New prospective clinical study shows that patients have three times greater chance of positive outcomes when their surgeons follow evidence-based guidelines for lumbar spinal fusion.
Since the 1990s, the rate of spinal fusion to treat lower back pain has been on the rise. A new prospective clinical study found that lumbar fusions were three times more likely to be effective and obtain better patient outcomes, when guidelines for fusion were followed. The results suggest that when surgeons operate outside of what the evidence based literature suggests, patients may not have significant improvements in their quality of life and could have increased pain or other limitations.
“Unfortunately, we don’t know how many lumbar fusion surgeries are not based on evidence-based best practice, or how these patients do clinically,” says neurosurgeon James Harrop, MD, MSHQS professor and chief of the Spine and Peripheral Nerve Surgery division at the Vickie and Jack Farber Institute for Neuroscience – Jefferson Health. “The study goal was to explore what drove the best clinical outcomes for lumbar fusion, specifically the outcomes that patients valued as important to them. Our results indicate that alignment with clinical guidelines was the best predictor of positive outcomes over all other factors we evaluated.”
The researchers assessed 325 lumbar fusion cases on whether they conformed to the North American Spine Societies (NASS) lumbar fusion guidelines. Assessments were done in a blinded fashion, and did not influence the decision of a patient’s surgical team. The researchers then followed the patients out for six months after surgery and had them fill out a validated survey tool (the Oswestry Disability Index – ODI), which assessed patient-reported outcomes measures (PROM). Rather than examining surgical success, the ODI examines patient centric outcomes including: pain, walking, lifting, sleep, social live and sex life.
