• Olga Ciobanu-Caraus, Alexandra Grob, Jonas Rohr, Vittorio Stumpo, Luca Ricciardi, Nicolai Maldaner, Hubert A J Eversdijk, Moira Vieli, Antonino Raco, Massimo Miscusi, Andrea Perna, Luca Proietti, Giorgio Lofrese, Michele Dughiero, Francesco Cultrera, Marcello D'Andrea, Seong Bae An, Yoon Ha, Aymeric Amelot, CadeloJorge BediaJBDepartment of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., Jose M Viñuela-Prieto, Maria L Gandía-González, Pierre-Pascal Girod, Sara Lener, Nikolaus Kögl, Anto Abramovic, Christoph J Laux, Mazda Farshad, Dave O'Riordan, Markus Loibl, Fabio Galbusera, Anne F Mannion, Alba Scerrati, Pasquale De Bonis, Granit Molliqaj, Enrico Tessitore, Marc L Schröder, Martin N Stienen, Giovanna Brandi, Luca Regli, Carlo Serra, and Victor E Staartjes.
• Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
• Spine. 2024 Oct 17.

Study DesignHeterogeneous data collection via a mix of prospective, retrospective, and ambispective methods.ObjectiveTo evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease.Summary Of Background DataCurrent literature suggests sex differences regarding clinical outcome after spine surgery may exist. Substantial methodological heterogeneity and limited comparability of studies warrants further investigation of sex-related differences in treatment outcomes.MethodsWe analyzed patients who underwent spinal fusion with or without pedicle screw insertion for lumbar degenerative disease included within a multinational study, comprising patients from 11 centers in 7 countries. Absolute values and change scores (change from pe-operative baseline to post-operative follow-up) for 12-month functional impairment (Oswestry disability index [ODI]) and back and leg pain severity (numeric rating scale [NRS]) were compared between male and female patients. Minimum clinically important difference (MCID) was defined as > 30% improvement.ResultsSix-hundred-sixty (59%) of 1115 included patients were female. Female patients presented with significantly baseline ODI (51.5 ± 17.2 vs. 47.8 ± 17.9, P<0.001) and back pain (6.96 ± 2.32 vs. 6.60 ± 2.30, P=0.010) and leg pain (6.49 ± 2.76 vs. 6.01 ± 2.76, P=0.005). At 12-months, female patients still reported significantly higher ODI (22.76 ± 16.97 vs. 20.50 ± 16.10, P=0.025), but not higher back (3.13 ± 2.38 vs. 3.00 ± 2.40, P=0.355) or leg pain (2.62 ± 2.55 vs. .34 ± 2.43, P=0.060). Change scores at 12 months did not differ significantly among male and female patients in ODI (∆ 1.31, 95% CI -3.88-1.25, P=0.315), back (∆ 0.22, 95% CI -0.57-0.12, P=0.197) and leg pain (∆ 0.16, 95% CI -0.56-0.24, P=0.439). MCID at 12-months was achieved in 330 (77.5%) male patients and 481 (76.3%) female patients (P=0.729) for ODI.ConclusionBoth sexes experienced a similar benefit from surgery in terms of relative improvement in scores for functional impairment and pain. Although female patients reported a higher degree of functional impairment and pain preoperatively, at 12 months only their average scores for functional impairment remained higher than those for their male counterparts, while absolute pain scores were similar for female and male patients.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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