What is the Association of the Subsections of the Oswestry Disability Index and Overall Improvement 2 Years After Lumbar Surgery for Degenerative Lumbar Spondylolisthesis?

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2025-04-01 Epub Date: 2024-06-21 DOI:10.1097/BRS.0000000000005076

Jan Hambrecht, Paul Köhli, Roland Duculan, Ranqing Lan, Erika Chiapparelli, Ali E Guven, Gisberto Evangelisti, Marco D Burkhard, Koki Tsuchiya, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes

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Abstract

Study design: Retrospective review of a prospective cohort study.

Objective: To identify the association between Oswestry Disability Index (ODI) subsections and overall improvement 2 years after lumbar surgery for degenerative lumbar spondylolisthesis (DLS).

Background: DLS often necessitates lumbar surgery. The ODI is a trusted measure for patient-reported outcomes (PROMs) in assessing spinal disorder outcomes. Surgeons utilize the ODI for baseline functional assessment and postsurgery progress tracking. However, it remains uncertain if and how each subsection influences overall ODI improvement.

Methods: This retrospective cohort study analyzed patients who underwent lumbar surgery for DLS between 2016 and 2018. Preoperative and 2-year postoperative ODI assessments were conducted. The study analyzed postoperative subsection scores and defined ODI improvement as ODIpreop-ODIpostop >0. Univariate linear regression was applied, and receiver operating characteristic (ROC) analysis determined cutoffs for subsection changes and postoperative target values to achieve overall ODI improvement.

Results: Two hundred sixty-five patients (60% female, mean age 67±8 yr) with a baseline ODI of 50±6 and a postoperative ODI of 20±7 were included. ODI improvement was noted in 91% (242 patients). Achieving a postoperative target score of ≤2 in subsections correlated with overall ODI improvement. Walking had the highest predictive value for overall ODI improvement (AUC: 0.91, sensitivity: 79%, and specificity: 91%). Pain intensity (AUC: 0.90, sensitivity: 86%, and specificity: 83%) and changing degree of pain (AUC: 0.87, sensitivity: 86%, and specificity: 74%) were also highly predictive. Sleeping had the lowest predictability (AUC: 0.79, sensitivity: 84%, and specificity: 65%). Except for sleeping, all subsections had a Youden index >50%.

Conclusions: These findings demonstrate how the different ODI subsections are associated with overall improvement post-lumbar surgery for DLS. This understanding is crucial for refining preoperative education, addressing particular disabilities, and evaluating surgical efficacy. In addition, it shows that surgical treatment does not affect all subsections equally.

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退行性腰椎滑脱症腰椎手术两年后，Oswestry 失能指数各分项与总体改善情况有何关联？

研究设计对一项前瞻性队列研究进行回顾性分析：目的：确定Oswestry残疾指数（ODI）分项与退行性腰椎滑脱症（DLS）腰椎手术后2年总体改善之间的关系：背景：DLS 通常需要进行腰椎手术。背景：DLS 通常需要进行腰椎手术。ODI 是评估脊柱疾病疗效的患者报告疗效 (PROM) 的可靠指标。外科医生利用 ODI 进行基线功能评估和术后进展跟踪。然而，目前仍不确定各分节是否以及如何影响 ODI 的整体改善：这项回顾性队列研究分析了 2016 年至 2018 年间因 DLS 而接受腰椎手术的患者。进行了术前和术后 2 年的 ODI 评估。研究分析了术后分节得分，并将 ODI 改善定义为 ODIpreop-ODIpostop >0。研究采用单变量线性回归，并通过接收器操作特征（ROC）分析确定了分节变化的临界值和术后目标值，以实现总体 ODI 改善。结果：研究纳入了 265 例患者（60% 为女性，平均年龄为 67±8 岁），基线 ODI 为 50±6，术后 ODI 为 20±7。91%的患者（242人）的ODI有所改善。术后小节目标得分≤2分与总体ODI改善相关。步行对总体 ODI 改善的预测值最高（AUC 0.91，敏感性 79%，特异性 91%）。疼痛强度（AUC 0.90，敏感性 86%，特异性 83%）和疼痛程度变化（AUC 0.87，敏感性 86%，特异性 74%）也具有很高的预测价值。睡眠的预测性最低（AUC 0.79，灵敏度 84%，特异性 65%）。除睡眠外，所有分项的尤登指数均大于 50%：这些研究结果表明了不同的 ODI 分项如何与腰椎手术后 DLS 的整体改善相关联。这种认识对于完善术前教育、解决特殊残疾问题和评估手术疗效至关重要。此外，研究还表明，手术治疗对所有分项的影响并不相同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.