Clinical outcomes research in spine surgery: what are appropriate follow-up times?

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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In Brief

The time course required for the patient-reported outcomes of pain, physical function, and mental health to reach a recovery plateau after elective lumbar spine surgery was assessed utilizing a prospectively maintained multicenter registry. The work is important as it demonstrates that specific health dimensions follow different recovery plateaus and it provides evidence that a 2-year postoperative follow-up is not required to accurately assess the treatment effect of established surgeries for lumbar spinal pathologies.

ABBREVIATIONS CSORN = Canadian Spine Outcomes and Research Network; DS = Disability Scale; LDH = lumbar disc herniation; LDS = lumbar degenerative spondylolisthesis; LSS = lumbar spinal stenosis; MCS = Mental Component Summary; PCS = Physical Component Summary; PRO = patient-reported outcome; QOL = quality of life; VAS = visual analog scale.

Article Information

Correspondence Charles G. Fisher: Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada. charles.fisher@vch.ca.

INCLUDE WHEN CITING Published online December 21, 2018; DOI: 10.3171/2018.8.SPINE18715.

Disclosures Dr. Fisher has received consultant fees from Medtronic and NuVasive, has received royalties to his institution from a Medtronic research grant, and has received fellowship support to his institution from AOSpine and Medtronic for work outside of the present study. Dr. Johnson has received grant support to his institution from Stryker. Dr. Paquet has received educational grant support to his institution from Medtronic of Canada. Dr. Manson has been a consultant for and received non–study-related support from Medtronic. Dr. Rampersaud has been a consultant for and received royalties from Medtronic.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Patient-reported outcomes for physical function over time after surgery for LDH (lumbar disc), LDS (lumbar spond.), and LSS (lumbar stenosis) according to the DS (A–C) and PCS (D–F). Recovery plateau indicated by inverted triangles.

  • View in gallery

    Patient-reported outcomes for the pain dimension over time after surgery for LDH, LDS, and LSS according to the VAS leg (A–C) and VAS back (D–F). Recovery plateau indicated by inverted triangles.

  • View in gallery

    Patient-reported outcomes for mental QOL over time after surgery for LDH, LDS, and LSS according to the MCS (A–C). Recovery plateau indicated by inverted triangles.

  • View in gallery

    Patient-reported outcomes for pain (A and B), physical function (C and D), and mental QOL (E) after fusion (solid line) and nonfusion (dashed line) for LSS. Recovery plateau indicated by inverted triangles for fusion and asterisks for nonfusion.

  • View in gallery

    Patient-reported outcomes for pain (A and B), physical function (C and D), and mental QOL (E) after fusion (solid line) and nonfusion (dashed line) for LDS. Recovery plateau indicated by inverted triangles for fusion and asterisks for nonfusion.

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