PMID- 27664340
OWN - NLM
STAT- MEDLINE
DCOM- 20170629
LR  - 20181202
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 17
IP  - 2
DP  - 2017 Feb
TI  - Independent predictors of a clinically significant improvement after lumbar 
      fusion surgery.
PG  - 236-243
LID - S1529-9430(16)30961-5 [pii]
LID - 10.1016/j.spinee.2016.09.011 [doi]
AB  - BACKGROUND CONTEXT: Multiple studies have determined minimum clinically important 
      difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar 
      fusion patients. However, a comprehensive understanding of predictors for a 
      clinically significant improvement (CSI) postoperatively does not exist. PURPOSE: 
      To determine medical, radiographic, and surgical predictors for obtaining a CSI 
      following lumbar fusion surgery. STUDY DESIGN: This is a retrospective review of 
      patients who underwent instrumented lumbar fusion. PATIENT SAMPLE: We included 
      patients who underwent lumbar fusion for any indication between 2008 and 2013. 
      OUTCOME MEASURES: Outcome measures included preoperative and postoperative EQ-5D 
      Index scores. MATERIALS AND METHODS: The medical records of patients who received 
      a lumbar fusion for any indication were retrospectively reviewed to identify 
      patient medical and surgical characteristics. A blinded reviewer assessed 
      radiographs for each patient to examine sagittal alignment following fusion. 
      Multivariable logistic regression was used to model the achievement of a CSI 
      based on two commonly cited MCID values. RESULTS: A total of 231 patients fit the 
      inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 
      16% exceeded an MCID value of 0.390. Statistically significant independent 
      predictors of not obtaining a CSI for an MCID threshold of 0.100 included a 
      higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). 
      For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a 
      diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas 
      spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For 
      both MCID values, patients who achieved a CSI had better postoperative quality of 
      life (QOL) scores for all metrics measured, despite worse QOL scores 
      preoperatively. CONCLUSIONS: This study is the first to use a combination of 
      medical, surgical, and postoperative sagittal balance variables as determinants 
      for the achievement of a CSI after lumbar fusion. The awareness of these 
      predictors may allow for better patient selection and surgical approach to 
      decrease the probability of acquiring a poor outcome postoperatively.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Alentado, Vincent J
AU  - Alentado VJ
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA.
FAU - Caldwell, Stephanie
AU  - Caldwell S
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA; Case Western Reserve University School of 
      Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA.
FAU - Gould, Heath P
AU  - Gould HP
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA; Case Western Reserve University School of 
      Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA.
FAU - Steinmetz, Michael P
AU  - Steinmetz MP
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland 
      Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
FAU - Benzel, Edward C
AU  - Benzel EC
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland 
      Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
FAU - Mroz, Thomas E
AU  - Mroz TE
AD  - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, 
      S-40, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland 
      Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA. Electronic address: 
      mrozt@ccf.org.
LA  - eng
PT  - Journal Article
DEP - 20160921
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Aged
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Lumbosacral Region/diagnostic imaging/*surgery
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*diagnosis
MH  - Quality of Life
MH  - Retrospective Studies
MH  - Spinal Fusion/adverse effects/*methods
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Depression
OT  - Lumbar fusion
OT  - Minimum clinically important difference
OT  - Outcomes
OT  - Quality of life
OT  - Spondylolisthesis
EDAT- 2016/10/25 06:00
MHDA- 2017/07/01 06:00
CRDT- 2016/09/25 06:00
PHST- 2016/07/15 00:00 [received]
PHST- 2016/09/14 00:00 [accepted]
PHST- 2016/10/25 06:00 [pubmed]
PHST- 2017/07/01 06:00 [medline]
PHST- 2016/09/25 06:00 [entrez]
AID - S1529-9430(16)30961-5 [pii]
AID - 10.1016/j.spinee.2016.09.011 [doi]
PST - ppublish
SO  - Spine J. 2017 Feb;17(2):236-243. doi: 10.1016/j.spinee.2016.09.011. Epub 2016 Sep 
      21.