Influence of previous surgery on patient-rated outcome after surgery for degenerative disorders of the lumbar spine
Few studies have used multivariate models to quantify the effect of multiple previous spine surgeries on patient-oriented outcome after spine surgery. This study sought to quantify the effect of prior spine surgery on 12-month postoperative outcomes in patients undergoing surgery for different degenerative disorders of the lumbar spine.
The study included 4940 patients with lumbar degenerative disease documented in the Spine Tango Registry of EUROSPINE, the Spine Society of Europe, from 2004 to 2015. Preoperatively and 12 months postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI; 0–10 scale). Patients’ medical history and surgical details were recorded using the Spine Tango Surgery 2006 and 2011 forms. Multiple linear regression models were used to investigate the relationship between the number of previous surgeries and the 12-month postoperative COMI score, controlling for the baseline COMI score and other potential confounders.
In the adjusted model including all cases, the 12-month COMI score showed a 0.37-point worse value [95 % confidence intervals (95 % CI) 0.29–0.45; p < 0.001] for each additional prior spine surgery. In the subgroup of patients with lumbar disc herniation, the corresponding effect was 0.52 points (95 % CI 0.27–0.77; p < 0.001) and in lumbar degenerative spondylolisthesis, 0.40 points (95 % CI 0.17–0.64; p = 0.001).
We were able to demonstrate a clear “dose–response” effect for previous surgery: the greater the number of prior spine surgeries, the systematically worse the outcome at 12 months’ follow-up. The results of this study can be used when considering or consenting a patient for further surgery, to better inform the patient of the likely outcome and to set realistic expectations.
KeywordsPrevious surgery Degenerative disorders of the lumbar spine Patient-rated outcome Spine Tango COMI
The study was funded by the Schulthess Klinik Research funds, the Mäxi Foundation (Switzerland), and Eurospine’s Spine Tango. We are grateful to Malgorzata Roos, Dept Biostatistics, University of Zürich, for her advice and assistance in conducting the statistical analysis. The participants of the Spine Tango Registry are acknowledged for their contribution of data. The data of the following centers were used in the present study (in alphabetic order of country, city, hospital and department): Dept. Orthopedic Surgery, Saint Pierre Clinic, Ottignies (Belgium); Dept. of Orthopaedic Surgery, University Hospital, St. Luc (Belgium); Dept. of Neurosurgery, Bethesda Hospital, Basel (Switzerland); Dept. of Orthopedic Surgery, Salem Hospital, Bern (Switzerland); Spine Center, Schulthess Clinic, Zurich (Switzerland); Dept. of Neurosurgery, The Walton Centre, Liverpool (UK).
Compliance with ethical standards
Conflict of interest
- 17.Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice. Eur Spine J 18(Suppl 3):367–373. doi: 10.1007/s00586-009-0942-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Röder C (2015) EUROSPINE Spine Tango. EUROSPINE. http://www.eurospine.org/spine-tango.htm. Accessed 02.07.2015
- 19.Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: Part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379. doi: 10.1007/s00586-009-0931-y CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Monticone M, Ferrante S, Maggioni S, Grenat G, Checchia GA, Testa M, Teli MG, Mannion AF (2014) Reliability, validity and responsiveness of the cross-culturally adapted Italian version of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 23:863–872. doi: 10.1007/s00586-013-3092-y CrossRefPubMedGoogle Scholar
- 22.Genevay S, Marty M, Courvoisier DS, Foltz V, Mahieu G, Demoulin C, Fontana AG, Norberg M, de Goumoens P, Cedraschi C, Rozenberg S, Section Rachisde la Societe Francaise de Rhumatologie (2014) Validity of the French version of the Core Outcome Measures Index for low back pain patients: a prospective cohort study. Eur Spine J 23:2097–2104. doi: 10.1007/s00586-014-3325-8 CrossRefPubMedGoogle Scholar
- 28.Gulati S, Nordseth T, Nerland US, Gulati M, Weber C, Giannadakis C, Nygaard OP, Solberg TK, Solheim O, Jakola AS (2015) Does daily tobacco smoking affect outcomes after microdecompression for degenerative central lumbar spinal stenosis? A multicenter observational registry-based study. Acta Neurochir (Wien) 157:1157–1164. doi: 10.1007/s00701-015-2437-1 CrossRefGoogle Scholar
- 30.Sobottke R, Aghayev E, Roder C, Eysel P, Delank SK, Zweig T (2012) Predictors of surgical, general and follow-up complications in lumbar spinal stenosis relative to patient age as emerged from the Spine Tango Registry. Eur Spine J 21:411–417. doi: 10.1007/s00586-011-2016-y CrossRefPubMedGoogle Scholar
- 31.Ulrich NH, Kleinstuck F, Woernle CM, Antoniadis A, Winklhofer S, Burgstaller JM, Farshad M, Oberle J, Porchet F, Min K (2015) Clinical outcome in lumbar decompression surgery for spinal canal stenosis in the aged population: a prospective Swiss multicenter cohort study. Spine (Phila Pa 1976) 40:415–422. doi: 10.1097/brs.0000000000000765 CrossRefGoogle Scholar
- 32.Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson OS, Cheng JS, Devin CJ, McGirt MJ (2012) Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 12:179–185. doi: 10.1016/j.spinee.2011.08.014 CrossRefPubMedGoogle Scholar
- 34.Nerland US, Jakola AS, Giannadakis C, Solheim O, Weber C, Nygaard OP, Solberg TK, Gulati S (2015) The risk of getting worse: predictors of deterioration after decompressive surgery for lumbar spinal stenosis—a multicenter observational study. World Neurosurg. doi: 10.1016/j.wneu.2015.05.055 Google Scholar
- 35.Soroceanu A, Ching A, Abdu W, McGuire K (2012) Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine (Phila Pa 1976) 37:E103–E108. doi: 10.1097/BRS.0b013e3182245c1f CrossRefGoogle Scholar