Melbourne Orthopaedic Group, 33 The Avenue, Windsor 3181, Melbourne, Victroria, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
Melbourne Orthopaedic Group, 33 The Avenue, Windsor 3181, Melbourne, Victroria, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
Spine J. 2024 Jul;24(7):1244-1252. doi: 10.1016/j.spinee.2024.03.018. Epub 2024 Apr 7.
Academic orthopedic journals and specialty societies emphasize the importance of two-year follow-up for patient-reported outcome measures (PROMS) after spine surgery, but there are limited data evaluating the appropriate length of follow-up.
To determine whether PROMs, as measured by the Oswestry Disability Index (ODI), would change significantly after 2-months postoperatively after lumbar decompression surgery for disc herniation or spinal stenosis.
Retrospective analysis of prospectively and consecutively enrolled patients undergoing lumbar decompression surgery between 2020 and 2021 from a single surgeon spine registry.
One hundred sixty-nine patients.
ODI, achievement of minimum clinically important difference (MCID), revisions.
Patients without a preoperative baseline score were excluded. Completion of the ODI questionnaire was assessed at the follow-up points. The median ODI was compared at time baseline, 2-month, 1-year and 2-year follow-up. Risk of reoperation was assessed with receiver operating characteristic (ROC) analysis to identify at-risk ODI thresholds of requiring reoperation.
Median ODI significantly improved at all time points compared to baseline (median baseline ODI: 40; 2-month ODI: 16, p=.001; 1-year ODI: 11.1, p=.001; 2-year ODI: 8, p=.001). Posthoc analysis demonstrated no difference between 2-months, 1-year and 2-year postoperative ODI (p=.9, p=.468, p=.606). The MCID was met in 87.9% of patients at 2 months, 80.7% at 1 year, and 87.3% at 2 years postoperatively. Twelve patients (7.7%) underwent revision surgery between 2 months and 2 years after the index surgery (median time to revision: 5.6 months). ROC curve analysis demonstrated that an ODI score ≥24 points at 2-months yielded a sensitivity of 85.7% and a specificity of 71.8% for predicting revision after lumbar decompression (AUC=0.758; 95% CI: 0.613-0.903). The Youden optimal threshold value of ≥24 points at 2-month postop ODI yielded an odd ratio (OR) for revision of 15.3 (CI: 1.8-131.8; p=.004). The positive predictive value (PPV) and negative predictive value (NPV) were 15.4% and 98.8%, respectively.
Two-year clinical follow-up may not be necessary for future peer-reviewed lumbar decompression surgery studies given that ODI plateaus at 8 weeks. Patients with a score ≥24 points at 2-months postoperatively have a higher risk of requiring a second surgery within the first 2 years and warrant continued follow-up.
学术骨科期刊和专业学会强调脊柱手术后患者报告结局测量（PROM）需要进行两年的随访，但评估适当随访时间长度的相关数据有限。
确定腰椎减压手术后，腰椎间盘突出症或腰椎狭窄症患者术后 2 个月时 Oswestry 功能障碍指数（ODI）是否会显著变化。
对 2020 年至 2021 年间一位脊柱外科医生的脊柱登记处连续纳入的患者进行前瞻性分析。
169 例患者。
ODI、达到最小临床重要差异（MCID）、翻修。
排除术前无基线评分的患者。在随访点评估 ODI 问卷的完成情况。比较基线、2 个月、1 年和 2 年随访时的中位数 ODI。使用受试者工作特征（ROC）分析评估再次手术的风险，以确定需要再次手术的 ODI 风险阈值。
与基线相比，所有时间点的中位数 ODI 均显著改善（基线 ODI 中位数：40；2 个月 ODI：16，p=.001；1 年 ODI：11.1，p=.001；2 年 ODI：8，p=.001）。术后 2 个月、1 年和 2 年的 ODI 比较差异无统计学意义（p=.9，p=.468，p=.606）。术后 2 个月时，87.9%的患者达到 MCID，1 年时为 80.7%，2 年时为 87.3%。12 例患者（7.7%）在索引手术后 2 个月至 2 年内接受了翻修手术（中位翻修时间：5.6 个月）。ROC 曲线分析显示，术后 2 个月时 ODI 评分≥24 分的患者预测腰椎减压后翻修的敏感性为 85.7%，特异性为 71.8%（AUC=0.758；95%CI：0.613-0.903）。术后 2 个月 ODI 最佳截断值≥24 分的约登指数得出的比值比（OR）为 15.3（95%CI：1.8-131.8；p=.004）。阳性预测值（PPV）和阴性预测值（NPV）分别为 15.4%和 98.8%。
考虑到 ODI 在 8 周时趋于平稳，未来关于腰椎减压的同行评审研究可能不需要 2 年的临床随访。术后 2 个月时评分≥24 分的患者在 2 年内需要再次手术的风险较高，需要持续随访。
