Wood Lianne, Hunter Rebecca, Williamson Esther, Salem Khalid M, Sahota Opinder, Phillips Bethan E, Hendrick Paul, Lamb Sarah E
University of Exeter, Exeter, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Eur Spine J. 2025 Jun 4. doi: 10.1007/s00586-025-09000-x.
Surgery for lumbar spinal stenosis (LSS) has a variable outcome with many not returning to pre-condition activity levels. We aimed to explore the (1) baseline characteristics of UK patients undergoing surgery, and (2) association of patient characteristics with a clinically important improvement in the 6-month Oswestry Disability Index (ODI) in a population defined by previously developed LSS criteria.
We used data from the British Spinal Registry (BSR) (2012-2023). Anonymised data included demographics, patient reported outcome measures (PROMs) (ODI; visual analogue scale (VAS) for back and leg pain); quality of life (EQ-5D)) at baseline, and 6-weeks and 6-months post-surgery, surgical procedure, surgery duration and intra-operative blood loss. We used descriptive and multivariate analyses to estimate the association between variables and the minimum clinically important difference (MCID) (30% improvement from baseline) in 6-month disability (ODI). MCIDs define the smallest benefit of value to patients. We explored differences in baseline values between 6-month responders and the total database, and between primary and revision surgery.
In 6801 patients sampled from the BSR the mean age was 70.5 (SD 9.1), 51% (3452/6794) were female, and most were from higher socioeconomic areas (mean Index of Multiple Deprivation rank 84.3, SD 38.8). Preoperatively most had severe disability (ODI 48.7, SD 17.5), moderate leg (VAS 7.0, SD 2.4) and back pain (VAS 6.3, SD 2.5). Proportionally 58% (1160/2008) of the 6-month responders achieved the MCID in ODI. Higher baseline back pain intensity (odds ratio (OR) 0.9, 95%CI 0.9, 0.9), revision surgery (OR 0.5 95%CI 0.3, 0.8), higher 6-week leg pain intensity (OR 0.9, 95%CI 0.8, 1.0) and severe 6-week disability (OR 0.3, 95%CI 0.2, 0.5) reduced the odds of achieving the MCID in 6-month ODI.
Patients undergoing surgery in the UK are severely disabled prior to surgery. The available data suggests that 42% of UK patients do not achieve a clinically important improvement in 6-month disability.
腰椎管狭窄症（LSS）手术的效果因人而异，许多患者无法恢复到术前的活动水平。我们旨在探讨：（1）接受手术的英国患者的基线特征；（2）在先前制定的LSS标准定义的人群中，患者特征与6个月Oswestry功能障碍指数（ODI）临床重要改善之间的关联。
我们使用了英国脊柱注册中心（BSR）（2012 - 2023年）的数据。匿名数据包括人口统计学信息、患者报告的结局指标（PROMs）（ODI；背部和腿部疼痛的视觉模拟量表（VAS））；基线时、术后6周和6个月时的生活质量（EQ - 5D）、手术方式、手术时长和术中失血量。我们使用描述性和多变量分析来估计变量与6个月功能障碍（ODI）中最小临床重要差异（MCID）（较基线改善30%）之间的关联。MCID定义了对患者有价值的最小益处。我们探讨了6个月有反应者与整个数据库之间以及初次手术和翻修手术之间基线值的差异。
在从BSR中抽取的6801例患者中，平均年龄为70.5岁（标准差9.1），51%（3452/6794）为女性，大多数来自社会经济地位较高地区（多重剥夺指数平均排名84.3，标准差38.8）。术前大多数患者有严重功能障碍（ODI 48.
