Hambrecht Jan, Köhli Paul, Duculan Roland, Lan Ranqing, Chiapparelli Erika, Guven Ali E, Evangelisti Gisberto, Burkhard Marco D, Tsuchiya Koki, Shue Jennifer, Sama Andrew A, Cammisa Frank P, Girardi Federico P, Mancuso Carol A, Hughes Alexander P
Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2025 Apr 1;50(7):447-453. doi: 10.1097/BRS.0000000000005076. Epub 2024 Jun 21.
Retrospective review of a prospective cohort study.
To identify the association between Oswestry Disability Index (ODI) subsections and overall improvement 2 years after lumbar surgery for degenerative lumbar spondylolisthesis (DLS).
DLS often necessitates lumbar surgery. The ODI is a trusted measure for patient-reported outcomes (PROMs) in assessing spinal disorder outcomes. Surgeons utilize the ODI for baseline functional assessment and postsurgery progress tracking. However, it remains uncertain if and how each subsection influences overall ODI improvement.
This retrospective cohort study analyzed patients who underwent lumbar surgery for DLS between 2016 and 2018. Preoperative and 2-year postoperative ODI assessments were conducted. The study analyzed postoperative subsection scores and defined ODI improvement as ODIpreop-ODIpostop >0. Univariate linear regression was applied, and receiver operating characteristic (ROC) analysis determined cutoffs for subsection changes and postoperative target values to achieve overall ODI improvement.
Two hundred sixty-five patients (60% female, mean age 67±8 yr) with a baseline ODI of 50±6 and a postoperative ODI of 20±7 were included. ODI improvement was noted in 91% (242 patients). Achieving a postoperative target score of ≤2 in subsections correlated with overall ODI improvement. Walking had the highest predictive value for overall ODI improvement (AUC: 0.91, sensitivity: 79%, and specificity: 91%). Pain intensity (AUC: 0.90, sensitivity: 86%, and specificity: 83%) and changing degree of pain (AUC: 0.87, sensitivity: 86%, and specificity: 74%) were also highly predictive. Sleeping had the lowest predictability (AUC: 0.79, sensitivity: 84%, and specificity: 65%). Except for sleeping, all subsections had a Youden index >50%.
These findings demonstrate how the different ODI subsections are associated with overall improvement post-lumbar surgery for DLS. This understanding is crucial for refining preoperative education, addressing particular disabilities, and evaluating surgical efficacy. In addition, it shows that surgical treatment does not affect all subsections equally.
对一项前瞻性队列研究进行回顾性分析。
确定腰椎退行性滑脱症（DLS）腰椎手术后2年时，奥斯维斯特残疾指数（ODI）各亚组与总体改善情况之间的关联。
DLS常常需要进行腰椎手术。ODI是评估脊柱疾病预后时用于患者报告结局（PROMs）的一项可靠指标。外科医生利用ODI进行基线功能评估和术后进展跟踪。然而，各亚组是否以及如何影响ODI总体改善仍不确定。
这项回顾性队列研究分析了2016年至2018年间因DLS接受腰椎手术的患者。进行了术前和术后2年的ODI评估。该研究分析了术后亚组评分，并将ODI改善定义为术前ODI - 术后ODI >0。应用单变量线性回归，通过受试者工作特征（ROC）分析确定亚组变化的临界值和术后目标值，以实现ODI总体改善。
纳入了265例患者（60%为女性，平均年龄67±8岁），基线ODI为50±6，术后ODI为20±7。91%（242例患者）出现了ODI改善。亚组术后目标评分≤2与ODI总体改善相关。行走对ODI总体改善的预测价值最高（曲线下面积：0.91，敏感性：79%，特异性：91%）。疼痛强度（曲线下面积：0.90，敏感性：86%，特异性：83%）和疼痛变化程度（曲线下面积：0.87，敏感性：86%，特异性：74%）也具有较高的预测性。睡眠的预测性最低（曲线下面积：0.79，敏感性：84%，特异性：65%）。除睡眠外，所有亚组的约登指数>50%。
这些发现表明了ODI不同亚组与DLS腰椎手术后总体改善之间的关联。这种认识对于完善术前教育、解决特定残疾问题以及评估手术疗效至关重要。此外，它表明手术治疗对所有亚组的影响并不相同。
