Skip to main content

Advertisement

SpringerLink
Log in

Association between the appropriateness of surgery, according to appropriate use criteria, and patient-rated outcomes after surgery for lumbar degenerative spondylolisthesis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

Treatment failures in spine surgery are often attributable to poor patient selection and the application of inappropriate treatment. We used published appropriate use criteria (AUC) to evaluate the appropriateness of surgery in a large group of patients operated for lumbar degenerative spondylolisthesis (LDS) and to evaluate its association with outcome.

Methods

This was a retrospective analysis of prospectively collected outcome data from patients operated in our Spine Centre, 2005–2012. Appropriateness of surgery was judged based on the AUC. Patients had completed the multidimensional Core Outcome Measures Index (COMI) before surgery and at 3 months' and 1, 2 and 5 years' follow-up (FU).

Results

In total, 448 patients (69.8 ± 9.6 years; 323 (72%) women) were eligible for inclusion and the AUC could be applied in 393 (88%) of these. Surgery was considered appropriate (A) in 234 (59%) of the patients, uncertain/equivocal (U) in 90 (23%) and inappropriate (I) in 69 (18%). A/U patients had significantly (p < 0.05) greater improvements in COMI than I patients at each FU time point. The minimal clinically important change (MCIC) score for COMI was reached by 82% A, 76% U and 54% I patients at 1-year FU (p < 0.001, I vs A and U); the odds of achieving MCIC were 3–4 times greater in A/U patients than in I patients.

Conclusions

The results suggest a relationship between appropriateness of surgery for LDS and the improvements in COMI score after surgery. The findings require confirmation in prospective studies that also include a control group of non-operated patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wiltse LL, Winter RB (1983) Terminology and measurement of spondylolisthesis. J Bone Jt Surg Am 65:768–772

    Article  CAS  Google Scholar 

  2. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the copenhagen osteoarthritis study. Spine. 32:120–125. https://doi.org/10.1097/01.brs.0000250979.12398.9600007632-200701010-00019

    Article  PubMed  Google Scholar 

  3. Weinstein J, Pearson A (2016) Fusion in degenerative spondylolisthesis becomes controversial...again. Evid Based Med 21:148–149. https://doi.org/10.1136/ebmed-2016-110474

    Article  PubMed  Google Scholar 

  4. Waddell G, Morris EW, Di Paola MP, Bircher M, Finlayson D (1986) A concept of illness tested as an improved basis for surgical decisions in low-back disorders. Spine 11:712–719

    Article  CAS  Google Scholar 

  5. Mannion AF, Elfering A (2008) Predictors of surgical outcome. In: Boos N, Aebi M (eds) Spinal disorders. Springer, Berlin

    Google Scholar 

  6. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, McDonell J, Vader J, Kahan JP (2001) The RAND/UCLA appropriateness method user’s manual. RAND Corporation, Santa Monica, CA

    Google Scholar 

  7. Mannion AF, Elfering A (2006) Predictors of surgical outcome and their assessment. Eur Spine J 15(Suppl 1):S93–S108

    Article  Google Scholar 

  8. Mannion A, Impellizzeri F, Leunig FM, Jeszenszky D, Becker H-J, Haschtmann D, Preiss S, Fekete FT (2018) Time to remove our rose-tinted spectacles: a candid appraisal of the relative success of surgery in over 4’500 patients with degenerative disorders of the lumbar spine, hip or knee. Eur Spine J 27:778–788

    Article  Google Scholar 

  9. Koenig S, Jauregui JJ, Shasti M, Jazini E, Koh EY, Banagan KE, Gelb DE, Ludwig SC (2019) Decompression versus fusion for Grade I degenerative spondylolisthesis: a meta-analysis. Glob Spine J 9:155–161. https://doi.org/10.1177/2192568218777476

    Article  Google Scholar 

  10. Weeks WB, Paraponaris A, Ventelou B (2014) Geographic variation in rates of common surgical procedures in France in 2008–2010, and comparison to the US and Britain. Health Policy 118:215–221. https://doi.org/10.1016/j.healthpol.2014.08.015

    Article  PubMed  Google Scholar 

  11. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS (2019) Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the united states, 2004 to 2015. Spine 44:369–376. https://doi.org/10.1097/BRS.0000000000002822

    Article  PubMed  Google Scholar 

  12. Widmer M, Matter P, Staub L, Schoeni-Affolter F, Busato A (2009) Regional variation in orthopedic surgery in switzerland. Health Place 15:791–798

    Article  Google Scholar 

  13. Desai A, Bekelis K, Ball PA, Lurie J, Mirza SK, Tosteson TD, Zhao W, Weinstein JN (2012) Outcome variation across centers after surgery for lumbar stenosis and degenerative spondylolisthesis: The SPORT experience. Spine. https://doi.org/10.1097/BRS.0b013e318278e571

    Article  PubMed  PubMed Central  Google Scholar 

  14. Von Korff M, Barlow W, Cherkin D, Deyo RA (1994) Effects of practice style in managing back pain. Ann Intern Med 121:187–195

    Article  Google Scholar 

  15. Deyo RA, Mirza SK (2006) Trends and variations in the use of spine surgery. Clin Orthop Relat Res 443:139–146

    Article  Google Scholar 

  16. Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE (1986) A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 2:53–63

    Article  CAS  Google Scholar 

  17. Naylor CD (1998) What is appropriate care? N Engl J Med 338:1918–1920

    Article  CAS  Google Scholar 

  18. Irwin ZN, Hilibrand A, Gustavel M, McLain R, Shaffer W, Myers M, Glaser J, Hart RA (2005) Variation in surgical decision making for degenerative spinal disorders Part I: lumbar spine. Spine 30:2208–2213

    Article  Google Scholar 

  19. Mannion AF, Pittet V, Steiger F, Vader JP, Becker HJ, Porchet F (2014) Development of appropriateness criteria for the surgical treatment of symptomatic lumbar degenerative spondylolisthesis (LDS). Eur Spine J 23:1903–1917. https://doi.org/10.1007/s00586-014-3284-0

    Article  CAS  PubMed  Google Scholar 

  20. Guessous I, Juillerat P, Pittet V, Froehlich F, Burnand B, Mottet C, Felley C, Michetti P, Vader JP (2007) Evaluating appropriateness of treatment for Crohn’s disease: feasibility of an explicit approach. Digestion 75:46–52. https://doi.org/10.1159/000101566

    Article  PubMed  Google Scholar 

  21. Fekete TF, Haschtmann D, Kleinstuck FS, Porchet F, Jeszenszky D, Mannion AF (2016) What level of pain are patients happy to live with after surgery for lumbar degenerative disorders? Spine J 16:S12-18. https://doi.org/10.1016/j.spinee.2016.01.180

    Article  PubMed  Google Scholar 

  22. Mannion AF, Porchet F, Kleinstück F, 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 (COMI) in clinical practice. Eur Spine J 18:367–373

    Article  Google Scholar 

  23. Pochon L, Kleinstuck FS, Porchet F, Mannion AF (2015) Influence of gender on patient-oriented outcomes in spine surgery. Eur Spine J. https://doi.org/10.1007/s00586-015-4062-3

    Article  PubMed  Google Scholar 

  24. 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 18:374–379

    Article  Google Scholar 

  25. Katz JN, Winter AR, Hawker G (2017) Measures of the appropriateness of elective orthopaedic joint and spine procedures. J Bone Joint Surg Am 99:e15. https://doi.org/10.2106/JBJS.16.00473

    Article  PubMed  Google Scholar 

  26. Danon-Hersch N, Samartzis D, Wietlisbach V, Porchet F, Vader JP (2010) Appropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica. Spine. 35:672–683

    Article  Google Scholar 

  27. Riddle DL, Perera RA, Jiranek WA, Dumenci L (2014) Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res (Hoboken). https://doi.org/10.1002/acr.22428

    Article  Google Scholar 

  28. Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J, Goenaga JI, Arenaza JC (2006) Health-related quality of life and appropriateness of knee or hip joint replacement. Arch Intern Med 166:220–226. https://doi.org/10.1001/archinte.166.2.220

    Article  PubMed  Google Scholar 

  29. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB (1996) Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 276:1253–1258

    Article  CAS  Google Scholar 

  30. Wartolowska K, Judge A, Hopewell S, Collins GS, Dean BJF, Rombach I, Brindley D, Savulescu J, Beard DJ, Carr AJ (2014) Use of placebo controls in the evaluation of surgery: systematicreview. BMJ 348:g3253

    Article  Google Scholar 

  31. Lawson EH, Gibbons MM, Ingraham AM, Shekelle PG, Ko CY (2011) Appropriateness criteria to assess variations in surgical procedure use in the United States. Arch Surg 146:1433–1440. https://doi.org/10.1001/archsurg.2011.581

    Article  PubMed  Google Scholar 

  32. Lawson EH, Gibbons MM, Ko CY, Shekelle PG (2012) The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures. J Clin Epidemiol 65:1133–1143. https://doi.org/10.1016/j.jclinepi.2012.07.002

    Article  PubMed  Google Scholar 

  33. Kahn KL, Park RE, Vennes J, Brook RH (1992) Assigning appropriateness ratings for diagnostic upper gastrointestinal endoscopy using two different approaches. Med Care 30:1016–1028

    Article  CAS  Google Scholar 

  34. Findlay JM, Deis N (2010) Appropriateness of lumbar spine referrals to a neurosurgical service. Can J Neurol Sci 37:843–848

    Article  Google Scholar 

  35. Jeannot JG, Vader JP, Porchet F, Larequi-Lauber T, Burnand B (1999) Can the decision to operate be judged retrospectively? A study of medical records. Eur J Surg 165:516–521

    Article  CAS  Google Scholar 

  36. Porchet F, Vader JP, Larequi-Lauber T, Costanza MC, Burnand B, Dubois RW (1999) The assessment of appropriate indications for laminectomy. J Bone Joint Surg Br 81:234–239

    Article  CAS  Google Scholar 

  37. Forsth P, Michaelsson K, Sanden B (2013) Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients. Bone Joint J. https://doi.org/10.1302/0301-620X.95B7.30776

    Article  PubMed  Google Scholar 

  38. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG 2nd, Benzel EC (2016) Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:1424–1434. https://doi.org/10.1056/NEJMoa1508788

    Article  CAS  PubMed  Google Scholar 

  39. Kleinstueck FS, Fekete TF, Mannion AF, Grob D, Porchet F, Mutter U, Jeszenszky D (2012) To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 21:268–275

    Article  CAS  Google Scholar 

  40. Austevoll IM, Gjestad R, Solberg T, Storheim K, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Hellum C (2020) Comparative effectiveness of microdecompression alone vs decompression plus instrumented fusion in lumbar degenerative spondylolisthesis. JAMA Netw Open 3:e2015015. https://doi.org/10.1001/jamanetworkopen.2020.15015

    Article  PubMed  PubMed Central  Google Scholar 

  41. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  Google Scholar 

Download references

Acknowledgements

We thank all the patients of the Schulthess Klinik who contributed their data. We thank Dave O’Riordan, Gordana Balaban, and Stéphanie Dosch for their administration of the Spine Tango surgery forms and patient-rated outcome measures. We thank John-Paul Vader for his help and advice throughout the project.

Author information

Authors and Affiliations

  1. Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Anne F. Mannion, Francine Mariaux, Felix Steiger, Martin Aepli, Tamás F. Fekete, Dezső Jeszenszky, Dave O’Riordan & François Porchet

  2. Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland

    Valérie Pittet

Authors
  1. Anne F. Mannion
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francine Mariaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valérie Pittet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felix Steiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin Aepli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tamás F. Fekete
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dezső Jeszenszky
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dave O’Riordan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. François Porchet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne F. Mannion.

Ethics declarations

Conflict of interest

The authors declare that they have no potential conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mannion, A.F., Mariaux, F., Pittet, V. et al. Association between the appropriateness of surgery, according to appropriate use criteria, and patient-rated outcomes after surgery for lumbar degenerative spondylolisthesis. Eur Spine J 30, 907–917 (2021). https://doi.org/10.1007/s00586-021-06725-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06725-3

Keywords

Search

Navigation