PMID- 26722957
OWN - NLM
STAT- MEDLINE
DCOM- 20170222
LR  - 20220331
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 25
IP  - 6
DP  - 2016 Dec
TI  - Do measures of surgical effectiveness at 1 year after lumbar spine surgery 
      accurately predict 2-year outcomes?
PG  - 689-696
AB  - OBJECTIVE With the recent passage of the Patient Protection and Affordable Care 
      Act, there has been a dramatic shift toward critical analyses of quality and 
      longitudinal assessment of subjective and objective outcomes after lumbar spine 
      surgery. Accordingly, the emergence and routine use of real-world institutional 
      registries have been vital to the longitudinal assessment of quality. However, 
      prospectively obtaining longitudinal outcomes for patients at 24 months after 
      spine surgery remains a challenge. The aim of this study was to assess if 
      12-month measures of treatment effectiveness accurately predict long-term 
      outcomes (24 months). METHODS A nationwide, multiinstitutional, prospective spine 
      outcomes registry was used for this study. Enrollment criteria included available 
      demographic, surgical, and clinical outcomes data. All patients had prospectively 
      collected outcomes measures and a minimum 2-year follow-up. Patient-reported 
      outcomes instruments (Oswestry Disability Index [ODI], SF-36, and visual analog 
      scale [VAS]-back pain/leg pain) were completed before surgery and then at 3, 6, 
      12, and 24 months after surgery. The Health Transition Index of the SF-36 was 
      used to determine the 1- and 2-year minimum clinically important difference 
      (MCID), and logistic regression modeling was performed to determine if achieving 
      MCID at 1 year adequately predicted improvement and achievement of MCID at 24 
      months. RESULTS The study group included 969 patients: 300 patients underwent 
      anterior lumbar interbody fusion (ALIF), 606 patients underwent transforaminal 
      lumbar interbody fusion (TLIF), and 63 patients underwent lateral interbody 
      fusion (LLIF). There was a significant correlation between the 12- and 24-month 
      ODI (r = 0.82; p < 0.0001), SF-36 Physical Component Summary score (r = 0.89; p < 
      0.0001), VAS-back pain (r = 0.90; p < 0.0001), and VAS-leg pain (r = 0.85; p < 
      0.0001). For the ALIF cohort, patients achieving MCID thresholds for ODI at 12 
      months were 13-fold (p < 0.0001) more likely to achieve MCID at 24 months. 
      Similarly, for the TLIF and LLIF cohorts, patients achieving MCID thresholds for 
      ODI at 12 months were 13-fold and 14-fold (p < 0.0001) more likely to achieve 
      MCID at 24 months. Outcome measures obtained at 12 months postoperatively are 
      highly predictive of 24-month outcomes, independent of the surgical procedure. 
      CONCLUSIONS In a multiinstitutional prospective study, patient-centered measures 
      of surgical effectiveness obtained at 12 months adequately predict long-term 
      (24-month) outcomes after lumbar spine surgery. Patients achieving MCID at 1 year 
      were more likely to report meaningful and durable improvement at 24 months, 
      suggesting that the 12-month time point is sufficient to identify effective 
      versus ineffective patient care.
FAU - Adogwa, Owoicho
AU  - Adogwa O
AD  - Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 
      and.
FAU - Elsamadicy, Aladine A
AU  - Elsamadicy AA
AD  - Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 
      and.
FAU - Han, Jing L
AU  - Han JL
AD  - Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 
      and.
FAU - Cheng, Joseph
AU  - Cheng J
AD  - Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, 
      Tennessee.
FAU - Karikari, Isaac
AU  - Karikari I
AD  - Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 
      and.
FAU - Bagley, Carlos A
AU  - Bagley CA
AD  - Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; 
      and.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160101
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Back Pain/etiology/surgery
MH  - Disability Evaluation
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Intervertebral Disc Degeneration/surgery
MH  - Longitudinal Studies
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Prognosis
MH  - Prospective Studies
MH  - Radiculopathy/complications/surgery
MH  - Registries
MH  - Spinal Fusion/*methods
MH  - Spondylolisthesis/surgery
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - ALIF = anterior lumbar interbody fusion
OT  - HRQOL = health-related quality of life
OT  - LLIF = lateral interbody fusion
OT  - MCID = minimum clinically important difference
OT  - MCS = Mental Component Summary
OT  - MDC = minimum detectable change
OT  - ODI = Oswestry Disability Index
OT  - PCS = Physical Component Summary
OT  - TLIF =transforaminal lumbar interbody fusion
OT  - VAS = visual analog scale
OT  - effective measures
OT  - long-term outcomes
OT  - lumbar spine
OT  - spinal surgery
OT  - surgical effectiveness
OT  - surgical outcomes
EDAT- 2016/01/02 06:00
MHDA- 2017/02/23 06:00
CRDT- 2016/01/02 06:00
PHST- 2016/01/02 06:00 [pubmed]
PHST- 2017/02/23 06:00 [medline]
PHST- 2016/01/02 06:00 [entrez]
AID - 10.3171/2015.8.SPINE15476 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2016 Dec;25(6):689-696. doi: 10.3171/2015.8.SPINE15476. Epub 
      2016 Jan 1.