• Eur Spine J · Dec 2023

    Development and temporal validation of clinical prediction models for 1-year disability and pain after lumbar decompressive surgery. The Norwich Lumbar Surgery Predictor (development version).

    • Jonathan H Geere, Paul R Hunter, Girish N Swamy, Andrew J Cook, and Amarjit S Rai.
    • Physiotherapy Department, Spire Norwich Hospital, Old Watton Road, Colney, Norwich, NR4 7TD, UK. jonathan.geere@nhs.net.
    • Eur Spine J. 2023 Dec 1; 32 (12): 421042194210-4219.

    PurposeTo identify clinical predictors and build prediction models for 1-year patient-reported outcomes measures (PROMs) after lumbar decompressive surgery for disc herniation or spinal stenosis.MethodsThe study included 1835 cases, with or without additional single-level fusion, from a single centre from 2008 through 2020. General linear models imputed with 37 clinical variables identified 18 significant 1-year PROM predictors for retention in development models. Interaction of surgical indication with each predictor was tested. Temporal validation was conducted at the same centre on cases through 2021. R2 was used to measure goodness-of-fit, and area under curve (AUC) used to measure classification to a satisfactory symptom state (Oswestry Disability Index (ODI) ≤ 22; back or leg pain ≤ 30 out of 100).ResultsA total 1228 (67%) had complete data for inclusion in model development. Predictors of ODI were baseline PROMs (ODI, back pain, leg pain), work status, condition duration, previous lumbar operation, multiple-joint osteoarthritis, female, diabetes, current smoker, rheumatic disorder, lower limb arthroplasty, mobility aided, provider status, facet cyst, scoliosis, and age, with BMI significantly associated with stenosis. Temporal validation (n = 188) found the ODI model R2 was 0.29 (95% confidence intervals (CI) 0.18-0.40) and AUC was 0.74 (95% CI 0.67-0.81). Back and leg pain models had lower R2 (0.12-0.14) and AUC (0.68-0.69) values.ConclusionImportant PROM predictors are baseline PROMs, specific co-morbidities, work status, condition duration, previous lumbar operation, female, and smoking status. The ODI model predicted the likelihood of achieving a satisfactory state of both disability and pain.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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