24 months follow-up (FU). The questionnaire comprised the multidimensional Core Outcome Measures Index (COMI; 0-10 scale) and, at FU, questions on global outcome and satisfaction with treatment (5-point scales, dichotomised to ''good'' and ''poor''), re-operation and patient-rated complications. The surgeon completed a Spine Tango Surgery form. The outcome data from 266 (208 fusion, 58 arthroplasty) out of 284 eligible patients who had reached 12 months FU, and 169 (139 fusion, 30 arthroplasty) out of 178 who had reached 24 months FU, were included. Patients with cervical disc arthroplasty were younger [46 (SD 8) years vs 56 (SD 11) years for fusion; P \ 0.05], had less comorbidity (P \ 0.05), more often had only mono-segmental pathology (69% arthroplasty, 47% fusion) and only one type of degenerative pathology (69% arthroplasty, 46% fusion). Surgical complication rates were similar in each group (arthroplasty, 1.5%; fusion, 2.6%). The reduction in the COMI score was significantly greater in the arthroplasty group (at 12 months, 4.8 (SD 3.0) vs 3.7 (SD 2.9) points for fusion, and at 24 months 5.1 (SD 2.8) vs 3.8 (SD 2.9) points; each P \ 0.05). In the arthroplasty group, a ''good'' global outcome was recorded in 90% patients (at 12 months) and 93% (at 24 months); in the fusion group the figures were 80 and 82%, respectively (group differences at each timepoint, P [ 0.09). Satisfaction with treatment was similar in both groups (89-93%), at each timepoint. In multiple regression analysis, treatment group was of borderline significance as a unique predictor of the change in COMI at FU (P = 0.059 at 12 months, P = 0.055 at 24 months) in a model in which known confounders (age, comorbidity, number of affected levels) were controlled for. Being in the arthroplasty group was associated with an approximately 1-point greater reduction in the COMI score at FU. The results of this observational study appear to support those of the RCTs and suggest that, in patients with degenerative pathology of the cervical spine, disc arthroplasty is associated with a slightly better outcome than fusion. However, given the small size of the difference, its clinical relevance is questionable, especially in view of the a priori more favourable outcome expected in the arthroplasty group due to ...

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“…Many possible reasons for mixed lumbar fusion surgery outcomes exist, including instrumentation failure, inadequate surgical technique and poor patient selection. Factors previously suggested to be predictive of pain and disability-related outcomes include pre-surgical pain/function [42], negative personality traits [19,31,40,41,44], emotional status [41], anxiety/depression [3,23,28,40,41], fear avoidance (FA) beliefs [28], negative outcome expectations [20,48] negative coping [3], smoking status [41], gender [9], exercise [9], litigation [23], duration of back pain and workers' compensation [3,19,40,41].…”

Section: Introductionmentioning

confidence: 99%

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

2011

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Prediction studies testing a thorough range of psychological variables in addition to demographic, workrelated and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Postoperative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and postoperative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

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Predictors of multidimensional outcome after spinal surgery

Cited by 112 publications

References 32 publications

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

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