Gideon R Budiono1, Miles H McCaffrey2, William C H Parr3, Wen J Choy4, Telvinderjit Singh5, Matthew H Pelletier6, Ralph J Mobbs5. 1. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia. Electronic address: gideonrichard2998@gmail.com. 2. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia. 3. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia; 3DMorphic Pty Ltd., Sydney, New South Wales, Australia. 4. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia. 5. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia. 6. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD. METHODS: A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed. RESULTS: After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001-0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05-1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44-1.09 and OR, 0.97, 95% CI, 0.81-1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line. CONCLUSIONS: This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD.
OBJECTIVE: Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD. METHODS: A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed. RESULTS: After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001-0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05-1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44-1.09 and OR, 0.97, 95% CI, 0.81-1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line. CONCLUSIONS: This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD.