Hébert Jeffrey J, Bigney Erin E, Nowell Sarah, Wang Shuaijin, Wedderkopp Niels, Small Christopher, Abraham Edward P, Attabib Najmedden, Evaniew Nathan, Paquet Jérôme, Charest-Morin Raphaele, Singh Supriya, Weber Michael H, Kelly Adrienne, Kingwell Stephen, Crawford Eric, Nataraj Andrew, Marion Travis, LaRue Bernard, Ahn Henry, Hall Hamilton, Fisher Charles G, Rampersaud Y Raja, Dea Nicolas, Bailey Christopher S, Manson Neil A
1Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.
2School of Allied Health, Murdoch University, Murdoch, Western Australia, Australia.
J Neurosurg Spine. 2024 Oct 4;42(1):33-42. doi: 10.3171/2024.6.SPINE24430. Print 2025 Jan 1.
This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making.
This retrospective cohort study included patients enrolled in the Canadian Spine Outcomes and Research Network who were diagnosed with lumbar disc pathology and radiculopathy and had undergone lumbar discectomy at one of 18 spine centers. Potential outcome predictors included preoperative demographic, health-related, and clinical prognostic factors. Clinical outcomes were 1) 2-year univariable latent trajectories of leg pain intensity (numeric pain rating scale) and 2) overall outcomes comprising multivariable trajectories showing the combined postoperative courses of leg and back pain intensity (numeric pain rating scale) together with pain-related disability (Oswestry Disability Index). Each outcome model identified a subgroup of patients classified as experiencing a poor outcome based on minimal change in their clinical status after surgery. Multivariable risk model performance and internal validity were evaluated with discrimination and calibration statistics based on bootstrap shrinkage with 500 resamplings.
The authors included data from 1142 patients (47.6% female). The trajectory models identified 3 subgroups based on the patients' postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery. Eleven individual demographic, health, and clinical factors predicted patients' poor leg pain and overall outcomes. The performance of the multivariable risk model for leg pain was inadequate, while the overall outcome model had acceptable discrimination, calibration, and internal validity for predicting a poor surgical outcome.
Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.
本研究旨在1）描述神经根病手术后2年腿部疼痛的轨迹及总体临床结局，2）确定术前预测不良临床结局轨迹的预后因素，3）开发并进行多变量预后模型的内部验证，以辅助临床决策。
这项回顾性队列研究纳入了加拿大脊柱结局与研究网络中被诊断为腰椎间盘病变和神经根病且在18个脊柱中心之一接受过腰椎间盘切除术的患者。潜在的结局预测因素包括术前人口统计学、健康相关及临床预后因素。临床结局为：1）腿部疼痛强度（数字疼痛评分量表）的2年单变量潜在轨迹；2）总体结局，包括多变量轨迹，显示腿部和背部疼痛强度（数字疼痛评分量表）与疼痛相关残疾（Oswestry残疾指数）的术后综合病程。每个结局模型都确定了一组患者，这些患者根据术后临床状态变化极小被归类为预后不良。基于500次重抽样的自举收缩法，利用判别和校准统计量评估多变量风险模型的性能和内部有效性。
作者纳入了1142例患者的数据（47.6%为女性）。轨迹模型根据患者术后疼痛或残疾病程确定了3个亚组：腿部疼痛模型中88.6%的患者以及总体结局模型中71.9%的患者预后良好至极佳。模型将11.4%（腿部疼痛结局）和28.2%（总体结局）的患者归类为临床结局不良，临床结局不良定义为术后疼痛或残疾改善极小。11个个体人口统计学、健康和临床因素预测了患者腿部疼痛和总体结局不良。腿部疼痛多变量风险模型的性能不足，而总体结局模型在预测手术不良结局方面具有可接受的判别、校准和内部有效性。
腰椎神经根病患者在腰椎间盘切除术后疼痛和残疾的术后轨迹存在异质性。个体术前因素与术后结局相关，可纳入多变量风险模型以预测患者总体结局。这些结果可能为临床实践提供参考，但在可靠地应用于临床之前需要外部验证。
