PMID- 32521016
OWN - NLM
STAT- MEDLINE
DCOM- 20210301
LR  - 20210301
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 87
IP  - 5
DP  - 2020 Oct 15
TI  - Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients 
      Undergoing Lumbar Spine Surgery.
PG  - 1037-1045
LID - 10.1093/neuros/nyaa240 [doi]
AB  - BACKGROUND: The impact of symptom characteristics on outcomes of spine surgery 
      remains elusive. OBJECTIVE: To determine the impact of symptom location, 
      severity, and duration on outcomes following lumbar spine surgery. METHODS: We 
      queried the Quality Outcomes Database (QOD) for patients undergoing elective 
      lumbar spine surgery for lumbar degenerative spine disease. Multivariable 
      regression was utilized to determine the impact of preoperative symptom 
      characteristics (location, severity, and duration) on improvement in disability, 
      quality of life, return to work, and patient satisfaction at 1 yr. Relative 
      predictor importance was determined using an importance metric defined as Wald chi2 
      penalized by degrees of freedom. RESULTS: A total of 22 022 subjects were 
      analyzed. On adjusted analysis, we found patients with predominant leg pain were 
      more likely to be satisfied (P < .0001), achieve minimum clinically important 
      difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to 
      work (P = .03) at 1 yr following surgery without significant difference in 
      Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal 
      leg and back pain were more likely to be satisfied (P < .0001), but showed no 
      significant difference in achieving MCID (P = .22) or return to work (P = .07). 
      Baseline numeric rating scale-leg pain and symptom duration were most important 
      predictors of achieving MCID and change in EQ-5D. Predominant symptom was not 
      found to be an important determinant of return to work. Worker's compensation was 
      found to be most important determinant of satisfaction and return to work. 
      CONCLUSION: Predominant symptom location is a significant determinant of 
      functional outcomes following spine surgery. However, pain severity and duration 
      have higher predictive importance. Return to work is more dependent on 
      sociodemographic features as compared to symptom characteristics.
CI  - Copyright (c) 2020 by the Congress of Neurological Surgeons.
FAU - Devin, Clinton J
AU  - Devin CJ
AD  - Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado.
AD  - Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas 
      Healthcare System, Charlotte, North Carolina.
FAU - Archer, Kristin R
AU  - Archer KR
AD  - Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
AD  - Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical 
      Center, Nashville, Tennessee.
FAU - Goyal, Anshit
AU  - Goyal A
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
FAU - Khan, Inamullah
AU  - Khan I
AD  - Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
FAU - Kerezoudis, Panagiotis
AU  - Kerezoudis P
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
FAU - Alvi, Mohammed Ali
AU  - Alvi MA
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
FAU - Pennings, Jacquelyn S
AU  - Pennings JS
AD  - Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
AD  - Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical 
      Center, Nashville, Tennessee.
FAU - Karacay, Bernes
AU  - Karacay B
AD  - Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, 
      Tennessee.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - Departments of Neurological Surgery, Duke University, Durham, North Carolina.
AD  - Departments of Orthopedic Surgery, Duke University, Durham, North Carolina.
FAU - Bisson, Erica F
AU  - Bisson EF
AD  - Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
FAU - Knightly, John J
AU  - Knightly JJ
AD  - Atlantic Neurosurgical Specialists, Morristown, New Jersey.
FAU - Mummaneni, Praveen V
AU  - Mummaneni PV
AD  - Department of Neurological Surgery, University of California, San Francisco, San 
      Francisco, California.
FAU - Foley, Kevin T
AU  - Foley KT
AD  - Department of Neurosurgery, University of Tennessee, Memphis, Tennessee.
FAU - Bydon, Mohamad
AU  - Bydon M
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Adult
MH  - Aged
MH  - Databases, Factual
MH  - Female
MH  - Humans
MH  - Intervertebral Disc Degeneration/*surgery
MH  - Low Back Pain/*surgery
MH  - Lumbar Vertebrae/surgery
MH  - Male
MH  - Middle Aged
MH  - Neurosurgical Procedures
MH  - *Patient Reported Outcome Measures
MH  - Patient Satisfaction
MH  - Quality of Life
MH  - *Symptom Assessment
MH  - *Treatment Outcome
OTO - NOTNLM
OT  - Back pain
OT  - Dominant symptom
OT  - Leg pain
OT  - Lumbar
OT  - Lumbar spine
OT  - Outcomes
OT  - Patient-reported outcomes
OT  - QOD
OT  - Quality Outcomes Database
OT  - Registry
OT  - Spine surgery
OT  - Spondylolisthesis
EDAT- 2020/06/11 06:00
MHDA- 2021/03/02 06:00
CRDT- 2020/06/11 06:00
PHST- 2019/09/10 00:00 [received]
PHST- 2020/04/08 00:00 [accepted]
PHST- 2020/06/11 06:00 [pubmed]
PHST- 2021/03/02 06:00 [medline]
PHST- 2020/06/11 06:00 [entrez]
AID - 5855653 [pii]
AID - 10.1093/neuros/nyaa240 [doi]
PST - ppublish
SO  - Neurosurgery. 2020 Oct 15;87(5):1037-1045. doi: 10.1093/neuros/nyaa240.