Departments of1Neurosurgery and.
4Wayne State University School of Medicine, Detroit, Michigan.
J Neurosurg Spine. 2023 Jun 16;39(4):452-461. doi: 10.3171/2023.5.SPINE23249. Print 2023 Oct 1.
There is a scarcity of large multicenter data on how preoperative lumbar symptom duration relates to postoperative patient-reported outcomes (PROs). The objective of this study was to determine the effect of preoperative and baseline symptom duration on PROs at 90 days, 1 year, and 2 years after lumbar spine surgery.
The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations between January 1, 2017, to December 31, 2021, with a follow-up of 2 years. Patients were stratified into three subgroups based on symptom duration: < 3 months, 3 months to < 1 year, and ≥ 1 year. The primary outcomes were reaching the minimal clinically important difference (MCID) for the PROs (i.e., leg pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), EQ-5D, North American Spine Society satisfaction, and return to work). The EQ-5D score was also analyzed as a continuous variable to calculate quality-adjusted life years. Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios, with the < 3-month cohort used as the reference.
There were 37,223 patients (4670 with < 3-month duration, 9356 with 3-month to < 1-year duration, and 23,197 with ≥ 1-year duration) available for analysis. Compared with patients with a symptom duration of < 1 year, patients with a symptom duration of ≥ 1 year were significantly less likely to achieve an MCID in PROMIS PF, EQ-5D, back pain relief, and leg pain relief at 90 days, 1 year, and 2 years postoperatively. Similar trends were observed for patient satisfaction and return to work. With the EQ-5D score as a continuous variable, a symptom duration of ≥ 1 year was associated with 0.04, 0.05, and 0.03 (p < 0.001) decreases in EQ-5D score at 90 days, 1 year, and 2 years after surgery, respectively.
A symptom duration of ≥ 1 year was associated with poorer outcomes on several outcome metrics. This suggests that timely referral and surgery for degenerative lumbar pathology may optimize patient outcome.
关于术前腰椎症状持续时间与术后患者报告的结局（PROs）之间的关系，目前缺乏大型多中心数据。本研究的目的是确定术前和基线症状持续时间对腰椎手术后 90 天、1 年和 2 年 PROs 的影响。
对密歇根州脊柱手术改进合作登记处 2017 年 1 月 1 日至 2021 年 12 月 31 日期间进行的所有腰椎手术进行了查询，随访时间为 2 年。根据症状持续时间将患者分为三组：<3 个月、3 个月至<1 年和≥1 年。主要结局是达到 PROs（即腿痛、患者报告的测量信息系统物理功能（PROMIS PF）、EQ-5D、北美脊柱协会满意度和重返工作岗位）的最小临床重要差异（MCID）。还对 EQ-5D 评分进行了连续变量分析，以计算质量调整生命年。使用多变量泊松广义估计方程模型报告调整后的风险比，<3 个月组作为参考。
共有 37223 例患者（4670 例症状持续时间<3 个月，9356 例症状持续时间 3 个月至<1 年，23197 例症状持续时间≥1 年）可供分析。与症状持续时间<1 年的患者相比，症状持续时间≥1 年的患者在术后 90 天、1 年和 2 年时，PROMIS PF、EQ-5D、腰背疼痛缓解和腿痛缓解达到 MCID 的可能性明显较低。患者满意度和重返工作岗位也存在类似的趋势。作为连续变量的 EQ-5D 评分，症状持续时间≥1 年与术后 90 天、1 年和 2 年时 EQ-5D 评分分别下降 0.04、0.05 和 0.03（p<0.001）相关。
症状持续时间≥1 年与多项结局指标的结局较差相关。这表明，对于退行性腰椎病变，及时转诊和手术可能会优化患者的结局。
