Suffering and Disability as a Predictor of Outcome After Lumbar Spinal Fusion Surgery in Real-World Practice
Vincent Raymaekers, Gert Roosen, Eric Put, Steven Vanvolsem, Salah-Eddine Achahbar, Sacha Meeuws, Maarten Wissels, Sven Bamps, Zoë Pieters, Dirk De Ridder, Tomas Menovsky, Mark PlazierStudy Design:
A prospective, multicenter, and observational cohort study.
Objective:
This study aims to explore the outcomes after lumbar spinal fusion surgery in daily practice, identifying significant patient clusters based on baseline characteristics to guide future decision-making.
Summary of Background Data:
Chronic low back pain from lumbar degenerative disease is a leading cause of global disability. Despite widespread use of spinal fusion surgery, patient outcomes vary. Real-world data are needed to identify which patients benefit most from surgery, particularly considering baseline levels of pain, disability, and psychosocial burden.
Methods:
This study involved 693 patients undergoing lumbar spinal fusion surgery. Data were collected using the BackApp. Missing observation at fixed time points were imputed using multiple imputation. A K-means cluster analysis was performed on baseline variables (VAS, ODI, EQ-5D, and PCS) to identify distinct patient subgroups. ANOVA and logistic regression were used to analyze primary and secondary outcomes after lumbar spinal fusion surgery to compare the identified patient subgroups.
Results:
Cluster 1 (N=337) comprised patients with painfulness without suffering and disability. Cluster 2 (N=356) involves patients experiencing higher pain scores, associated with a decrease in QOL, disability, and suffering. Only cluster 2 showed significant and clinically relevant improvement in painfulness (VAS back: −2.67 [95% CI: −4.53 to −0.80], VAS leg: −3.56 [95% CI: −3.56 to −1.78]), disability (ODI: −7.01 [95% CI: −13.31 to −0.82]) and QOL (EQ-5D: 0.27 [95% CI: 0.19–0.36]) after lumbar fusion surgery. There were no significant differences in return to work, pain medication reduction, or patient satisfaction between the clusters.
Conclusion:
Real-world evidence indicates that patients with preoperative suffering and disability benefit significantly more from lumbar spinal fusion surgery. These findings highlight the importance of comprehensive baseline health assessments to guide personalized treatment strategies and improve patient outcomes. Selecting the right patients for spinal fusion surgery may have important repercussions, both clinically and economically, and may benefit the development of clinical guidelines.