Introduction: Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a CSI postoperatively does not exist.
Methods: The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.
Results: A total of 231 patients fit the inclusion criteria; 58% exceeded a MCID value for EQ-5D of 0.100 and 16% exceeded a MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for a MCID threshold of 0.100 included a higher preoperative EQ-5D score (OR=44.8) and L5-S1 fusion (OR=3.3). For a MCID value of 0.390, a higher preoperative EQ-5D score (OR=2080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.
Conclusions: This study is the first to use a combination of medical, surgical and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively.
Patient Care: The use of a multi-faceted approach within a single patient cohort enables more comprehensive prediction of achieving a CSI postoperatively. The identified predictors presented herein may allow for better patient selection and surgical approach to increase the probability of obtaining a CSI postoperatively.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of identifying factors which may predict a CSI after lumbar fusion surgery, 2) Discuss, in small groups, factors which predict a CSI after lumbar fusion, 3) Identify an effective treatment strategy to approaching lumbar fusion surgery.