Can 3-month models or observed 3- or 6-month patient-reported outcome measures accurately predict 12-month disability and pain after lumbar decompressive surgery?

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Geere, Jonathan H., Hunter, Paul R., Cook, Andrew J. and Rai, Amarjit S. (2025) Can 3-month models or observed 3- or 6-month patient-reported outcome measures accurately predict 12-month disability and pain after lumbar decompressive surgery? Archives of Orthopaedic and Trauma Surgery, 145. ISSN 0936-8051

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Abstract

Introduction: Most lumbar decompressive surgery patients experience symptom improvement to 3 months, after which about 13% experience a clinically relevant deterioration. Patient-reported outcome measures (PROMs) are accepted as indicators of clinical outcome, but the earliest timepoint when PROMs stabilise is unknown and few studies have assessed risk factors for symptom deterioration. This study aimed to identify risk factors for symptom deterioration and identify whether 3-month models or observed 3- or 6-month outcomes accurately predict 12-month disability and pain.   Methods: The development cohort included 1096 prospectively collected discectomy or laminectomy cases with or without single-level fusion from 01/01/2008–31/12/2020 at a single centre. Three-month models were developed using baseline clinical variables and 3-month PROM. The primary 12-month outcome was the Oswestry Disability Index (ODI), and secondary outcomes were back and leg pain. Validation was on 364 cases from 01/01/2021–31/12/2022. Predictive accuracy was evaluated by interclass correlation coefficient (ICC) and by area-under-the-curve (AUC) to classify to a minimal clinically important difference (MCID). MCID concordance rates for observed 3-month and 6-month with 12-month PROM were calculated.   Results: Three-month predictors of 12-month disability and pain were condition duration, smoking, diabetes, rheumatic disorder, lower limb arthroplasty, mobility aided, underweight (BMI < 18.5 kg/m2), and 3-month PROM. ODI model and observed 3-month ODI had equivalent ICC and AUC values. Observed 3-month ODI ICC was 0.71 [95% confidence intervals (CI) 0.68–0.74] and AUC was 0.83 [95%CI 0.80–0.86]. Observed 6-month ODI ICC was 0.82 [95%CI 0.79–0.85] and AUC was 0.92 [95%CI 0.89–0.95]. MCID concordance for 3-month ODI was 84% and 6-month ODI was 91%.   Conclusion: Symptom deterioration after 3 months is linked to baseline factors. This study demonstrates that 6-month PROM accurately predict individual patient 12-month disability and pain after 1–2 level discectomy or laminectomy. Fusion surgery requires a minimum 12-month PROM follow-up.

Item Type: Article
Additional Information: Data availability statement: Due to data protection regulations, the datasets generated and analysed during the current study are not publicly available. However, we are committed to supporting further research and are willing to collaborate with other researchers for additional analyses. Interested parties can contact the corresponding author to discuss potential collaborations and access to the data under appropriate confidentiality agreements. Funding information: No funds, grants, or other support was received.
Uncontrolled Keywords: discectomy,lumbar surgery,outcomes,spine register,stenosis,surgery,orthopedics and sports medicine ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School:
Faculty of Medicine and Health Sciences > Norwich Medical School
University of East Anglia Research Groups/Centres > Theme - ClimateUEA
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Social Sciences > Research Centres > Water Security Research Centre
Faculty of Medicine and Health Sciences > Research Centres > Population Health
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Depositing User: LivePure Connector
Date Deposited: 01 May 2025 16:30
Last Modified: 06 May 2025 08:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/99181
DOI: 10.1007/s00402-025-05877-x

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