Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis. Methods: A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded. Results: Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used—studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work. Conclusions: The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.

Trends in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…As such, a unifying measure for determining value after ACL reconstruction should be disease specific and include measures of satisfaction, employment/RTS, pain, and general health. 47 It is our recommendation that outcomes after ACL reconstruction be reported in a manner consistent with the guidelines developed at the ACL Consensus Meeting Panther Symposium 2019. 42 Three of the 9 consensus statements generated at the symposium pertain to PROs: (1) assessment of PROs should optimally include 1 kneespecific outcome tool, 1 activity rating scale, and 1 measure of health-related quality of life; (2) the IKDC Subjective Knee Evaluation Form is the recommended knee-related outcome measure for ACL injury and treatment; and (3) measurement of the Patient Acceptable Symptom State is valuable in the assessment of outcome after ACL injury and treatment.…”

Circumferential Fusion Employing Transforaminal vs. Direct Lateral Lumbar Interbody Fusion—A Potential Impact on Implants Stability

“…Firstly, the application of numeric scores is not standardized yet ( 8 ). Secondly, the results of those studies can be influenced by many irrelevant to the applied surgery causes, including the accuracy of diagnoses, socioeconomic, behavioral, psychological factors, sacroiliac joints dysfunction, and adjacent level degeneration ( 9 , 10 , 27 , 28 ). To avoid bias relevant to the application of subjective numeric scores, radiographic signs of PSL were used in the current study.…”

“…On the other hand, the evidence that the application of DLIF provides better outcomes than direct decompression with TLIF is insufficient especially if short fusion is required, therefore, no clear guidelines exist on the rational application of those techniques ( 5 – 8 ). An additional source of confusion is that the majority of studies focused on comparative analysis of various fusion techniques and the results are based on numeric scores, which can be strongly biased by different reasons that are irrelevant to the applied surgery ( 9 – 11 ).…”

Comparative analysis of the results using direct lateral interbody spondilodesis and transforaminal lumbar interbody spondilodesis in patients with degenerative diseases of the lumbar spine

“…Несмотря на значительное количество опубликованных работ, четких рекомендаций по рациональному применению различных видов спондилодеза на данный момент не разработано. Источником дополнительных противоречий в результатах многих анализов является то, что подавляющее большинство работ основано на динамике субъективных шкал оценки интенсивности боли, индекса ограничения жизнедеятельности и качества жизни, которые не всегда стандартизированы [8]. Слабыми сторонами таких исследований является то, что оценка результатов оперативного лечения может зависеть от многих факторов, включающих точность постановки диагноза, социально-экономические, поведенческие и психологические аспекты [9,10].…”