Comparative effectiveness research across two spine registries
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Comparative effectiveness research in spine surgery is still a rarity. In this study, pain alleviation and quality of life (QoL) improvement after lumbar total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF) were anonymously compared by surgeon and implant.
A total of 534 monosegmental TDAs from the SWISSspine registry were analyzed. Mean age was 42 years (19–65 years), 59 % were females. Fifty cases with ALIF were documented in the international Spine Tango registry and used as concurrent comparator group for the pain analysis. Mean age was 46 years (21–69 years), 78 % were females. The average follow-up time in both samples was 1 year. Comparison of back/leg pain alleviation and QoL improvement was performed. Unadjusted and adjusted probabilities for achievement of minimum clinically relevant improvements of 18 VAS points or 0.25 EQ-5D points were calculated for each surgeon.
Mean preoperative back pain decreased from 69 to 30 points at 1 year (ØΔ 39pts) after TDA, and from 66 to 27 points after ALIF (ØΔ 39pts). Mean preoperative QoL improved from 0.34 to 0.74 points at 1 year (ØΔ 0.40pts). There were surgeons with better patient selection, indicated by lower adjusted probabilities reflecting worsening of outcomes if they had treated an average patient sample. ALIF had similar pain alleviation than TDA.
Pain alleviation after TDA and ALIF was similar. Differences in surgeon’s patient selection based on pain and QoL were revealed. Some surgeons seem to miss the full therapeutic potential of TDA by selecting patients with lower symptom severity.
KeywordsComparative effectiveness Spine registry SWISSspine Total disc arthroplasty Benchmark
Anterior lumbar interbody fusion
Core outcome measures index
Minimum clinically relevant improvement of quality of life = 0.25 EQ-5D points 
Minimum clinically relevant pain improvement = 18 VAS points 
North American Spine Society outcome assessment instrument
Quality of life
Total disc arthroplasty
Visual analogue scale
We thank Daniel Dietrich, PhD, for statistical consulting in all analyses presented in the current article. We are indebted to the SWISSspine and Spine Tango registry groups who made this research possible by populating the database with their valuable and much appreciated entries. The analysed data were recorded by: Bärlocher C (n = 76), Sgier F (n = 65), Etter C (n = 41), Hausmann O (n = 40), Schwarzenbach O (n = 38), Huber J (n = 36), Aebi M (n = 31), Heini P (n = 23), Berlemann U (n = 23), Markwalder T (n = 19), Otten P (n = 17), Schaeren S (n = 16), Maestretti GL (n = 12), Schizas C (n = 12), Waelchli B (n = 12), Porchet F (n = 10), Baur M (n = 9), Kast E (n = 9), Seidel U (n = 9), Lutz T (n = 7), Grob D (n = 6), Jeanneret B (n = 5), Kroeber M (n = 5), Min K (n = 5), Hasdemir M (n = 4), Lattig F (n = 4), Morard M (n = 4), Renella R (n = 4), Richter H (n = 4), Van Domelen K (n = 4), Wernli FO (n = 4), Binggeli R (n = 3), Stoll TM (n = 3), Marchesi D (n = 3), Tessitore E (n = 3), Vernet O (n = 3), Faundez A (n = 2), Favre J (n = 2), Ramadan A (n = 2), Selz T (n = 2), Boos N (n = 1), Cathrein P (n = 1), Forster T (n = 1), Heilbronner R (n = 1), Kleinstueck F (n = 1), Martinez R (n = 1), Rischke B (n = 1).
Conflict of interest
None of the authors has any potential conflict of interest.
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