Predicting Patient-Centered Outcomes from Spine Surgery Using Risk Assessment Tools: a Systematic Review

Abstract

Purpose of Review

The purpose of this systematic review is to evaluate the current literature in patients undergoing spine surgery in the cervical, thoracic, and lumbar spine to determine the available risk assessment tools to predict the patient-centered outcomes of pain, disability, physical function, quality of life, psychological disposition, and return to work after surgery.

Recent Findings

Risk assessment tools can assist surgeons and other healthcare providers in identifying the benefit-risk ratio of surgical candidates. These tools gather demographic, medical history, and other pertinent patient-reported measures to calculate a probability utilizing regression or machine learning statistical foundations. Currently, much is still unknown about the use of these tools to predict quality of life, disability, and other factors following spine surgery. A systematic review was conducted using PRISMA guidelines that identified risk assessment tools that utilized patient-reported outcome measures as part of the calculation. From 8128 identified studies, 13 articles met inclusion criteria and were accepted into this review.

Summary

The range of c-index values reported in the studies was between 0.63 and 0.84, indicating fair to excellent model performance. Post-surgical patient-reported outcomes were identified in the following categories (n = total number of predictive models): return to work (n = 3), pain (n = 9), physical functioning and disability (n = 5), quality of life (QOL) (n = 6), and psychosocial disposition (n = 2). Our review has synthesized the available evidence on risk assessment tools for predicting patient-centered outcomes in patients undergoing spine surgery and described their findings and clinical utility.

Appendix. Comprehensive search strategy used to identify relevant studies

PubMed https://mclibrary.duke.edu/pubmed

Set		Results
1	(“spine/surgery”[mesh] OR “Spinal Diseases/surgery”[mesh] OR “Lumbosacral Region/surgery”[mesh] OR “Diskectomy”[Mesh] OR discectomy[tiab] OR diskectomy[tiab] OR diskectomies[tiab] OR discectomies[tiab] OR Microdiscectomy[tiab] OR “Spinal Fusion”[Mesh] OR fusion[tiab] OR fusions[tiab] OR “Laminectomy”[Mesh] OR Laminectomy[tiab] OR “laminoplasty”[MeSH Terms] OR laminoplasty[tiab] OR Laminotomy[tiab] OR “Total Disc Replacement”[Mesh] OR “disc replacement”[tiab] OR foraminotomy[tiab] OR “foraminal decompression”[tiab] OR kyphoplasty[tiab] OR kyphoplasties[tiab] OR “facetectomy”[tiab] OR “arthrodesis”[MeSH Terms] OR “arthrodesis”[tiab] OR “cementoplasty”[MeSH Terms] OR “cementoplasty”[tiab] OR “vertebroplasty”[MeSH Terms] OR “vertebroplasty”[tiab] OR corpectomies[tiab] OR corpectomy[tiab] OR spondylodesis[tiab] OR spondylodeses[tiab] OR Spondylosyndesis[tiab]) OR ((“spine”[MeSH Terms] OR “spine”[tiab] OR spinal[tiab] OR disc[tiab] OR “lumbosacral region”[MeSH Terms] OR “lumbosacral”[tiab] OR “lumbar”[tiab]) AND (“Decompression, Surgical”[Mesh] OR “decompression”[tiab] OR “stabilization”[tiab] OR “surgery”[tiab] OR “Arthroplasty, Replacement”[mesh] OR “Surgical Procedures, Operative”[Mesh] OR “operative”[tiab] OR “operation”[tiab] OR “surgery”[Subheading] OR “surgery”[tiab] OR “surgeries”[tiab] OR “surgical”[tiab]))	353,221
2	“risk assessment”[mesh] OR “Risk Adjustment”[mesh] OR “risk calculator”[tiab] OR “risk calculators”[tiab] OR “risk assessment”[tiab] OR “risk prediction”[tiab] OR “risk stratification”[tiab] OR “risk stratified”[tiab] OR “stratified risk”[tiab] OR “SpineSage”[tiab] OR “Outcomes Assessment Program”[tiab] OR “Quality Outcomes Database”[tiab] OR “prediction tool”[tiab] OR “Predictive tool”[tiab] OR “prediction tools”[tiab] OR “Predictive tools”[tiab] OR “Predictive analytics”[tiab] OR “predictive model” OR “Predictive Value of Tests”[mesh] OR “machine learning”[MeSH Terms] OR “machine learning”[tiab]	507,154
3	“patient reported outcome measures”[MeSH Terms] OR “physical function”[tiab] OR “patient reported outcome”[tiab] OR “patient reported outcome measures”[tiab] OR “failed back surgery syndrome”[MeSH Terms] OR “failed back surgery syndrome”[tiab] OR “postoperative complications”[mesh] OR “postoperative complications”[tiab] OR “back pain”[MeSH Terms] OR “low back pain”[MeSH Terms] OR “back pain”[tiab] OR “Opioid-Related Disorders”[mesh] OR “opioid dependency”[tiab] OR “opiate dependency”[tiab] OR “opiate dependence”[tiab] OR “opioid dependence”[tiab] OR “opiate addiction”[tiab] OR “opioid addiction”[tiab] OR “opiate abuse”[tiab] OR “opiate misuse”[tiab] OR “Functional impairment”[tiab] OR “functional outcome”[tiab] OR “functional outcomes”[tiab] OR “disability”[tiab] OR “Disability Evaluation”[mesh] OR “Pain Measurement”[mesh] OR “Pain, Postoperative”[mesh] OR “pain”[MeSH Terms] OR “pain”[tiab] OR “pains”[tiab] OR “painful “[tiab] OR “discomfort “[tiab] OR “suffering “[tiab] OR “sufferings “[tiab] OR “ache “[tiab] OR “aches “[tiab] OR “aching”[tiab] OR “sore “[tiab] OR “soreness “[tiab] OR “analgesia “[tiab] OR “quality of life”[mesh] OR “quality of life”[tiab] OR “function test”[tiab] OR “function tests”[tiab] OR “functional testing”[tiab] OR “measure function”[tiab] OR “functional measure”[tiab] or “measuring function”[tiab] OR “measure functions”[tiab]	1,887,576
4	#1 AND #2 AND #3	2093
5	NOT ((“Adolescent”[Mesh] OR “Child”[Mesh] OR “Infant”[Mesh]) NOT “Adult”[Mesh])	1964
6	#4 NOT (Editorial[ptyp] OR Letter[ptyp] OR Case Reports[ptyp] OR Comment[ptyp])	1730

Database: Embase http://proxy.lib.duke.edu/login?url=http://www.embase.com

Set		Results
1	‘spine surgery’/exp OR ‘spine disease’/exp/dm_su OR ‘discectomy’/exp OR ‘laminectomy’/exp OR ‘laminoplasty’/exp OR ‘percutaneous vertebroplasty’/exp OR ‘cementoplasty’/exp OR ‘kyphoplasty’/exp OR ‘spine fusion’/exp OR ‘spondylodesis’/exp OR ‘arthrodesis’/exp OR ‘spine surgery’:ab,ti OR ‘discectomy’:ab,ti OR ‘diskectomy’:ab,ti OR ‘discectomies’:ab,ti OR ‘diskectomies’:ab,ti OR ‘laminectomy’:ab,ti OR ‘laminoplasty’:ab,ti OR ‘percutaneous vertebroplasty’:ab,ti OR ‘cementoplasty’:ab,ti OR ‘kyphoplasty’:ab,ti OR ‘spine fusion’:ab,ti OR ‘spondylodesis’:ab,ti OR ‘arthrodesis’:ab,ti OR ‘microdiscectomy’:ab,ti OR ‘fusion’:ab,ti OR ‘fusions’:ab,ti OR ‘laminotomy’/exp OR ‘total disc replacement’/exp OR ‘foraminotomy’/exp OR ‘kyphoplasty’/exp OR ‘facetectomy’/exp OR ‘corpectomy’/exp OR ‘laminotomy’:ab,ti OR ‘total disc replacement’:ab,ti OR ‘foraminotomy’:ab,ti OR ‘kyphoplasty’:ab,ti OR ‘facetectomy’:ab,ti OR ‘corpectomy’:ab,ti OR ‘corpectomies’:ab,ti OR ‘spondylodeses’:ab,ti OR ‘spondylosyndesis’:ab,ti OR ((‘spine’/exp OR ‘lumbosacral spine’/exp OR ‘spine’:ab,ti OR ‘spinal’:ab,ti OR ‘disc’:ab,ti OR ‘lumbosacral region’:ab,ti OR ‘lumbosacral’:ab,ti OR ‘lumbar’:ab,ti) AND (‘spinal cord decompression’/exp OR ‘decompression’:ab,ti OR ‘stabilization’:ab,ti OR ‘surgery’:ab,ti OR ‘operative’:ab,ti OR ‘surgeries’:ab,ti OR ‘surgical’:ab,ti OR ‘operation’:ab,ti OR ‘spinal’:ab,ti OR ‘surgery’:lnk OR ‘spinal’:ab,ti OR ‘surgery’/exp OR ‘replacement arthroplasty’/exp))	686,268
2	‘risk assessment’/exp OR ‘risk calculator’/exp OR ‘risk prediction’/exp OR ‘risk prediction model’/exp OR ‘risk stratification’/exp OR ‘prediction’/exp OR ‘predictive value’/exp OR ‘predictive model’/exp OR ‘machine learning’/exp OR ‘risk assessment’:ab,ti OR ‘risk calculator’:ab,ti OR ‘risk calculators’:ab,ti OR ‘risk prediction’:ab,ti OR ‘risk stratification’:ab,ti OR ‘predictive value’:ab,ti OR ‘predictive model’:ab,ti OR ‘machine learning’:ab,ti OR ‘risk adjustment’:ab,ti OR ‘risk stratified’:ab,ti OR ‘stratified risk’:ab,ti OR ‘SpineSage’:ab,ti OR ‘outcomes assessment program’:ab,ti OR ‘quality outcomes database’:ab,ti OR ‘prediction tool’:ab,ti OR ‘prediction tools’:ab,ti OR ‘predictive tool’:ab,ti OR ‘predictive tools’:ab,ti OR ‘predictive analytics’:ab,ti	1,184,970
3	‘patient-reported outcome’/exp OR ‘physical function’/exp OR ‘physical performance’/exp OR ‘failed back surgery syndrome’/exp OR ‘postoperative complication’/exp OR ‘backache’/exp OR ‘back pain’/exp OR ‘low back pain’/exp OR ‘patient-reported outcome’:ab,ti OR ‘physical function’:ab,ti OR ‘physical performance’:ab,ti OR ‘failed back surgery syndrome’:ab,ti OR ‘postoperative complication’:ab,ti OR ‘backache’:ab,ti OR ‘low back pain’:ab,ti OR ‘opiate addiction’/exp OR ‘Opioid-Related Disorders’:ab,ti OR ‘opioid dependency’:ab,ti OR ‘opiate dependency’:ab,ti OR ‘opiate dependence’:ab,ti OR ‘opioid dependence’:ab,ti OR ‘opiate addiction’:ab,ti OR ‘opioid addiction’:ab,ti OR ‘opiate abuse’:ab,ti OR ‘opiate misuse’:ab,ti OR ‘functional disease’/exp OR ‘disability’/exp OR ‘physical disability’/exp OR ‘pain measurement’/exp OR ‘postoperative pain’/exp OR ‘pain’/exp OR ‘discomfort’/exp OR ‘suffering’/exp OR ‘quality of life’/exp OR ‘quality of life assessment’/exp OR ‘function test’/exp OR ‘functional disease’:ab,ti OR ‘disability’:ab,ti OR ‘physical disability’:ab,ti OR ‘pain measurement’:ab,ti OR ‘postoperative pain’:ab,ti OR ‘pain’:ab,ti OR ‘pains’:ab,ti OR ‘painful’:ab,ti OR ‘discomfort’:ab,ti OR ‘suffering’:ab,ti OR ‘sufferings’:ab,ti OR ‘quality of life’:ab,ti OR ‘quality of life assessment’:ab,ti OR ‘function test’:ab,ti OR ‘function tests’:ab,ti OR ‘functional testing’:ab,ti OR ‘functional impairment’:ab,ti OR ‘functional outcome’:ab,ti OR ‘functional outcomes’:ab,ti OR ‘disability evaluation’:ab,ti OR ‘ache’:ab,ti OR ‘aches’:ab,ti OR ‘aching’:ab,ti OR ‘sore’:ab,ti OR ‘soreness’:ab,ti OR ‘analgesia’:ab,ti OR ‘measure function’:ab,ti OR ‘functional measure’:ab,ti OR ‘measuring function’:ab,ti OR ‘measure functions’:ab,ti	3,714,634
4	#1 AND #2 AND #3	5117
5	NOT (([child]/lim OR [infant]/lim OR [newborn]/lim OR [preschool]/lim OR [school]/lim OR [very elderly]/lim) NOT ([adult]/lim OR [middle aged]/lim OR [young adult]/lim))	4915
6	NOT (‘case report’/exp OR ‘case study’/exp OR ‘editorial’/exp OR ‘letter’/exp OR ‘note’/exp OR [conference abstract]/lim)	3735

Database: Scopus http://proxy.lib.duke.edu/login?url=http://www.scopus.com

Set		Results
1	TITLE-ABS-KEY (“spine surgery” OR “lumbosacral surgery” OR “Diskectomy” OR “discectomy” OR “diskectomies” OR “discectomies” OR “Microdiscectomy” OR “Spinal Fusion” OR “Laminectomy” OR “laminoplasty” OR “Laminotomy” OR “disc replacement” OR “foraminotomy” OR “foraminal decompression” OR “kyphoplasty” OR “kyphoplasties” OR “facetectomy” OR “arthrodesis” OR “cementoplasty” OR “vertebroplasty” OR “corpectomies” OR “corpectomy” OR “spondylodesis” OR “spondylodeses” OR “Spondylosyndesis”) OR TITLE-ABS-KEY ((“spine” OR “spinal” OR “disc” OR “lumbosacral” OR “lumbar”) AND (“decompression” OR “stabilization” OR “surgery” OR “replacement arthroplasty” OR “operative” OR “operation” OR “surgery” OR “surgeries” OR “surgical”))	206,607
2	TITLE-ABS-KEY (“risk assessment” OR “Risk Adjustment” OR “risk calculator” OR “risk calculators” OR “risk prediction” OR “risk stratification” OR “risk stratified” OR “stratified risk” OR “SpineSage” OR “Outcomes Assessment Program” OR “Quality Outcomes Database” OR “prediction tool” OR “Predictive tool” OR “prediction tools” OR “Predictive tools” OR “Predictive analytics” OR “predictive model” OR “Predictive Value” OR “machine learning”)	1,191,809
3	TITLE-ABS-KEY (“patient reported outcome” OR “patient reported outcomes” OR “physical function” OR “failed back surgery syndrome” OR “failed back surgery syndrome” OR “postoperative complications” OR “postoperative complications” OR “back pain” OR “low back pain” OR “back pain” OR “Opioid-Related Disorders” OR “opioid dependency” OR “opiate dependency” OR “opiate dependence” OR “opioid dependence” OR “opiate addiction” OR “opioid addiction” OR “opiate abuse” OR “opiate misuse” OR “Functional impairment” OR “functional outcome” OR “functional outcomes” OR “disability” OR “Pain Measurement” OR “Postoperative pain” OR “pain” OR “pains” OR “painful “OR “discomfort “OR “suffering “OR “sufferings “OR “ache “OR “aches “OR “aching” OR “sore “OR “soreness” OR “analgesia “OR “quality of life” OR “function test” OR “function tests” OR “functional testing” OR “measure function” OR “functional measure” or “measuring function” OR “measure functions”)	2,756,655
4	#1 AND #2 AND #3	3755
5	#4 AND (TITLE-ABS-KEY (“aging” OR “older adult” OR “elderly” OR “geriatric” OR “adult” OR {middle age} OR {middle aged} OR “aged”))	2655