Purpose

On average, 56% of patients report a clinically relevant reduction in pain after lumbar spinal fusion (LSF). Preoperatively identifying which patient will benefit from LSF is paramount to improve clinical decision making, expectation management and treatment selection. Therefore, this multicentre study aimed to develop and validate a clinical prediction tool for a clinically relevant reduction in pain 1 to 2 years after elective LSF.

Methods

The outcomes were defined as a clinically relevant reduction in predominant (worst reported pain in back or legs) pain 1 to 2 years after LSF. Patient-reported outcome measures and patient characteristics from 202 patients were used to develop a prediction model by logistic regression. Data from 251 patients were used to validate the model.

Results

Nonsmokers (odds ratio = 0.41 [95% confidence interval = 0.19–0.87]), with lower Body Mass Index (0.93 [0.85–1.01]), shorter pain duration (0.49 [0.20–1.19]), lower American Society of Anaesthesiologists score (4.82 [1.35–17.25]), higher Visual Analogue Scale score for predominant pain (1.05 [1.02–1.08]), lower Oswestry Disability Index (0.96 [0.93–1.00]) and higher RAND-36 mental component score (1.03 [0.10–1.06]) preoperatively had a higher chance of a clinically relevant reduction in predominant pain. The area under the curve of the externally validated model yielded 0.68. A nomogram was developed to aid clinical decision making.

Conclusions

Using the developed nomogram surgeons can estimate the probability of achieving a clinically relevant pain reduction 1 to 2 years after LSF and consequently inform patients on expected outcomes when considering treatment.

中文翻译：

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开发和验证用于减少接受选择性腰椎融合术的成年患者疼痛的预测工具：一项多中心队列研究。

目的

平均而言，56% 的患者报告腰椎融合术 (LSF) 后疼痛有临床意义的减轻。术前确定哪些患者将从 LSF 中受益对于改善临床决策、期望管理和治疗选择至关重要。因此，这项多中心研究旨在开发和验证一种临床预测工具，用于在选择性 LSF 后 1 至 2 年临床相关的疼痛减轻。

方法

结果被定义为 LSF 后 1 至 2 年主要（最严重的背部或腿部疼痛）疼痛的临床相关减轻。来自 202 名患者的患者报告结果测量和患者特征用于通过逻辑回归开发预测模型。来自 251 名患者的数据用于验证该模型。

结果

不吸烟者（比值比 = 0.41 [95% 置信区间 = 0.19–0.87]），体重指数较低（0.93 [0.85–1.01]），疼痛持续时间较短（0.49 [0.20–1.19]），美国麻醉医师协会评分较低(4.82 [1.35–17.25])，主要疼痛的视觉模拟量表评分较高 (1.05 [1.02–1.08])，Oswestry 残疾指数较低 (0.96 [0.93–1.00]) 和 RAND-36 心理成分评分较高 (1.03 [0.10]) –1.06]) 术前显着疼痛临床相关减轻的机会更高。外部验证模型的曲线下面积为 0.68。制定了列线图以帮助临床决策。

结论

使用开发的列线图外科医生可以估计 LSF 后 1 到 2 年实现临床相关疼痛减轻的可能性，从而在考虑治疗时告知患者预期结果。