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Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression
Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is les...
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| Published in: | The spine journal 2023-08, Vol.23 (8), p.1152-1160 |
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| container_end_page | 1160 |
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| container_title | The spine journal |
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| creator | Singh, Sumedha Shahi, Pratyush Asada, Tomoyuki Kaidi, Austin Subramanian, Tejas Zhao, Eric Kim, Ashley Yeo Eun Maayan, Omri Araghi, Kasra Singh, Nishtha Tuma, Olivia Korsun, Maximilian Kamil, Robert Sheha, Evan Dowdell, James Qureshi, Sheeraz Iyer, Sravisht |
| description | Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression.
Retrospective cohort.
Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) |
| doi_str_mv | 10.1016/j.spinee.2023.04.004 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2801980825</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1529943023001572</els_id><sourcerecordid>2801980825</sourcerecordid><originalsourceid>FETCH-LOGICAL-c408t-45da266ea4379d21af1da590d69fddb072687667928b32cb3db55c8741e96a153</originalsourceid><addsrcrecordid>eNp9kU2O1DAQhS0EYoaBGyDkJZuEsp3E9gYJ9fDT0qBhAWvLsStqt5I42OlGcwcOjaMeWLJxWarvvVLVI-Q1g5oB694d67yEGbHmwEUNTQ3QPCHXTElVsU7wp-Xfcl3pRsAVeZHzEQCUZPw5uRISWi1AXpPf32JMdDplNyI9oB3XA7Wzp2P8RZeEccFk13BGen-7pzYhDbPHBcszrxvgg1tjynQoLrmIMFHrDgHPOG1EHOjX3f6W2mEtnSnMYbLj-FBczjZvth5dnIpPziHOL8mzwY4ZXz3WG_Lj08fvuy_V3f3n_e7DXeUaUGvVtN7yrkPbCKk9Z3Zg3rYafKcH73uQvFOy66Tmqhfc9cL3beuUbBjqzrJW3JC3F98lxZ8nzKuZQnY4jnbGeMqGK2BageIb2lxQl2LOCQezpLJDejAMzJaDOZpLDmbLwUBjSg5F9uZxwqmf0P8T_T18Ad5fACx7ngMmk13A2ZWDJnSr8TH8f8If-rGdoQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2801980825</pqid></control><display><type>article</type><title>Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression</title><source>ScienceDirect Freedom Collection</source><creator>Singh, Sumedha ; Shahi, Pratyush ; Asada, Tomoyuki ; Kaidi, Austin ; Subramanian, Tejas ; Zhao, Eric ; Kim, Ashley Yeo Eun ; Maayan, Omri ; Araghi, Kasra ; Singh, Nishtha ; Tuma, Olivia ; Korsun, Maximilian ; Kamil, Robert ; Sheha, Evan ; Dowdell, James ; Qureshi, Sheeraz ; Iyer, Sravisht</creator><creatorcontrib>Singh, Sumedha ; Shahi, Pratyush ; Asada, Tomoyuki ; Kaidi, Austin ; Subramanian, Tejas ; Zhao, Eric ; Kim, Ashley Yeo Eun ; Maayan, Omri ; Araghi, Kasra ; Singh, Nishtha ; Tuma, Olivia ; Korsun, Maximilian ; Kamil, Robert ; Sheha, Evan ; Dowdell, James ; Qureshi, Sheeraz ; Iyer, Sravisht</creatorcontrib><description>Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression.
Retrospective cohort.
Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded.
MCID achievement in ODI (cut off 12.8).
Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early ≤3 months, late ≥6 months). Nonradiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI – Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray – spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by ≤3 months) and nonachievement of MCID (MCID not achieved at ≥6 months).
A total of 338 patients were included. At ≤3 months, patients who did not achieve MCID had significantly lower preoperative ODI (40.1 vs 48.1, p<0.001) and worse psoas Goutallier grading (p=.048). At ≥6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs 47.5, p<.001), higher age (68 vs 63 years, p=.007), worse average L1-S1 Pfirrmann grading (3.5 vs 3.2, p=.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late timepoint came out as independent predictors for MCID nonachievement.
After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For nonachievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor.</description><identifier>ISSN: 1529-9430</identifier><identifier>EISSN: 1878-1632</identifier><identifier>DOI: 10.1016/j.spinee.2023.04.004</identifier><identifier>PMID: 37059307</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Failure ; Laminectomy ; Lumbar decompression ; MCID ; ODI ; Predictors ; Radiological ; Risk factors ; Slower improvement</subject><ispartof>The spine journal, 2023-08, Vol.23 (8), p.1152-1160</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-45da266ea4379d21af1da590d69fddb072687667928b32cb3db55c8741e96a153</citedby><cites>FETCH-LOGICAL-c408t-45da266ea4379d21af1da590d69fddb072687667928b32cb3db55c8741e96a153</cites><orcidid>0000-0002-7177-1756 ; 0000-0003-3470-5546 ; 0000-0002-2581-5447 ; 0000-0003-0323-6716 ; 0000-0001-7289-7564 ; 0000-0003-4339-6079 ; 0000-0002-8338-9757 ; 0000-0001-7086-2341 ; 0000-0002-6149-9939 ; 0000-0003-4903-9697</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37059307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Singh, Sumedha</creatorcontrib><creatorcontrib>Shahi, Pratyush</creatorcontrib><creatorcontrib>Asada, Tomoyuki</creatorcontrib><creatorcontrib>Kaidi, Austin</creatorcontrib><creatorcontrib>Subramanian, Tejas</creatorcontrib><creatorcontrib>Zhao, Eric</creatorcontrib><creatorcontrib>Kim, Ashley Yeo Eun</creatorcontrib><creatorcontrib>Maayan, Omri</creatorcontrib><creatorcontrib>Araghi, Kasra</creatorcontrib><creatorcontrib>Singh, Nishtha</creatorcontrib><creatorcontrib>Tuma, Olivia</creatorcontrib><creatorcontrib>Korsun, Maximilian</creatorcontrib><creatorcontrib>Kamil, Robert</creatorcontrib><creatorcontrib>Sheha, Evan</creatorcontrib><creatorcontrib>Dowdell, James</creatorcontrib><creatorcontrib>Qureshi, Sheeraz</creatorcontrib><creatorcontrib>Iyer, Sravisht</creatorcontrib><title>Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression</title><title>The spine journal</title><addtitle>Spine J</addtitle><description>Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression.
Retrospective cohort.
Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded.
MCID achievement in ODI (cut off 12.8).
Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early ≤3 months, late ≥6 months). Nonradiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI – Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray – spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by ≤3 months) and nonachievement of MCID (MCID not achieved at ≥6 months).
A total of 338 patients were included. At ≤3 months, patients who did not achieve MCID had significantly lower preoperative ODI (40.1 vs 48.1, p<0.001) and worse psoas Goutallier grading (p=.048). At ≥6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs 47.5, p<.001), higher age (68 vs 63 years, p=.007), worse average L1-S1 Pfirrmann grading (3.5 vs 3.2, p=.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late timepoint came out as independent predictors for MCID nonachievement.
After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For nonachievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor.</description><subject>Failure</subject><subject>Laminectomy</subject><subject>Lumbar decompression</subject><subject>MCID</subject><subject>ODI</subject><subject>Predictors</subject><subject>Radiological</subject><subject>Risk factors</subject><subject>Slower improvement</subject><issn>1529-9430</issn><issn>1878-1632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kU2O1DAQhS0EYoaBGyDkJZuEsp3E9gYJ9fDT0qBhAWvLsStqt5I42OlGcwcOjaMeWLJxWarvvVLVI-Q1g5oB694d67yEGbHmwEUNTQ3QPCHXTElVsU7wp-Xfcl3pRsAVeZHzEQCUZPw5uRISWi1AXpPf32JMdDplNyI9oB3XA7Wzp2P8RZeEccFk13BGen-7pzYhDbPHBcszrxvgg1tjynQoLrmIMFHrDgHPOG1EHOjX3f6W2mEtnSnMYbLj-FBczjZvth5dnIpPziHOL8mzwY4ZXz3WG_Lj08fvuy_V3f3n_e7DXeUaUGvVtN7yrkPbCKk9Z3Zg3rYafKcH73uQvFOy66Tmqhfc9cL3beuUbBjqzrJW3JC3F98lxZ8nzKuZQnY4jnbGeMqGK2BageIb2lxQl2LOCQezpLJDejAMzJaDOZpLDmbLwUBjSg5F9uZxwqmf0P8T_T18Ad5fACx7ngMmk13A2ZWDJnSr8TH8f8If-rGdoQ</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Singh, Sumedha</creator><creator>Shahi, Pratyush</creator><creator>Asada, Tomoyuki</creator><creator>Kaidi, Austin</creator><creator>Subramanian, Tejas</creator><creator>Zhao, Eric</creator><creator>Kim, Ashley Yeo Eun</creator><creator>Maayan, Omri</creator><creator>Araghi, Kasra</creator><creator>Singh, Nishtha</creator><creator>Tuma, Olivia</creator><creator>Korsun, Maximilian</creator><creator>Kamil, Robert</creator><creator>Sheha, Evan</creator><creator>Dowdell, James</creator><creator>Qureshi, Sheeraz</creator><creator>Iyer, Sravisht</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7177-1756</orcidid><orcidid>https://orcid.org/0000-0003-3470-5546</orcidid><orcidid>https://orcid.org/0000-0002-2581-5447</orcidid><orcidid>https://orcid.org/0000-0003-0323-6716</orcidid><orcidid>https://orcid.org/0000-0001-7289-7564</orcidid><orcidid>https://orcid.org/0000-0003-4339-6079</orcidid><orcidid>https://orcid.org/0000-0002-8338-9757</orcidid><orcidid>https://orcid.org/0000-0001-7086-2341</orcidid><orcidid>https://orcid.org/0000-0002-6149-9939</orcidid><orcidid>https://orcid.org/0000-0003-4903-9697</orcidid></search><sort><creationdate>202308</creationdate><title>Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression</title><author>Singh, Sumedha ; Shahi, Pratyush ; Asada, Tomoyuki ; Kaidi, Austin ; Subramanian, Tejas ; Zhao, Eric ; Kim, Ashley Yeo Eun ; Maayan, Omri ; Araghi, Kasra ; Singh, Nishtha ; Tuma, Olivia ; Korsun, Maximilian ; Kamil, Robert ; Sheha, Evan ; Dowdell, James ; Qureshi, Sheeraz ; Iyer, Sravisht</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-45da266ea4379d21af1da590d69fddb072687667928b32cb3db55c8741e96a153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Failure</topic><topic>Laminectomy</topic><topic>Lumbar decompression</topic><topic>MCID</topic><topic>ODI</topic><topic>Predictors</topic><topic>Radiological</topic><topic>Risk factors</topic><topic>Slower improvement</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Singh, Sumedha</creatorcontrib><creatorcontrib>Shahi, Pratyush</creatorcontrib><creatorcontrib>Asada, Tomoyuki</creatorcontrib><creatorcontrib>Kaidi, Austin</creatorcontrib><creatorcontrib>Subramanian, Tejas</creatorcontrib><creatorcontrib>Zhao, Eric</creatorcontrib><creatorcontrib>Kim, Ashley Yeo Eun</creatorcontrib><creatorcontrib>Maayan, Omri</creatorcontrib><creatorcontrib>Araghi, Kasra</creatorcontrib><creatorcontrib>Singh, Nishtha</creatorcontrib><creatorcontrib>Tuma, Olivia</creatorcontrib><creatorcontrib>Korsun, Maximilian</creatorcontrib><creatorcontrib>Kamil, Robert</creatorcontrib><creatorcontrib>Sheha, Evan</creatorcontrib><creatorcontrib>Dowdell, James</creatorcontrib><creatorcontrib>Qureshi, Sheeraz</creatorcontrib><creatorcontrib>Iyer, Sravisht</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singh, Sumedha</au><au>Shahi, Pratyush</au><au>Asada, Tomoyuki</au><au>Kaidi, Austin</au><au>Subramanian, Tejas</au><au>Zhao, Eric</au><au>Kim, Ashley Yeo Eun</au><au>Maayan, Omri</au><au>Araghi, Kasra</au><au>Singh, Nishtha</au><au>Tuma, Olivia</au><au>Korsun, Maximilian</au><au>Kamil, Robert</au><au>Sheha, Evan</au><au>Dowdell, James</au><au>Qureshi, Sheeraz</au><au>Iyer, Sravisht</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression</atitle><jtitle>The spine journal</jtitle><addtitle>Spine J</addtitle><date>2023-08</date><risdate>2023</risdate><volume>23</volume><issue>8</issue><spage>1152</spage><epage>1160</epage><pages>1152-1160</pages><issn>1529-9430</issn><eissn>1878-1632</eissn><abstract>Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression.
Retrospective cohort.
Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded.
MCID achievement in ODI (cut off 12.8).
Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early ≤3 months, late ≥6 months). Nonradiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI – Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray – spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by ≤3 months) and nonachievement of MCID (MCID not achieved at ≥6 months).
A total of 338 patients were included. At ≤3 months, patients who did not achieve MCID had significantly lower preoperative ODI (40.1 vs 48.1, p<0.001) and worse psoas Goutallier grading (p=.048). At ≥6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs 47.5, p<.001), higher age (68 vs 63 years, p=.007), worse average L1-S1 Pfirrmann grading (3.5 vs 3.2, p=.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late timepoint came out as independent predictors for MCID nonachievement.
After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For nonachievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37059307</pmid><doi>10.1016/j.spinee.2023.04.004</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7177-1756</orcidid><orcidid>https://orcid.org/0000-0003-3470-5546</orcidid><orcidid>https://orcid.org/0000-0002-2581-5447</orcidid><orcidid>https://orcid.org/0000-0003-0323-6716</orcidid><orcidid>https://orcid.org/0000-0001-7289-7564</orcidid><orcidid>https://orcid.org/0000-0003-4339-6079</orcidid><orcidid>https://orcid.org/0000-0002-8338-9757</orcidid><orcidid>https://orcid.org/0000-0001-7086-2341</orcidid><orcidid>https://orcid.org/0000-0002-6149-9939</orcidid><orcidid>https://orcid.org/0000-0003-4903-9697</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The spine journal, 2023-08, Vol.23 (8), p.1152-1160 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_2801980825 |
| source | ScienceDirect Freedom Collection |
| subjects | Failure Laminectomy Lumbar decompression MCID ODI Predictors Radiological Risk factors Slower improvement |
| title | Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression |
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