University of Rochester Medical Center, Department of Orthopaedics & Physical Performance, Rochester, NY, USA.
Spine (Phila Pa 1976). 2024 May 1;49(9):601-608. doi: 10.1097/BRS.0000000000004709. Epub 2023 May 8.
Retrospective review of a single institution cohort.
The goal of this study is to identify features that predict delayed achievement of minimum clinically important difference (MCID) following elective lumbar spine fusion using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys.
Preoperative prediction of delayed recovery following lumbar spine fusion surgery is challenging. While many studies have examined factors impacting the achievement of MCID for patient-reported outcomes in similar cohorts, few studies have assessed predictors of early functional improvement.
We retrospectively reviewed patients undergoing elective one-level posterior lumbar fusion for degenerative pathology. Patients were subdivided into two groups based on achievement of MCID for each respective PROMIS domain either before six months ("early responders") or after six months ("late responders") following surgical intervention. Multivariable logistic regression analysis was used to determine features associated with odds of achieving distribution-based MCID before or after six months follow up.
147 patients were included. The average age was 64.3±13.0 years. At final follow-up, 57.1% of patients attained MCID for PI and 72.8% for PF. However, 42 patients (49.4%) reached MCID for PI by six months, compared to 44 patients (41.1%) for PF. Patients with severe symptoms had the highest probability of attaining MCID for PI (OR 10.3; P =0.001) and PF (OR 10.4; P =0.001) Preoperative PROMIS symptomology did not predict early achievement of MCID for PI or PF. Patients who received concomitant iliac crest autograft during their lumbar fusion had increased odds of achieving MCID for PI (OR 8.56; P =0.001) before six months.
Our study demonstrated that the majority of patients achieved MCID following elective one-level lumbar spine fusion at long-term follow-up, although less than half achieved this clinical benchmark for each PROMIS metric by six months. We also found that preoperative impairment was not associated with when patients would achieve MCID. Further prospective investigations are warranted to characterize the trajectory of clinical improvement and identify the risk factors associated with poor outcomes more accurately.
单中心回顾性研究。
本研究旨在通过患者报告结局测量信息系统（PROMIS）调查，确定预测择期腰椎融合术后达到最小临床重要差异（MCID）的特征。
腰椎融合术后延迟恢复的预测具有挑战性。虽然许多研究已经检查了影响类似队列中患者报告结局达到 MCID 的因素，但很少有研究评估早期功能改善的预测因素。
我们回顾性分析了因退行性病变而行择期单节段后路腰椎融合术的患者。根据患者在手术干预后 6 个月内（“早期反应者”）或 6 个月后（“晚期反应者”）各自 PROMIS 域达到 MCID 的情况，将患者分为两组。多变量逻辑回归分析用于确定与 6 个月随访前后达到分布基础 MCID 的可能性相关的特征。
共纳入 147 例患者。平均年龄为 64.3±13.0 岁。最终随访时，57.1%的患者 PI 达到 MCID，72.8%的患者 PF 达到 MCID。然而，42 例（49.4%）患者在 6 个月时达到 PI 的 MCID，而 44 例（41.1%）患者达到 PF 的 MCID。症状严重的患者 PI（OR 10.3；P=0.001）和 PF（OR 10.4；P=0.001）达到 MCID 的可能性最高。术前 PROMIS 症状并不能预测 PI 或 PF 的早期 MCID 达到。在腰椎融合术中同时接受髂嵴自体移植物的患者 PI 达到 MCID 的可能性增加（OR 8.56；P=0.001）。
我们的研究表明，大多数患者在长期随访中达到了选择性单节段腰椎融合术后的 MCID，尽管不到一半的患者在 6 个月时达到了每个 PROMIS 指标的临床基准。我们还发现，术前损伤与患者何时达到 MCID无关。需要进一步的前瞻性研究来描述临床改善的轨迹，并更准确地确定与不良结局相关的风险因素。
