Influence of previous surgery on patient-rated outcome after surgery for degenerative disorders of the lumbar spine.
- Zehnder P Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
- Aghayev E Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3012, Bern, Switzerland.
- Fekete TF Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
- Haschtmann D Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
- Pigott T Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK.
- Mannion AF Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland. anne.mannion@yahoo.com.
- 2016-01-24
Published in:
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - 2016
COMI
Degenerative disorders of the lumbar spine
Patient-rated outcome
Previous surgery
Spine Tango
Aged
Female
Humans
Intervertebral Disc Displacement
Lumbar Vertebrae
Male
Middle Aged
Retrospective Studies
Spondylolisthesis
Treatment Outcome
English
PURPOSE
Few studies have used multivariate models to quantify the effect of multiple previous spine surgeries on patient-oriented outcome after spine surgery. This study sought to quantify the effect of prior spine surgery on 12-month postoperative outcomes in patients undergoing surgery for different degenerative disorders of the lumbar spine.
METHODS
The study included 4940 patients with lumbar degenerative disease documented in the Spine Tango Registry of EUROSPINE, the Spine Society of Europe, from 2004 to 2015. Preoperatively and 12 months postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI; 0-10 scale). Patients' medical history and surgical details were recorded using the Spine Tango Surgery 2006 and 2011 forms. Multiple linear regression models were used to investigate the relationship between the number of previous surgeries and the 12-month postoperative COMI score, controlling for the baseline COMI score and other potential confounders.
RESULTS
In the adjusted model including all cases, the 12-month COMI score showed a 0.37-point worse value [95 % confidence intervals (95 % CI) 0.29-0.45; p < 0.001] for each additional prior spine surgery. In the subgroup of patients with lumbar disc herniation, the corresponding effect was 0.52 points (95 % CI 0.27-0.77; p < 0.001) and in lumbar degenerative spondylolisthesis, 0.40 points (95 % CI 0.17-0.64; p = 0.001).
CONCLUSIONS
We were able to demonstrate a clear "dose-response" effect for previous surgery: the greater the number of prior spine surgeries, the systematically worse the outcome at 12 months' follow-up. The results of this study can be used when considering or consenting a patient for further surgery, to better inform the patient of the likely outcome and to set realistic expectations.
Few studies have used multivariate models to quantify the effect of multiple previous spine surgeries on patient-oriented outcome after spine surgery. This study sought to quantify the effect of prior spine surgery on 12-month postoperative outcomes in patients undergoing surgery for different degenerative disorders of the lumbar spine.
METHODS
The study included 4940 patients with lumbar degenerative disease documented in the Spine Tango Registry of EUROSPINE, the Spine Society of Europe, from 2004 to 2015. Preoperatively and 12 months postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI; 0-10 scale). Patients' medical history and surgical details were recorded using the Spine Tango Surgery 2006 and 2011 forms. Multiple linear regression models were used to investigate the relationship between the number of previous surgeries and the 12-month postoperative COMI score, controlling for the baseline COMI score and other potential confounders.
RESULTS
In the adjusted model including all cases, the 12-month COMI score showed a 0.37-point worse value [95 % confidence intervals (95 % CI) 0.29-0.45; p < 0.001] for each additional prior spine surgery. In the subgroup of patients with lumbar disc herniation, the corresponding effect was 0.52 points (95 % CI 0.27-0.77; p < 0.001) and in lumbar degenerative spondylolisthesis, 0.40 points (95 % CI 0.17-0.64; p = 0.001).
CONCLUSIONS
We were able to demonstrate a clear "dose-response" effect for previous surgery: the greater the number of prior spine surgeries, the systematically worse the outcome at 12 months' follow-up. The results of this study can be used when considering or consenting a patient for further surgery, to better inform the patient of the likely outcome and to set realistic expectations.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s00586-016-4383-x
- PMID 26801193
- Persistent URL
- https://sonar.ch/global/documents/278720
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