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Comparative effectiveness research across two spine registries

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

ALIF:

Anterior lumbar interbody fusion

COMI:

Core outcome measures index

EQ-5D:

EuroQoL-5D instrument

MCRIQL:

Minimum clinically relevant improvement of quality of life = 0.25 EQ-5D points [2]

MCRPI:

Minimum clinically relevant pain improvement = 18 VAS points [10]

NASS:

North American Spine Society outcome assessment instrument

QoL:

Quality of life

TDA:

Total disc arthroplasty

VAS:

Visual analogue scale

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Acknowledgments

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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Authors and Affiliations

  1. Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

    Emin Aghayev & Christoph Röder

  2. Inselspital, University Hospital, University of Bern, Bern, Switzerland

    Julia Henning & Peter Diel

  3. Clinique Saint Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium

    Everard Munting

  4. Swiss Paraplegic Center Nottwil, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland

    Patrick Moulin

Authors
  1. Emin Aghayev
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  2. Julia Henning
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  3. Everard Munting
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  4. Peter Diel
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  5. Patrick Moulin
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  6. Christoph Röder
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On behalf of the SWISSspine and Spine Tango Registry groups

Corresponding author

Correspondence to Emin Aghayev.

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Aghayev, E., Henning, J., Munting, E. et al. Comparative effectiveness research across two spine registries. Eur Spine J 21, 1640–1647 (2012). https://doi.org/10.1007/s00586-012-2256-5

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  • DOI: https://doi.org/10.1007/s00586-012-2256-5

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