An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

McGirt, Matthew J.; Bydon, Mohamad; Archer, Kristin R.; Devin, Clinton J.; Chotai, Silky; Parker, Scott L.; Nian, Hui; Harrell, Frank E.; Speroff, Theodore; Dittus, Robert S.; Philips, Sharon E.; Shaffrey, Christopher I.; Foley, Kevin T.; Asher, Anthony L.

doi:10.3171/2016.11.spine16526

Cited by 176Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationCervical and Thoracic Myelopathy

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

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McGirt, Matthew J., Bydon, Mohamad, Archer, Kristin R., Devin, Clinton J., Chotai, Silky, Parker, Scott L., Nian, Hui, Harrell, Frank E. +6 more·2017·Journal of Neurosurgery: Spine

DOI 10.3171/2016.11.spine16526

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Abstract

OBJECTIVE: Quality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery. METHODS: Included in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers’ compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO. RESULTS: There was a significant improvement in all PROs (p < 0.0001) at 12 months following lumbar spine surgery. The most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers’ compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes). CONCLUSIONS: This study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.

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Asher, A. M., Oleisky, E. R., Pennings, J. S., Khan, I., Sivaganesan, A., Devin, C. J., Bydon, M., Asher, A. L., & Archer, K. R. (2020) · The Spine Journal · doi:10.1016/j.spinee.2020.01.010 · Cited by 99 · see citing works
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Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database
Asher, A. L., Devin, C. J., Kerezoudis, P., Chotai, S., Nian, H., Harrell, F. E., Sivaganesan, A., McGirt, M. J., Archer, K. R., Foley, K. T., et al. (2018) · Neurosurgery · doi:10.1093/neuros/nyy144 · Cited by 95 · see citing works
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Prognostic prediction models for chronic postsurgical pain in adults: a systematic review
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Quality Outcomes Database Spine Care Project 2012–2020: milestones achieved in a collaborative North American outcomes registry to advance value-based spine care and evolution to the American Spine Registry
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Bundled Payment Models in Spine Surgery: Current Challenges and Opportunities, a Systematic Review
Dietz, N. E., Sharma, M., Alhourani, A., Ugiliweneza, B., Wang, D., Nuno, M. A., Drazin, D. G., & Boakye, M. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.12.001 · Cited by 71 · see citing works
A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis
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Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful?
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Racial Disparities in Outcomes After Spine Surgery: A Systematic Review and Meta-Analysis
Khan, I. S., Huang, E., Maeder-York, W., Yen, R. W., Simmons, N. E., Ball, P. A., & Ryken, T. C. (2021) · World Neurosurgery · doi:10.1016/j.wneu.2021.09.140 · Cited by 58 · see citing works
Frailty and Sarcopenia: Impact on Outcomes Following Elective Degenerative Lumbar Spine Surgery
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A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database
Devin, C. J., Bydon, M., Alvi, M. A., Kerezoudis, P., Khan, I., Sivaganesan, A., McGirt, M. J., Archer, K. R., Foley, K. T., Mummaneni, P. V., et al. (2018) · Neurosurgical FOCUS · doi:10.3171/2018.8.focus18326 · Cited by 58 · see citing works
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Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery
Khan, I., Bydon, M., Archer, K. R., Sivaganesan, A., Asher, A. M., Alvi, M. A., Kerezoudis, P., Knightly, J. J., Foley, K. T., Bisson, E. F., et al. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.08.007 · Cited by 57 · see citing works
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A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective Quality Outcomes Database
Chan, A. K.-H., Bisson, E. F., Bydon, M., Foley, K. T., Glassman, S. D., Shaffrey, C. I., Wang, M. Y., Park, P., Potts, E. A., Shaffrey, M. E., et al. (2020) · Neurosurgery · doi:10.1093/neuros/nyaa097 · Cited by 53 · see citing works
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Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery
Oleisky, E. R., Pennings, J. S., Hills, J. M., Sivaganesan, A., Khan, I., Call, R., Devin, C. J., & Archer, K. R. (2019) · The Spine Journal · doi:10.1016/j.spinee.2018.12.014 · Cited by 48 · see citing works
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Black Race as a Social Determinant of Health and Outcomes After Lumbar Spinal Fusion Surgery
Aladdin, D. E. H., Tangel, V. E., Lui, B., Pryor, K. O., Witkin, L. R., & White, R. S. (2020) · Spine · doi:10.1097/brs.0000000000003367 · Cited by 48 · see citing works
Development of prediction models for clinically meaningful improvement in PROMIS scores after lumbar decompression
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Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery
Berg, B., Gorosito, M. A., Fjeld, O., Haugerud, H., Storheim, K., Solberg, T. K., & Grotle, M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.55024 · Cited by 46 · see citing works
Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery
Elsamadicy, A. A., Kemeny, H. R., Adogwa, O., Sankey, E. W., Goodwin, C. R., Yarbrough, C. K., Lad, S. P., Karikari, I. O., & Gottfried, O. N. (2018) · Journal of Neurosurgery Spine · doi:10.3171/2017.12.spine171079 · Cited by 46 · see citing works
Preoperative PROMIS Scores Predict Postoperative Outcomes in Lumbar Spine Surgery Patients
Snavely, J. E., Weiner, J. A., Johnson, D. J., Hsu, W. K., & Patel, A. A. (2021) · Spine · doi:10.1097/brs.0000000000003972 · Cited by 46 · see citing works
Prediction Models in Degenerative Spine Surgery: A Systematic Review
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Posterior Instrumented Spinal Surgery Outcomes in the Elderly: A Comparison of the 5-Item and 11-Item Modified Frailty Indices
Kweh, B. T. S., Lee, H. Q., Tan, T. C. F., Liew, S. M., Hunn, M., & Tee, J. (2022) · Global Spine Journal · doi:10.1177/21925682221117139 · Cited by 44 · see citing works
PROMIS Physical Function for prediction of postoperative pain, narcotics consumption, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion
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Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery
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Predicting patient-reported outcomes following lumbar spine surgery: development and external validation of multivariable prediction models
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Pediatric brain arteriovenous malformation recurrence: a cohort study, systematic review and meta-analysis
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Effects of Reiki Versus Physiotherapy on Relieving Lower Back Pain and Improving Activities Daily Living of Patients With Intervertebral Disc Hernia
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Prediction of Oswestry Disability Index (ODI) using PROMIS-29 in a national sample of lumbar spine surgery patients
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Comparison of patient- and clinician-reported outcome measures in lower back rehabilitation: introducing a new integrated performance measure (t2D)
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How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?
Master, H., Pennings, J. S., Coronado, R. A., Bley, J. A., Robinette, P. E., Haug, C. M., Skolasky, R. L., Riley, L. H., Neuman, B. J., Cheng, J. S., et al. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.06.002 · Cited by 32 · see citing works
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Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study
Lotzke, H., Jakobsson, M., Gutke, A., Hagströmer, M., Brisby, H., Hägg, O., Smeets, R., & Lundberg, M. (2018) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2274-5 · Cited by 31 · see citing works
Adding 3-month patient data improves prognostic models of 12-month disability, pain, and satisfaction after specific lumbar spine surgical procedures: development and validation of a prediction model
Rundell, S. D., Pennings, J. S., Nian, H., Harrell, F. E., Khan, I., Bydon, M., Asher, A. L., Devin, C. J., & Archer, K. R. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.12.010 · Cited by 31 · see citing works
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Fear of Movement Is Related to Low Back Disability During a Two-Year Period in Patients Who Have Undergone Elective Lumbar Spine Surgery
Kemani, M. K., Hägg, O., Jakobsson, M., & Lundberg, M. (2020) · World Neurosurgery · doi:10.1016/j.wneu.2020.01.218 · Cited by 29 · see citing works
Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery
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Use of machine learning to model surgical decision-making in lumbar spine surgery
Xie, N., Wilson, P. J., & Reddy, R. (2022) · European Spine Journal · doi:10.1007/s00586-021-07104-8 · Cited by 28 · see citing works
Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database
Asher, A. L., Devin, C. J., Kerezoudis, P., Nian, H., Alvi, M. A., Khan, I., Sivaganesan, A., Harrell, F. E., Archer, K. R., & Bydon, M. (2019) · Journal of Neurosurgery Spine · doi:10.3171/2019.6.spine19426 · Cited by 28 · see citing works
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Predicting Patient-Centered Outcomes from Spine Surgery Using Risk Assessment Tools: a Systematic Review
White, H. J., Bradley, J., Hadgis, N., Wittke, E., Piland, B., Tuttle, B., Erickson, M. M., & Horn, M. E. (2020) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-020-09630-2 · Cited by 28 · see citing works
The patient acceptable symptom state for the Oswestry Disability Index following single-level lumbar fusion for degenerative spondylolisthesis
Goh, G. S.-H., Soh, R. C. C., Yue, W.-M., Guo, C. M., Tan, S. B., & Chen, J. L.-T. (2020) · The Spine Journal · doi:10.1016/j.spinee.2020.11.008 · Cited by 27 · see citing works
Research using the Quality Outcomes Database: accomplishments and future steps toward higher-quality real-world evidence
Asher, A. L., Haid, R. W., Stroink, A. R., Michalopoulos, G. D., Alexander, A. Y., Zeitouni, D., Chan, A. K.-H., Virk, M. S., Glassman, S. D., Foley, K. T., et al. (2023) · Journal of neurosurgery · doi:10.3171/2023.3.jns222601 · Cited by 25 · see citing works
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In Reply: A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective Quality Outcomes Database
Chan, A. K.-H., Bission, E. F., Bydon, M., & Mummaneni, P. V. (2020) · Neurosurgery · doi:10.1093/neuros/nyaa372 · Cited by 25 · see citing works
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Risk prediction in spine surgery: a scoping review of traditional models, artificial intelligence, and the challenge of clinical translation
Salman, S. G., Phadke, R. A., Kumar, R., Momin, A. A., & Tavakkoli, A. (2026) · Spine Deformity · doi:10.1007/s43390-026-01365-3 · Cited by 24 · see citing works
Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practice—a qualitative study
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SpineCloud: image analytics for predictive modeling of spine surgery outcomes
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Sensitivity and specificity of patient-entered red flags for lower back pain
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Can the Charlson Comorbidity Index be used to predict the ASA grade in patients undergoing spine surgery?
Mannion, A. F., Bianchi, G., Mariaux, F. B., Fekete, T. F., Reitmeir, R., Moser, B., Whitmore, R. G., Ratliff, J. K., & Haschtmann, D. (2020) · European Spine Journal · doi:10.1007/s00586-020-06595-1 · Cited by 22 · see citing works
Age as a Predictor for Complications and Patient-reported Outcomes in Multilevel Transforaminal Lumbar Interbody Fusions
Claus, C. F., Tong, D. W., Lytle, E. J., Bahoura, M., Garmo, L. G., Li, C., Park, P., Carr, D. A., Easton, R. W., Abdulhak, M. M., et al. (2020) · Spine · doi:10.1097/brs.0000000000003792 · Cited by 22 · see citing works
A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients’ Expectations, Experiences, and Satisfaction
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The Effect of the Severity of Preoperative Back Pain on Patient-Reported Outcomes, Recovery Ratios, and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)
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A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery
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Socioeconomic Effects on Lumbar Fusion Outcomes
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Value of Adding Predictive Clinical Decision Tools to Spine Surgery
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Evaluation of growth production factors as predictors of the incidence and severity of white striping and woody breast in broiler chickens
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The association of patient education level with outcomes after elective lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study
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Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results
Khan, J. M., Harada, G. K., Basques, B. A., Nolte, M. T., Louie, P. K., Iloanya, M. N., Tchalukov, K., Berkowitz, M., Derman, P. B., Colman, M. W., et al. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.09.021 · Cited by 18 · see citing works
The Influence of Baseline Clinical Status and Surgical Strategy on Early Good to Excellent Result in Spinal Lumbar Arthrodesis: A Machine Learning Approach
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Maxillomandibular Advancement for Obstructive Sleep Apnea Is Associated With Very Long-Term Overall Sleep-Related Quality-of-Life Improvement
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Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register
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The Effect of the Severity of Preoperative Disability on Patient-Reported Outcomes and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
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Prognostic prediction model for chronic postsurgical pain among adult patients: a systematic review and meta-analysis
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Association of prolonged symptom duration with poor outcomes in lumbar spine surgery: a Michigan Spine Surgery Improvement Collaborative study
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Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder
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Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery
Devin, C. J., Asher, A. L., Archer, K. R., Goyal, A., Khan, I., Kerezoudis, P., Alvi, M. A., Pennings, J. S., Karacay, B., Shaffrey, C. I., et al. (2020) · Neurosurgery · doi:10.1093/neuros/nyaa240 · Cited by 16 · see citing works
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Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review
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Feasibility and Assessment of a Machine Learning-Based Predictive Model of Outcome After Lumbar Decompression Surgery
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Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries
Aithala, J. P., Kumar, S., Aithal, S., & Kotian, S. M. (2018) · Asian Spine Journal · doi:10.31616/asj.2018.12.6.1106 · Cited by 15 · see citing works
Age and Gender Confound PROMIS Scores in Spine Patients With Back and Neck Pain
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Experience of Pain and Satisfaction with Pain Management in Patients After a Lumbar Disc Herniation Surgery
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Patient Participation With a Mobile Phone Application for Objective Activity Assessment Before and After Spinal Fusion
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The Role of the Lumbar Paravertebral Muscles in the Development of Short-term Residual Pain After Lumbar Fusion Surgery
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Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease
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Impact of surgeon and hospital factors on surgical decision-making for grade 1 degenerative lumbar spondylolisthesis: a Quality Outcomes Database analysis
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Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges
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Authors: McGirt, M. J., Bydon, M., Archer, K. R., Devin, C. J., Chotai, S., Parker, S. L., Nian, H., Harrell, F. E., Speroff, T., Dittus, R. S., Philips, S. E., Shaffrey, C. I., Foley, K. T., & Asher, A. L.
Affiliations: Carolinas Healthcare System (US)
Mayo Clinic (US)
Vanderbilt University (US)
Vanderbilt University Medical Center (US)
Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee;
University of Virginia Hospital (US)
University of Tennessee Health Science Center (US)
ORCID: Bydon, Mohamad
Archer, Kristin R.
Devin, Clinton J.
Chotai, Silky
Nian, Hui
Harrell, Frank E.
Shaffrey, Christopher I.
Foley, Kevin T.
Asher, Anthony L.
Venue: Journal of Neurosurgery: Spine
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Published: 2017-10
Volume: 27
Issue: 4
Pages: 357-369
ISSN: 1547-5646 (ISSN-L)
1547-5654
DOI: 10.3171/2016.11.spine16526
OpenAlex: W2613104890
Cited by: 176
References: 69
Citations by year: 2026: 9 · 2025: 11 · 2024: 13 · 2023: 22 · 2022: 21 · 2021: 31 · 2020: 30 · 2019: 19 · 2018: 20
FWCI: 14.82
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Neurosurgery Spine (publishedVersion)
PubMed (publishedVersion)
Funders: Neurosurgery Research and Education Foundation
Topics: Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords: lumbar spine surgery, patient-reported outcomes, disability, quality of life, postoperative pain, prediction model, shared decision-making, Quality Outcomes Database, workers' compensation, psychological distress, leg pain, back pain, employment status, prognostic factors, spinal fusion, surgical approach, insurance status, racial disparities, educational attainment, smoking status, ASA physical status, symptom duration, ordinal logistic regression
MeSH terms: Aged, Back Pain, Decision Making, Disability Evaluation, Female, Follow-Up Studies, Humans, Longitudinal Studies, Lumbar Vertebrae, Male, Middle Aged, Pain Measurement, Postoperative Pain, Prognosis, Prospective Studies, Quality of Life, Registries, Sensitivity and Specificity, Socioeconomic Factors, Spinal Diseases, Databases, Factual, Treatment Outcome

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An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

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