Search

Background and aims: Previous studies in lumbar spine surgery have mainly studied functioning and pain by comparing average scores from Patient Reported Outcome Measures (PROMs) at different time points. Less is known about these changes in different subgroups. It is self-evident that, while most patients may demonstrate trajectories of these changes close to the average one, some groups may follow more or less different trends. Also, it is unclear which preoperative factors may affect the probability of being classified into groups with different development trajectories of surgical outcome. The objective of this study was to identify groups exhibiting distinct trajectories within the broader cohort of patients undergoing lumbar spine surgery and to determine whether certain factors may be associated with a probability of being classified into a particular group. Methods: This was a register-based study of 1,451 patients undergoing lumbar spine surgery. The group-based trajectory analysis was used separately for leg pain, for back pain, and for functioning. The probability of group membership was calculated based on sex, age, leg and back pain duration before surgery, and obesity. Results: Two kinds of group-based trajectories were identified for each of three-factor variables: a long-term and a short-term improvement group. Sex and age were not associated with being classified into short-term improvement groups, but obesity was associated for all three-factor variables with relative risk ratios (RRR) varying from 1.26 (95% CI 1.02 to 1.56) to 1.45 (95% CI 1.10 to 1.90). Preoperative leg and back pain duration was significantly associated solely with back pain severity with an RRR of 1.28 (95% CI 1.01 to 1.61). Conclusions: The results of this study suggest that most of the patients may experience pain relief and improved functioning within three months after lumbar surgery, and this effect may last, at least, for two years. Higher BMI and worse preoperative pain and disability were associated with the inferior outcome of surgery. When considering surgery, planning pre- and postoperative rehabilitation, or forecasting the use of pain medications, a higher probability of worse outcome could be expected for overweight and initially more painful patients with higher level of disability. [ABSTRACT FROM AUTHOR]

To investigate if the responses to the Neck Disability Index (NDI) may produce some differential item functioning (DIF) comparing men and women. Register-based study among patients undergoing cervical surgery. Item response theory (IRT) analysis including a model for detecting a DIF. Of 338 patients, 171 (51%) were women and 167 (49%) were men. The mean age was 54.0 years. For most of the items, the average level of disability in a studied sample was associated with the middle point of the scale. The ability to distinguish people with different levels of disability was high or perfect for seven out of 10 items. While the DIF could be seen for all 10 items, only three items demonstrated statistically significant DIF – "pain intensity", "headaches" and "recreation". While the other seven items did not show statistically significant DIFs, better discrimination (steeper curves) for women could be graphically observed for "personal care", "lifting", "work", "driving" and "sleeping". It seemed that the NDI may behave differently depending on the sex of respondents. Several items of the NDI may be more precise and more sensitive when detecting restrictions in functioning among women compared to men. This finding should be taken into account when using the NDI in research and clinical practice. While the Neck Disability Index have been found to be a reliable and valid scale, potential differences in its properties across different sexes have mostly remained uninvestigated. This study showed that the Neck Disability Index may behave differently depending on the sex of respondents. Several items of the Neck Disability Index were more precise and sensitive when detecting restrictions in functioning among women compared to men. This difference should be taken into account when using the NDI in research and clinical practice. [ABSTRACT FROM AUTHOR]

Background and purpose - The role of pelvic incidence in hip disorders is unclear. Therefore, we undertook a literature review to evaluate the evidence on that role. Methods - A search was carried out on MEDLINE, SCOPUS, CENTRAL, and CINAHL databases. Quantitative analysis was based on comparison with a reference population of asymptomatic subjects. Results - The search resulted in 326 records: 15 studies were analyzed qualitatively and 13 quantitatively. The estimates of pelvic incidence varied more than 10 degrees from 47 (SD 3.7) to 59 (SD 14). 2 studies concluded that higher pelvic incidence might contribute to the development of coxarthrosis while 1 study reported the opposite findings. In 2 studies, lower pelvic incidence was associated with a mixed type of femoroacetabular impingement. We formed a reference population from asymptomatic groups used or cited in the selected studies. The reference comprised 777 persons with pooled average pelvic incidence of 53 (SD 10) degrees. The estimate showed a relatively narrow 95% CI of 52 to 54 degrees. The 95% CIs of only 4 studies did not overlap the CIs of reference: 2 studies on coxarthrosis, 1 on mixed femoroacetabular impingement, and 1 on ankylosing spondylitis Interpretation - We found no strong evidence that pelvic incidence plays any substantial role in hip disorders. Lower pelvic incidence may be associated with the mixed type of femoroacetabular impingement and hip problems amongst patients with ankylosing spondylitis. The evidence on association between pelvic incidence and coxarthrosis remained inconclusive. [ABSTRACT FROM AUTHOR]

Background and Purpose:  While the rates of lumbar spinal stenosis (LSS) surgery have increased continuously internationally, the role of fusion surgery in the treatment of LSS has been under debate. We aimed to assess the outcome of LSS surgery at 1 year postoperatively and to compare decompression surgery with or without fusion based on the Finnish national spine register FinSpine data., Methods:  FinSpine data of surgically treated LSS from 2015 to 2022 was included. The primary outcome was Oswestry Disability Index (ODI), and secondary ones were Visual Analogue Scale for leg and back pain. Predetermined minimal clinically important difference (MCID) for all outcome measures was used to assess the clinical significance of differences in outcomes. Propensity score matching was utilized to ensure that the treatment groups were comparable., Results:  There were 8,647 LSS patients in the data, of whom 6,751 (77%) were the subject of decompression surgery. Over 90% of patients without spondylolisthesis received decompression alone. At 1-year follow-up, ODI was on average 20.6 (95% confidence interval [CI] 19.3-21.9]) for the fusion group and 23.3 (CI 22.5-24.0) for the decompression group. Differences in ODI, VAS leg pain, or VAS back pain were below the MCID. The share of patients reaching ODI percentage change score ≥ 30% was 74% (CI 71-78) in the fusion group and 66% (CI 63-68) in the decompression group., Conclusion:  Most of the LSS patients experienced significant improvement after LSS surgery. We found no clinical differences between decompression surgery with and without fusion.

Background and Purpose:  The Oswestry Disability Index has usually only been used as a composite score but, according to previous studies, disability caused by back pain may be too broad a concept to be explained by a single number. We aimed to analyze changes in each ODI item's score from preoperative to 3, 12, and 24 months after surgery by creating a functional profile., Methods:  This was a register-based study of 1,451 patients undergoing lumbar spinal surgery between 2018 and 2021. The patients responded to a repeated survey preoperatively and 3, 12, and 24 months after surgery. The significance of change in the ODI items' scores was assessed by a symmetry test., Results:  All the ODI items' scores and total score improved between baseline and 3-month follow-up (P < 0.001). The magnitude of this improvement varied across different items. After 3 months, no significant change was seen for most of the items., Conclusion:  During a postoperative 2-year follow-up, individual items of the ODI demonstrated changes of different magnitude. The results imply that the use of a single composite score of the ODI might be insufficient to describe changes in functioning among patients undergoing lumbar spinal surgery. Instead, in some situations, creating a functional profile based on the scores from individual items may be a better solution to describe the changes in disability level.

Background: The Oswestry Disability Index (ODI) is a well-validated and widely used patient-reported outcome instrument to evaluate lumbar spinal stenosis (LSS) patients' treatment outcomes. The objective of the present study was to determine long the average interval between 2 preoperative measurements can be before a clinically significant difference of 10 points or more might appear., Methods: This was a retrospective observational study utilizing prospectively collected data from a single university hospital database, which was compatible with the national registry. One hundred and four surgically treated LSS patients were included in this observational study using systematic sampling. The preoperative ODI score was obtained at 2 timepoints. The 2-month mark as a potential turning point was of special interest, as the registry in question excludes preoperative data as outdated if the data are older than 2 months. Possible time dependence of the change in ODI scores was explored using a linear mixed-effects model with ODI as the dependent variable and interval length, sex, age, body mass index (BMI), and the presence of a concomitant disease as fixed effects., Results: The mean ODI score was 41.7 points (SD = 16.0) at the first and 41.1 points (SD = 15.5) at the second measurement. Mean time between the ODI scores was 74 days (range 8-361). On average, ODI changed by 9.17 points (SD = 7.16) between the 2 measurements, increasing for 48 patients, remaining unchanged for 9 patients, and decreasing for 47 patients. The arithmetic mean of the changes was -0.60 points and the median was 0.00 points. The estimated change in the population mean was -0.0005 points/day (95% CI [-0.022, 0.022], P = 0.97), meaning that we have strong evidence that the change in the mean is not clinically significant for up to 15 months (95% CI between ±10 points). Furthermore, no evidence was found that age, sex, BMI, or concomitant diseases were associated with the change of ODI score over time. Furthermore, the probability to observe a clinically significant change in a patient did not depend on the number of days between the 2 measurements (OR 1.003, 95% CI [0.997, 1.010], P = 0.30). Variance in ODI change did not grow over time., Conclusions: The probability of observing a clinically significant differences does not depend on the length of the observation interval, and ODI scores can be considered equally reliable for a significantly longer time than 2 months, even up to 1 year., Clinical Relevance: Preoperative ODI scores do not lose reliability up to 1 year in patients undergoing operatively treatment for LSS., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2025 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Study Design: Systematic review and meta-analysis., Objective: To investigate evidence on the prevalence and timeline of RTW after lumbar microdiskectomy., Summary of Background Data: While lumbar microdiskectomy is a widely used and well-studied procedure, there is lack of evidence on the postoperative prevalence and schedule of return to work after this type of surgery., Methods: Search at Medline, Embase, Cinahl, Scopus and Web of Science. Assessment of risk of systematic bias using Quality in Prognosis Studies (QUIPS). Random effects meta-analysis and meta-regression. Adults undergoing lumbar microdiskectomy due to degenerative disc herniation, excluding spinal stenosis, percutaneous diskectomy, artificial disk, arthroplasty, laminectomy, fusion or symptoms of cauda equina., Results: Of identified 2,285 records, 31 were included in meta-analysis. Most of the studies had low risk of systematic bias. Pooling 21 studies, the mean prevalence of postoperative return to work was 78% (95% CI 71% to 83%). Pooling 13 studies the mean time of return to work was 4.79 (95% CI 3.88 to 5.70) weeks. The meta-regression of prevalence of return to work by the duration of follow-up resulted in significant but small coefficient of 0.02 (95% CI 0.01 to 0.03, P=0.006). There was considerable heterogeneity for all three models., Conclusion: The results of this review suggest that approximately 70%-80% of patients who undergo a microsurgical procedure for disc herniation return to work within the first month and a half. It also seems that returning to work after this period is quite unlikely. The duration of preoperative symptoms did not affect significantly the prevalence of RTW. Information about these trends should be taken into account both in the planning phase of the procedure and in setting goals for postoperative rehabilitation., Competing Interests: CONFLICT OF INTEREST: None to declare, (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)