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Association of prolonged symptom duration with poor outcomes in lumbar spine surgery: a Michigan Spine Surgery Improvement Collaborative study

Travis Hamilton Departments ofNeurosurgery and

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Seamus Bartlett Wayne State University School of Medicine, Detroit, Michigan;

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Nachiket Deshpande Michigan State University College of Human Medicine, East Lansing, Michigan;

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Moustafa Hadi Michigan State University College of Human Medicine, East Lansing, Michigan;

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Jared C. Reese Departments ofNeurosurgery and

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Tarek R. Mansour Departments ofNeurosurgery and

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Edvin Telemi Departments ofNeurosurgery and

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Kylie Springer Public Health Sciences and

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Lonni Schultz Public Health Sciences and

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David R. Nerenz Center for Health Services Research, Henry Ford Health, Detroit, Michigan;

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Muwaffak Abdulhak Departments ofNeurosurgery and

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Teck Soo Division of Neurosurgery, Ascension Providence Hospital, Farmington Hills, Michigan;

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Jason Schwalb Departments ofNeurosurgery and

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Jad G. Khalil Departments ofOrthopedics and

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Ilyas Aleem Departments ofOrthopedics and

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Richard Easton Department of Orthopedics, Beaumont Troy Hospital, Troy, Michigan

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Miguelangelo Perez-Cruet Neurosurgery, Beaumont Royal Oak Hospital, Royal Oak, Michigan;

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Paul Park Neurosurgery, University of Michigan, Ann Arbor, Michigan; and

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Victor Chang Departments ofNeurosurgery and

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Publication Date:
16 Jun 2023
Page Range:
1–10
Volume/Issue:
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DOI link:
https://doi.org/10.3171/2023.5.SPINE23249
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OBJECTIVE

有一个缺乏大型多中心数据在how preoperative lumbar symptom duration relates to postoperative patient-reported outcomes (PROs). The objective of this study was to determine the effect of preoperative and baseline symptom duration on PROs at 90 days, 1 year, and 2 years after lumbar spine surgery.

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The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations between January 1, 2017, to December 31, 2021, with a follow-up of 2 years. Patients were stratified into three subgroups based on symptom duration: < 3 months, 3 months to < 1 year, and ≥ 1 year. The primary outcomes were reaching the minimal clinically important difference (MCID) for the PROs (i.e., leg pain, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), EQ-5D, North American Spine Society satisfaction, and return to work). The EQ-5D score was also analyzed as a continuous variable to calculate quality-adjusted life years. Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios, with the < 3-month cohort used as the reference.

RESULTS

There were 37,223 patients (4670 with < 3-month duration, 9356 with 3-month to < 1-year duration, and 23,197 with ≥ 1-year duration) available for analysis. Compared with patients with a symptom duration of < 1 year, patients with a symptom duration of ≥ 1 year were significantly less likely to achieve an MCID in PROMIS PF, EQ-5D, back pain relief, and leg pain relief at 90 days, 1 year, and 2 years postoperatively. Similar trends were observed for patient satisfaction and return to work. With the EQ-5D score as a continuous variable, a symptom duration of ≥ 1 year was associated with 0.04, 0.05, and 0.03 (p < 0.001) decreases in EQ-5D score at 90 days, 1 year, and 2 years after surgery, respectively.

CONCLUSIONS

A symptom duration of ≥ 1 year was associated with poorer outcomes on several outcome metrics. This suggests that timely referral and surgery for degenerative lumbar pathology may optimize patient outcome.

ABBREVIATIONS

ASA = American Society of Anesthesiologists ; CAD = coronary artery disease ; CHF = congestive heart failure ; COPD = chronic obstructive pulmonary disease ; DVT = deep vein thrombosis ; GEE = generalized estimating equation ; MCID = minimal clinically important difference ; MI = myocardial infarction ; MSSIC = Michigan Spine Surgery Improvement Collaborative ; NASS = North American Spine Society ; OR = operating room ; PE = pulmonary embolism ; PRO = patient-reported outcome ; PROMIS PF = Patient-Reported Outcomes Measurement Information System Physical Function ; QALY = quality-adjusted life year ; SSI = surgical site infection ; UTI = urinary tract infection .
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Contributor Notes

CorrespondenceVictor Chang: Henry Ford Health, Detroit, MI.vchang1@hfhs.org.

INCLUDE WHEN CITINGPublished online June 16, 2023; DOI: 10.3171/2023.5.SPINE23249.

DisclosuresNerenz博士报道合同MSSIC coordinating center from Blue Cross Blue Shield of Michigan. Dr. Abdulhak reported salary support (paid to his employer) from Blue Cross Blue Shield; and being a consultant for and receiving royalties from SeaSpine, outside the submitted work. Dr. Schwalb reported salary support for his role as Co-Director of MSSIC (paid directly to his employer) from Blue Cross Blue Shield of Michigan during the conduct of the study; grants from Medtronic paid directly to his employer; being a consultant for Stimwave, Yates, McLamb & Weyher LLP, Jackson & Campbell PC, and BlueRock Therapeutics; having teaching/speaking agreements with Oregon Health Services University, Cleveland Clinic Foundation, and Michigan State University; and being on the scientific advisory board and holding another position with NeuroPoint Alliance, outside the submitted work. Dr. Khalil reported grants from Stryker, Medtronic, Relievant, DePuy Synthes, Centinel Spine, Limiflex, Fziomed, SI Bone, NuVasive, Synergy, and Nevro; personal fees from Centinel Spine, Boston Scientific, Nevro, NuVasive, Medtronic, Relievant, Stryker, SI Bone, Zimvie, Atheneum, and AAOS, outside the submitted work. Dr. Perez-Cruet reported stock ownership in Thompson MIS/BoneBac; being a consultant for and on the speakers bureau of Orthofix; and royalties from Thieme Publishing Inc., outside the submitted work; and a patent issued for Thompson MIS/Bonebac. Dr. Park reported personal fees from Globus, NuVasive, DePuy Spine, Accelus, and LifeNet; being a consultant for NuVasive and Globus Medical; grants from DePuy Spine, ISSG, Cerapedics, and SI Bone (paid to his employer); royalties from Globus; lodging and travel to meeting from Medtronic; having a speaking/teaching agreement with Globus Medical; and fellowship support from NREF, outside the submitted work. Dr. Chang reported salary support from Blue Cross Blue Shield; grants from Blue Cross Blue Shield; personal fees from Globus Medical and Bioventus; and being a consultant for Globus Medical, outside the submitted work.
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