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Time to achievement of minimum clinically important difference after lumbar decompression

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Abstract

Objective

The objective of this study is to examine factors associated with delayed time to achieve minimum clinically important difference (MCID) in patients undergoing lumbar decompression (LD) for the Patient-Reported Outcomes (PROs) of Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg pain.

Methods

Patients undergoing LD with preoperative and postoperative ODI, VAS back, and VAS leg scores were retrospectively reviewed from April 2016 to January 2021. MCID values from previously established studies were utilized to determine MCID achievement. Kaplan–Meier survival analysis determined the time to achieve MCID. Hazard ratios from multivariable Cox regression were utilized to determine the preoperative factors predictive of MCID achievement.

Results

Three-hundred and forty-three patients were identified undergoing LD. Overall MCID achievement rates were 67.4% for ODI, 67.1% for VAS back, and 65.0% for VAS leg. The mean time in weeks for MCID achievement was 22.52 ± 30.48 for ODI, 18.90 ± 27.43 for VAS back, and 20.96 ± 29.81 for VAS leg. Multivariable Cox regression revealed active smoker status, preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), ODI, VAS Back, and VAS Leg (HR 1.03–2.14) as predictors of early MCID achievement, whereas an American Society of Anesthesiologist (ASA) classification of 2, Black ethnicity, workers’ compensation, private insurance, and diagnosis of foraminal stenosis were predictors of late MCID achievement (HR 0.34–0.58).

Conclusion

Most patients undergoing LD achieved MCID within 6 months of surgery. Significant factors for early MCID achievement were active smoking status and baseline PROs. Significant factors for late MCID achievement were ASA = 2, Black ethnicity, type of insurance, and foraminal stenosis diagnosis. These factors may be considered by surgeons in setting patient expectations.

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Data Availability

The findings presented in this study are available upon request from the corresponding principle investigator, Kern Singh at kern.singh@rushortho.com.

Abbreviations

ASA :

American Society of Anesthesiologist

BMI :

Body mass index

CCI :

Charlson Comorbidity Index

HR :

Hazard ratio

LD :

Lumbar decompression

MCID :

Minimum clinically important difference

MCS :

Mental Component Score

MIS :

Minimally invasive surgery

ODI :

Oswestry Disability Index

PCS :

Physical Component Score

PHQ-9 :

Patient Health Questionnaire-9

PROs :

Patient-reported outcomes

PROMIS-PF :

Patient-Reported Outcomes Measurement Information System Physical Function

POD :

Postoperative day

SD :

Standard deviation

SF-12 :

12-Item Short Form

VAS :

Visual Analog Scale

RCTs :

Randomized controlled trials

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA

    James W. Nie, Vincent P. Federico, Timothy J. Hartman, Eileen Zheng, Omolabake O. Oyetayo, Keith R. MacGregor, Dustin H. Massel, Arash J. Sayari & Kern Singh

Authors
  1. James W. Nie
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  2. Vincent P. Federico
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  3. Timothy J. Hartman
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  9. Kern Singh
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Corresponding author

Correspondence to Kern Singh.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Rush University Medical Center (ORA #14051301).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial interests

Kern Singh, MD, receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. Kern Singh, MD, owns stock in Avaz Surgical LLC and Vital 5 LLC. Kern Singh, MD, holds a consulting position with Zimmer Biomet and K2M. Kern Singh, MD, holds board membership with Vital 5 LLC. Kern Singh, MD, is on the editorial board of Contemporary Spine Surgery. Kern Singh, MD, received a research grant from the Cervical Spine Research Society.

Non-financial interests

Kern Singh, MD, holds board membership with TDi LLC and Minimally Invasive Spine Study Group and receives no compensation as board member. Kern Singh, MD, is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as member of the editorial board. Kern Singh, MD, is on the board of directors of Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as member of the board of directors.

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Nie, J.W., Federico, V.P., Hartman, T.J. et al. Time to achievement of minimum clinically important difference after lumbar decompression. Acta Neurochir 165, 2625–2631 (2023). https://doi.org/10.1007/s00701-023-05709-0

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  • DOI: https://doi.org/10.1007/s00701-023-05709-0

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