Examining the value of lumbar spine surgery
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A new clinical study published in the journal Neurosurgery found that lumbar fusions were three times more likely to be effective and obtain better patient outcomes when guidelines for fusion were followed. The results suggest that when surgeons operate outside of what the evidence-based literature suggests, patients may not have significant improvements in their quality of life and could have increased pain or other limitations.

The objective was to assess whether patients who met specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar fusion would achieve higher rates of achieving the minimal clinical important difference (MCID) than those who did not meet the EBM indications.

All elective lumbar fusion cases were prospectively evaluated and categorized based on EBM guidelines for surgical indications. The MCID was defined as a reduction of ≥5 points in the Oswestry Disability Index (ODI). Multiple logistic regression identified multivariable-adjusted odds ratio of EBM concordance.

A total of 325 lumbar fusion patients were entered with 6-mo follow-up data available for 309 patients. The median preoperative ODI score was 24.4 with the median 6-mo improvement of 7.0 points.

--Based on ODI scores, 79.6% improved, 3.8% had no change, and 16% worsened. A total of 191 patients had ODI improvement reaching the MCID. 93.2% cases were EBM concordant, while 6.7% were not.

--In multivariate analysis, EBM concordance, lower preoperative ODI, lower ASA, and primary surgeries were significantly associated with improved functional outcomes.

--EBM concordance conferred 3.04 times greater odds of achieving MCID in ODI at 6 mo, adjusting for other factors.

In conclusion, this analysis provides validation of EBM guideline criteria to establish optimal patient outcomes. The EBM concordant patients had a greater than 3 times improved outcome compared to those not meeting EBM fusion criteria.

Source: https://doi.org/10.1093/neuros/nyab062
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