Koivunen Konsta, Arokoski Jari, Widbom-Kolhanen Sara, Pernaa Katri, Juhola Juhani, Saltychev Mikhail
Clinical Division, Turku University Hospital and University of Turku, Turku, Finland.
Division of Rehabilitation, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
PLoS One. 2025 Jan 9;20(1):e0313528. doi: 10.1371/journal.pone.0313528. eCollection 2025.
Previous studies in lumbar spine surgery have mainly studied functioning and pain by comparing average scores from Patient Reported Outcome Measures (PROMs) at different time points. Less is known about these changes in different subgroups. It is self-evident that, while most patients may demonstrate trajectories of these changes close to the average one, some groups may follow more or less different trends. Also, it is unclear which preoperative factors may affect the probability of being classified into groups with different development trajectories of surgical outcome. The objective of this study was to identify groups exhibiting distinct trajectories within the broader cohort of patients undergoing lumbar spine surgery and to determine whether certain factors may be associated with a probability of being classified into a particular group.
This was a register-based study of 1,451 patients undergoing lumbar spine surgery. The group-based trajectory analysis was used separately for leg pain, for back pain, and for functioning. The probability of group membership was calculated based on sex, age, leg and back pain duration before surgery, and obesity.
Two kinds of group-based trajectories were identified for each of three-factor variables: a long-term and a short-term improvement group. Sex and age were not associated with being classified into short-term improvement groups, but obesity was associated for all three-factor variables with relative risk ratios (RRR) varying from 1.26 (95% CI 1.02 to 1.56) to 1.45 (95% CI 1.10 to 1.90). Preoperative leg and back pain duration was significantly associated solely with back pain severity with an RRR of 1.28 (95% CI 1.01 to 1.61).
The results of this study suggest that most of the patients may experience pain relief and improved functioning within three months after lumbar surgery, and this effect may last, at least, for two years. Higher BMI and worse preoperative pain and disability were associated with the inferior outcome of surgery. When considering surgery, planning pre- and postoperative rehabilitation, or forecasting the use of pain medications, a higher probability of worse outcome could be expected for overweight and initially more painful patients with higher level of disability.
以往关于腰椎手术的研究主要通过比较患者报告结局量表（PROMs）在不同时间点的平均得分来研究功能和疼痛情况。对于不同亚组中的这些变化了解较少。不言而喻，虽然大多数患者可能表现出接近平均水平的这些变化轨迹，但某些组可能或多或少遵循不同的趋势。此外，尚不清楚哪些术前因素可能影响被归类到手术结局具有不同发展轨迹的组中的概率。本研究的目的是在接受腰椎手术的更广泛患者队列中识别出表现出不同轨迹的组，并确定某些因素是否可能与被归类到特定组的概率相关。
这是一项基于登记的对1451例接受腰椎手术患者的研究。基于组的轨迹分析分别用于腿痛、背痛和功能。基于性别、年龄、术前腿痛和背痛持续时间以及肥胖情况计算分组概率。
对于三个因素变量中的每一个都识别出了两种基于组的轨迹：一个长期改善组和一个短期改善组。性别和年龄与被归类到短期改善组无关，但肥胖与所有三个因素变量相关，相对风险比（RRR）从1.26（95%可信区间1.02至1.56）到1.45（95%可信区间1.10至1.90）不等。术前腿痛和背痛持续时间仅与背痛严重程度显著相关，RRR为1.28（95%可信区间1.01至1.61）。
本研究结果表明，大多数患者在腰椎手术后三个月内可能会经历疼痛缓解和功能改善，并且这种效果可能至少持续两年。较高的体重指数以及术前更严重的疼痛和残疾与较差的手术结局相关。在考虑手术、规划术前和术后康复或预测止痛药物的使用时，超重且最初疼痛更严重、残疾程度更高的患者预后较差的可能性更大。
