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How does patient-rated outcome change over time following the surgical treatment of degenerative disorders of the thoracolumbar spine?

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Abstract

Purpose

Patient-rated measures are considered the gold standard for assessing the outcome of spine surgery, but there is no consensus on the appropriate timing of follow-up. Journals often demand a minimum 2-year follow-up, but the indiscriminate application of this principle may not be warranted. We examined the course of change in patient outcomes up to 5 years after surgery for degenerative spinal disorders.

Methods

The data were evaluated from 4287 consecutive patients (2287 women, 2000 men; aged 62 ± 15 years) with degenerative disorders of the thoracolumbar spine, undergoing first-time surgery at the given level between 01/01/2005 and 31/12/2011. The Core Outcome Measures Index (COMI; scored 0–10) was completed by 4012 (94%) patients preoperatively, 4008 (93%) at 3-month follow-up, 3897 (91%) at 1-year follow-up, 3736 (87%) at 2-year follow-up, and 3387 (79%) at 5-year follow-up. 2959 (69%) completed the COMI at all five time-points.

Results

The individual COMI change scores from preoperatively to the various follow-up time-points showed significant correlations ranging from r = 0.50 (for change scores at the earliest vs the latest follow-up) to r = 0.75 (for change scores after 12- vs 24-month follow-up). Concordance with respect to whether the minimum clinically important change score was achieved at consecutive time-points was also good (70–82%). COMI decreased significantly (p < 0.05) from preop to 3 months (by 3.6 ± 2.8 points) and from 3 to 12 months (by 0.3 ± 2.4 points), then levelled off up to 5 years (0.04–0.05 point change; p > 0.05). The course of change up to 12 months differed slightly (p < 0.05) depending on pathology/whether fusion was carried out. For patients undergoing simple decompression, 3-month follow-up was sufficient; those undergoing fusion continued to show further slight but significant change up to 12 months.

Conclusions

Stable group mean COMI scores were observed for all patients from 12 months postoperatively onwards. The early postoperative results appeared to herald the longer term outcome. As such, a ‘wait and see policy’ in patients with a poor initial outcome at 3 months is not advocated. The insistence on a 2-year follow-up could result in a failure to intervene early to achieve better long-term outcomes.

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Acknowledgements

We thank all the patients of the Schulthess Klinik who have contributed data to our in-house registry. We thank Dave O’Riordan, Gordana Balaban, Julian Amacker, Kirsten Clift, Selina Nauer, Sara Preziosa, Stéphanie Dosch, and Riccardo Curatolo for the administration of the Spine Tango Surgery and Patient Self-Assessment forms.

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Authors and Affiliations

  1. Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Tamas F. Fekete, M. Loibl, D. Jeszenszky, D. Haschtmann, F. S. Kleinstück, H. J. Becker & F. Porchet

  2. National Institute of Clinical Neurosciences, Budapest, Hungary

    P. Banczerowski

  3. Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    A. F. Mannion

Authors
  1. Tamas F. Fekete
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  2. M. Loibl
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  3. D. Jeszenszky
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  4. D. Haschtmann
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  5. P. Banczerowski
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  6. F. S. Kleinstück
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  7. H. J. Becker
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  8. F. Porchet
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  9. A. F. Mannion
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Corresponding author

Correspondence to Tamas F. Fekete.

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All authors declared that they have no potential conflict of interest.

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Fekete, T.F., Loibl, M., Jeszenszky, D. et al. How does patient-rated outcome change over time following the surgical treatment of degenerative disorders of the thoracolumbar spine?. Eur Spine J 27, 700–708 (2018). https://doi.org/10.1007/s00586-017-5358-2

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  • DOI: https://doi.org/10.1007/s00586-017-5358-2

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