Prognostic Factors Associated with Best Outcomes (Minimal Symptom State) Following Fusion for Lumbar Degenerative Conditions,,✯✯✯

Publication date: Available online 28 June 2018
Source:The Spine Journal
Author(s): Charles H. Crawford, Steven D. Glassman, Mladen Djurasovic, R. Kirk Owens, Jeffrey L. Gum, Leah Y. Carreon
Background ContextPrevious studies suggest that a post-operative symptom state with ODI ≤ 20 and pain NRS ≤ 2 following surgery for lumbar degenerative conditions are reasonable thresholds for best outcomes in which patients will be unlikely to seek additional medical care or require additional healthcare resources.PurposeTo identify prognostic factors that predict a "best outcome", defined as post-operative ODI ≤ 20 and pain NRS ≤ 2 following fusion for lumbar degenerative conditions.Study DesignLongitudinal observational cohortPatient Sample396 patients from a single site enrolled in the Quality Outcomes Database who underwent fusion for lumbar degenerative conditions.Outcome measuresOswestry Disability Index (ODI), Back and Leg Pain Numeric Rating Scales (NRS, 0 to 10).MethodsCollected and analyzed variables included age, sex, BMI, ASA grade, number of surgical levels, surgical time, pre-operative ODI, pre-operative back pain, pre-operative leg pain, workmen compensation status, surgical approach, smoking status, and principal diagnosis.Results74 patients (19%) reported a minimal symptom state at one-year post-operative (ODI ≤ 20, AND back pain NRS ≤ 2, AND leg pain NRS ≤ 2) and were included in the best outcomes group. Patients in the best outcomes group were older (62 vs. 57 years, p=0.001), had lower pre-operative ODI (43 vs. 56, p=0.000), lower pre-operative back pain (6.5 vs. 7.5, p=0.000). They had fewer surgical levels (1.25 vs. 1.47, p=0.005) and shorter OR times (208 vs. 241 minutes, p=0.002). They were more likely to have a pre-operative diagnosis of spondylolisthesis or disc herniation and less likely to have a diagnosis of adjacent segment disease or mechanical disc collapse (p=0.001). Stepwise forward regression analysis revealed diagnosis (p=0.023, OR=0.75), age (p=0.000, OR=1.04), baseline ODI (p=0.000, OR=0.96), and number of levels (p=0.019, OR=0.53) as predictive variables.ConclusionAchieving a minimal symptom state, defined here as a post-operative ODI ≤ 20 and pain NRS ≤ 2, following fusion for lumbar degenerative conditions is more likely in an older patient with a lower baseline ODI undergoing a single level lumbar fusion for spondylolisthesis.



https://ift.tt/2yQ0fs3