Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry.
OBJECT
The authors have established a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures using prospectively collected outcomes. Collection of these data requires an extensive commitment of resources from each site. The aim of this study was to determine whether outcomes data from shorter-interval follow-up could be used to accurately estimate long-term outcome following lumbar discectomy.


METHODS
An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level lumbar discectomy for treatment of disc herniation were included. SF-36 and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Quality-adjusted life year (QALY) data were calculated using SF-6D utility scores. Correlations among outcomes at each follow-up time point were tested using the Spearman rank correlation test.


RESULTS
One hundred forty-eight patients were enrolled over 1 year. Their mean age was 46 years (49% female). Eleven patients (7.4%) required a reoperation by 1 year postoperatively. The overall 1-year follow-up rate was 80.4%. Lumbar discectomy was associated with significant improvements in ODI and SF-36 scores (p < 0.0001) and with a gain of 0.246 QALYs over the 1-year study period. The greatest gain occurred between baseline and 3-month follow-up and was significantly greater than improvements obtained between 3 and 6 months or 6 months and 1 year(p < 0.001). Correlations between 3-month, 6-month, and 1-year outcomes were similar, suggesting that 3-month data may be used to accurately estimate 1-year outcomes for patients who do not require a reoperation. Patients who underwent reoperation had worse outcomes scores and nonsignificant correlations at all time points.


CONCLUSIONS
This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. Three-month outcome data may be used to accurately estimate outcome at future time points and may lower costs associated with registry data collection. This registry effort provides a practical foundation for the acquisition of outcome data following lumbar discectomy.
['Whitmore|Robert G|RG|', 'Curran|Jill N|JN|', 'Ali|Zarina S|ZS|', 'Mummaneni|Praveen V|PV|', 'Shaffrey|Christopher I|CI|', 'Heary|Robert F|RF|', 'Kaiser|Michael G|MG|', 'Asher|Anthony L|AL|', 'Malhotra|Neil R|NR|', 'Cheng|Joseph S|JS|', 'Hurlbert|John|J|', 'Smith|Justin S|JS|', 'Magge|Subu N|SN|', 'Steinmetz|Michael P|MP|', 'Resnick|Daniel K|DK|', 'Ghogawala|Zoher|Z|']
D004185:Disability Evaluation D017586:Diskectomy D005260:Female D006801:Humans D007405:Intervertebral Disc Displacement D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D011788:Quality of Life D012042:Registries D012086:Reoperation D016896:Treatment Outcome
lumbar discectomy outcome QALY correlation IRB = institutional review board MCID = minimum clinically important difference ODI = Oswestry Disability Index QALY = quality-adjusted life year QOL = quality of life SF-36 = 36-Item Short-Form Health Survey SPORT = Spine Patient Outcomes Research Trial VAS = visual analog scale