PMID- 32384932 OWN - NLM STAT- MEDLINE DCOM- 20210201 LR - 20210201 IS - 1471-2474 (Electronic) IS - 1471-2474 (Linking) VI - 21 IP - 1 DP - 2020 May 8 TI - Definitions of unfavorable surgical outcomes and their risk factors based on disability score after spine surgery for lumbar spinal stenosis. PG - 288 LID - 10.1186/s12891-020-03323-0 [doi] LID - 288 AB - BACKGROUND: Risk factors for unfavorable surgical outcomes are dependent on the definitions of the unfavorable surgical outcomes. The aims of this study were to compare risk factors for each unfavorable surgical outcome according to two different definitions of "unfavorable" surgical outcomes after surgery for lumbar spinal stenosis (LSS) as well as compare the clinical course from the preoperative period to 3 years postoperatively between cases with favorable and unfavorable outcomes according to the two different definitions. METHODS: Overall, 295 patients who underwent spine surgery for LSS and a follow-up evaluation at 3 years postoperatively were enrolled and divided into favorable and unfavorable groups, based on two different definitions for unfavorable surgical outcomes, as evaluated at 12 months postoperatively: the patient-reported outcome (PRO) and minimal clinically important difference (MCID) methods. In the PRO method, patients with a postoperative Oswestry Disability Index (ODI) score > 22 were considered as having an "unfavorable" outcome, whereas in the MCID method, those with a postoperative ODI score that changed < 12.8 points from the preoperative value were classified as having an "unfavorable" outcome. As a primary outcome, risk factors for unfavorable surgical outcomes according to each definition were investigated at 12 months postoperatively. RESULTS: In the PRO method, female sex (P = 0.011; odds ratio (OR): 2.340), elementary school attainment (vs. university attainment; P = 0.035; OR: 2.875), and higher preoperative ODI score (P = 0.028; OR: 2.340) were associated with higher odds for an unfavorable surgical outcome. In the MCID method, a higher preoperative ODI score was associated with higher odds (P < 0.001; OR: 0.920) of a favorable surgical outcome. In the PRO method, the favorable outcome group demonstrated significantly lower visual analog scale for back and leg pain and lower ODI scores than the unfavorable outcome group at 3 years postoperatively, whereas in the MCID method, clinical outcomes were not different between the two groups at 3 years postoperatively. CONCLUSION: A higher preoperative ODI score may be a risk factor for postoperative ODI > 22 after surgery for LSS. It may also be associated with higher odds for improvements in the ODI score of > 12.8. FAU - Kim, Gang-Un AU - Kim GU AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. AD - Department of Orthopaedic Surgery, Hanil General Hospital, 308 Uicheon-ro, Dobong-gu, Seoul, 01450, Republic of Korea. FAU - Park, Jiwon AU - Park J AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. FAU - Kim, Ho-Joong AU - Kim HJ AUID- ORCID: 0000-0002-8205-4648 AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. oshjkim@gmail.com. FAU - Shen, Feng AU - Shen F AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. FAU - Cho, Jaewoo AU - Cho J AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. FAU - Chang, Bong-Soon AU - Chang BS AD - Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 28 Yeonkeon-dong, Chongro-gu, Seoul, 110-744, Republic of Korea. FAU - Lee, Choon-Ki AU - Lee CK AD - Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 28 Yeonkeon-dong, Chongro-gu, Seoul, 110-744, Republic of Korea. FAU - Chun, Heoung-Jae AU - Chun HJ AD - Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, 03722, Republic of Korea. FAU - Yeom, Jin S AU - Yeom JS AD - Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea. LA - eng GR - 2016R1A2B3012850/National Research Foundation of Korea/ PT - Journal Article PT - Observational Study DEP - 20200508 PL - England TA - BMC Musculoskelet Disord JT - BMC musculoskeletal disorders JID - 100968565 SB - IM MH - Aged MH - Back Pain/etiology MH - *Disability Evaluation MH - Female MH - Follow-Up Studies MH - Humans MH - Longitudinal Studies MH - Lumbar Vertebrae/physiopathology/*surgery MH - Male MH - Middle Aged MH - Neurosurgical Procedures/*adverse effects MH - *Patient Reported Outcome Measures MH - Postoperative Complications/*etiology MH - Prospective Studies MH - Retrospective Studies MH - Risk Factors MH - Spinal Stenosis/*surgery MH - Treatment Outcome MH - Visual Analog Scale PMC - PMC7206812 OTO - NOTNLM OT - Lumbar spinal stenosis OT - Minimal clinically important difference OT - Patient-reported outcomes OT - Spine surgery COIS- The authors declare no competing interests. EDAT- 2020/05/10 06:00 MHDA- 2021/02/02 06:00 PMCR- 2020/05/08 CRDT- 2020/05/10 06:00 PHST- 2019/12/08 00:00 [received] PHST- 2020/04/30 00:00 [accepted] PHST- 2020/05/10 06:00 [entrez] PHST- 2020/05/10 06:00 [pubmed] PHST- 2021/02/02 06:00 [medline] PHST- 2020/05/08 00:00 [pmc-release] AID - 10.1186/s12891-020-03323-0 [pii] AID - 3323 [pii] AID - 10.1186/s12891-020-03323-0 [doi] PST - epublish SO - BMC Musculoskelet Disord. 2020 May 8;21(1):288. doi: 10.1186/s12891-020-03323-0.