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Reassessing the minimum two-year follow-up standard after lumbar decompression surgery: a 2-months follow-up seems to be an acceptable minimum – Lumbar Spinal Stenosis

The article discusses the importance of patient-reported outcome measures (PROMS) after spine surgery, specifically lumbar decompression surgery for disc herniation or spinal stenosis. The study analyzed 169 patients undergoing surgery between 2020 and 2021, with a focus on the Oswestry Disability Index (ODI) scores at various follow-up points. The results showed that ODI significantly improved at all time points compared to baseline, with no significant difference between 2-month, 1-year, and 2-year postoperative ODI scores. The study suggests that two-year follow-up may not be necessary for future studies, as ODI plateaus at 8 weeks postoperatively. Patients with an ODI score ≥24 points at 2 months postoperatively have a higher risk of requiring revision surgery within the first two years. The findings highlight the importance of continued follow-up for these patients

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: Two-year clinical follow-up may not be necessary for future peer-reviewed lumbar decompression surgery studies given that ODI plateaus at 8 weeks. Patients with a score ≥ 24 points at 2-months postoperatively have a higher risk of requiring a second surgery within the first two years and warrant continued follow-up.

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Spine J. 2024 Apr 6:S1529-9430(24)00160-8. doi: 10.1016/j.spinee.2024.03.018. Online ahead of print. ABSTRACT BACKGROUND CONTEXT: Academic orthopaedic journals and specialty societies emphasize the importance of two-year follow-up for patient-reported outcome measures (PROMS) after spine surgery, but there are limited data evaluating the appropriate length of follow-up. PURPOSE: To determine whether PROMs, as measured by the Oswestry,

Spine J. 2024 Apr 6:S1529-9430(24)00160-8. doi: 10.1016/j.spinee.2024.03.018. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Academic orthopaedic journals and specialty societies emphasize the importance of two-year follow-up for patient-reported outcome measures (PROMS) after spine surgery, but there are limited data evaluating the appropriate length of follow-up.

PURPOSE: To determine whether PROMs, as measured by the Oswestry Disability Index (ODI), would change significantly after 2-months postoperatively after lumbar decompression surgery for disc herniation or spinal stenosis.

STUDY DESIGN: Retrospective analysis of prospectively and consecutively enrolled patients undergoing lumbar decompression surgery between 2020 and 2021 from a single surgeon spine registry.

PATIENT SAMPLE: One hundred sixty-nine patients OUTCOME MEASURES: ODI, achievement of minimum clinically important difference (MCID), revisions.

METHODS: Patients without a preoperative baseline score were excluded. Completion of the ODI questionnaire was assessed at the follow-up points. The median ODI was compared at time baseline, 2-month, 1-year and 2-year follow-up. Risk of reoperation was assessed with receiver operating characteristic (ROC) analysis to identify at-risk ODI thresholds of requiring reoperation.

RESULTS: Median ODI significantly improved at all time points compared to baseline (median baseline ODI: 40; 2-month ODI: 16, p = 0.001; 1-year ODI: 11.1, p = 0.001; 2-year ODI: 8, p = 0.001). Post-hoc analysis demonstrated no difference between 2-months, 1-year and 2-year postoperative ODI (p = 0.9, p = 0.468, p = 0.606). The MCID was met in 87.9% of patients at two months, 80.7% at one year, and 87.3% at two years postoperatively. Twelve patients (7.7%) underwent revision surgery between 2 months and 2 years after the index surgery (median time to revision: 5.6 months). ROC curve analysis demonstrated that an ODI score ≥24 points at 2-months yielded a sensitivity of 85.7% and a specificity of 71.8% for predicting revision after lumbar decompression (AUC = 0.758; 95% CI: 0.613-0.903). The Youden optimal threshold value of ≥24 points at 2-month postop ODI yielded an odd’s ratio (OR) for revision of 15.3 (CI: 1.8-131.8; p = 0.004). The positive predictive value (PPV) and negative predictive value (NPV) were 15.4% and 98.8%, respectively.

CONCLUSION: Two-year clinical follow-up may not be necessary for future peer-reviewed lumbar decompression surgery studies given that ODI plateaus at 8 weeks. Patients with a score ≥ 24 points at 2-months postoperatively have a higher risk of requiring a second surgery within the first two years and warrant continued follow-up.

PMID:38588722 | DOI:10.1016/j.spinee.2024.03.018

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Reassessing the minimum two-year follow-up standard after lumbar decompression surgery: a 2-months follow-up seems to be an acceptable minimum

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Spine J. 2024 Apr 6:S1529-9430(24)00160-8. doi: 10.1016/j.spinee.2024.03.018. Online ahead of print. ABSTRACT BACKGROUND CONTEXT: Academic orthopaedic journals and specialty societies emphasize the importance of two-year follow-up for patient-reported outcome measures (PROMS) after spine surgery, but there are limited data evaluating the appropriate length of follow-up. PURPOSE: To determine whether PROMs, as measured by the Oswestry

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