• Clinton J Devin, Anthony L Asher, Kristin R Archer, Anshit Goyal, Inamullah Khan, Panagiotis Kerezoudis, Mohammed Ali Alvi, Jacquelyn S Pennings, Bernes Karacay, Christopher I Shaffrey, Erica F Bisson, John J Knightly, Praveen V Mummaneni, Kevin T Foley, and Mohamad Bydon.
• Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado.
• Neurosurgery. 2020 Oct 15; 87 (5): 1037-1045.

BackgroundThe impact of symptom characteristics on outcomes of spine surgery remains elusive.ObjectiveTo determine the impact of symptom location, severity, and duration on outcomes following lumbar spine surgery.MethodsWe queried the Quality Outcomes Database (QOD) for patients undergoing elective lumbar spine surgery for lumbar degenerative spine disease. Multivariable regression was utilized to determine the impact of preoperative symptom characteristics (location, severity, and duration) on improvement in disability, quality of life, return to work, and patient satisfaction at 1 yr. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom.ResultsA total of 22 022 subjects were analyzed. On adjusted analysis, we found patients with predominant leg pain were more likely to be satisfied (P < .0001), achieve minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to work (P = .03) at 1 yr following surgery without significant difference in Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal leg and back pain were more likely to be satisfied (P < .0001), but showed no significant difference in achieving MCID (P = .22) or return to work (P = .07). Baseline numeric rating scale-leg pain and symptom duration were most important predictors of achieving MCID and change in EQ-5D. Predominant symptom was not found to be an important determinant of return to work. Worker's compensation was found to be most important determinant of satisfaction and return to work.ConclusionPredominant symptom location is a significant determinant of functional outcomes following spine surgery. However, pain severity and duration have higher predictive importance. Return to work is more dependent on sociodemographic features as compared to symptom characteristics.Copyright © 2020 by the Congress of Neurological Surgeons.

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