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Observational Study
. 2023 Jul;32(7):2303-2318.
doi: 10.1007/s00586-023-07754-w. Epub 2023 May 26.

Predictors of poor outcome following lumbar spinal fusion surgery: a prospective observational study to derive two clinical prediction rules using British Spine Registry data

Alison B Rushton  1   2 , Feroz Jadhakhan  3 , Martin L Verra  4 , Andrew Emms  5 , Nicola R Heneghan  3 , Deborah Falla  3 , Michael Reddington  6 , Ashley A Cole  7 , Paul C Willems  8 , Lorin Benneker  9 , David Selvey  10 , Michael Hutton  11 , Martijn W Heymans  12 , J Bart Staal  13
Affiliations
Observational Study

Predictors of poor outcome following lumbar spinal fusion surgery: a prospective observational study to derive two clinical prediction rules using British Spine Registry data

Alison B Rushton et al. Eur Spine J. 2023 Jul.

Abstract

Purpose: Lumbar spinal fusion surgery (LSFS) is common for lumbar degenerative disorders. The objective was to develop clinical prediction rules to identify which patients are likely to have a favourable outcome to inform decisions regarding surgery and rehabilitation.

Methods: A prospective observational study recruited 600 (derivation) and 600 (internal validation) consecutive adult patients undergoing LSFS for degenerative lumbar disorder through the British Spine Registry. Definition of good outcome (6 weeks, 12 months) was reduction in pain intensity (Numerical Rating Scale, 0-10) and disability (Oswestry Disability Index, ODI 0-50) > 1.7 and 14.3, respectively. Linear and logistic regression models were fitted and regression coefficients, Odds ratios and 95% CIs reported.

Results: Lower BMI, higher ODI and higher leg pain pre-operatively were predictive of good disability outcome, higher back pain was predictive of good back pain outcome, and no previous surgery and higher leg pain were predictive of good leg pain outcome; all at 6 weeks. Working and higher leg pain were predictive of good ODI and leg pain outcomes, higher back pain was predictive of good back pain outcome, and higher leg pain was predictive of good leg pain outcome at 12 months. Model performance demonstrated reasonable to good calibration and adequate/very good discrimination.

Conclusions: BMI, ODI, leg and back pain and previous surgery are important considerations pre-operatively to inform decisions for surgery. Pre-operative leg and back pain and work status are important considerations to inform decisions for management following surgery. Findings may inform clinical decision making regarding LSFS and associated rehabilitation.

Keywords: Clinical prediction rules; Lumbar spinal fusion surgery; Prospective observational study; Rehabilitation; Surgery.

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