Observational studyEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2017
Criteria for failure and worsening after surgery for lumbar disc herniation: a multicenter observational study based on data from the Norwegian Registry for Spine Surgery.
Observational study in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 32 citations in OpenAlex.
- Mid- to Long-Term Clinical Outcomes After Lumbar Microdiscectomy in Adolescent Patients: A Descriptive Study.Children (Basel, Switzerland) · 2026Article
- Beyond raw comparisons: Adjusted analysis reveals only minor inter-hospital differences in ACDF outcomes in Norway.Brain & spine · 2026Article
- A Retrospective Study of Lumbar Disk Herniation: An Analysis of Clinical Cases and Treatment Plans.Journal of clinical medicine · 2025Article
- Patient lived experiences of functioning and disability following lumbar discectomy: a secondary analysis of qualitative data.BMC musculoskeletal disorders · 2024Article
- Perspective on Intradiscal Therapies for Lumbar Discogenic Pain: State of the Science, Knowledge Gaps, and Imperatives for Clinical Adoption.Journal of pain research · 2024Article
- Mental state as a predictor of outcome in spinal stenosis surgery: Four quadrants model integrating patient satisfaction and functional outcome.Brain & spine · 2024Article
- The Norwegian registry for spine surgery (NORspine): cohort profile.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Article
- Practical answers to frequently asked questions in minimally invasive lumbar spine surgery.The spine journal : official journal of the North American Spine Society · 2023Review
- The minimal important change for the EQ VAS based on the SF-36 health transition item: observations from 25772 spine surgery procedures.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2022Article
- Single item self-rated general health: SF-36 based observations from 16,910 spine surgery procedures.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2022Article
- Success and failure after surgery of degenerative disease of the lumbar spine: an operational definition based on satisfaction, pain, and disability from a prospective cohort.BMC musculoskeletal disorders · 2022Article
- Article
- Is surgery for recurrent lumbar disc herniation worthwhile or futile? A single center observational study with patient reported outcomes.Brain & spine · 2022Article
- Evaluation of the EQ-5D-3L and 5L versions in low back pain patients.Health and quality of life outcomes · 2021Article
- Association of quantitative sensory testing parameters with clinical outcome in patients with lumbar radiculopathy undergoing microdiscectomy.European journal of pain (London, England) · 2020Article
- Can a Successful Outcome After Surgery for Lumbar Disc Herniation Be Defined by the Oswestry Disability Index Raw Score?Global spine journal · 2020Article
- Predictors of Treatment Success Following Limited Discectomy With Annular Closure for Lumbar Disc Herniation.International journal of spine surgery · 2020Article
- Article
- Letter to Editor concerning "Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial" by Kim HJ, Ahn HS, Nam Y, Chang BS, Lee CK, Yeom JS (2017) Eur Spine J 26:2961-2968.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2018Article
- The value of patient global assessment in lumbar spine surgery: an evaluation based on more than 90,000 patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2018Article
Corrections and comments
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Authors and funding
7 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIn clinical decision-making, it is crucial to discuss the probability of adverse outcomes with the patient. A large proportion of the outcomes are difficult to classify as either failure or success. Consequently, cutoff values in patient-reported outcome measures (PROMs) for "failure" and "worsening" are likely to be different from those of "non-success". The aim of this study was to identify dichotomous cutoffs for failure and worsening, 12 months after surgical treatment for lumbar disc herniation, in a large registry cohort.
methodsA total of 6840 patients with lumbar disc herniation were operated and followed for 12 months, according to the standard protocol of the Norwegian Registry for Spine Surgery (NORspine). Patients reporting to be unchanged or worse on the Global Perceived Effectiveness (GPE) scale at 12-month follow-up were classified as "failure", and those considering themselves "worse" or "worse than ever" after surgery were classified as "worsening". These two dichotomous outcomes were used as anchors in analyses of receiver operating characteristics (ROC) to define cutoffs for failure and worsening on commonly used PROMs, namely, the Oswestry Disability Index (ODI), the EuroQuol 5D (EQ-5D), and Numerical Rating Scales (NRS) for back pain and leg pain.
results"Failure" after 12 months for each PROM, as an insufficient improvement from baseline, was (sensitivity and specificity): ODI change <13 (0.82, 0.82), ODI% change <33% (0.86, 0.86), ODI final raw score >25 (0.89, 0.81), NRS back-pain change <1.5 (0.74, 0.86), NRS back-pain % change <24 (0.85, 0.81), NRS back-pain final raw score >5.5 (0.81, 0.87), NRS leg-pain change <1.5 (0.81, 0.76), NRS leg-pain % change <39 (0.86, 0.81), NRS leg-pain final raw score >4.5 (0.91, 0.85), EQ-5D change <0.10 (0.76, 0.83), and EQ-5D final raw score >0.63 (0.81, 0.85). Both a final raw score >48 for the ODI and an NRS >7.5 were indicators for "worsening" after 12 months, with acceptable accuracy.
conclusionThe criteria with the highest accuracy for defining failure and worsening after surgery for lumbar disc herniation were an ODI percentage change score <33% for failure and a 12-month ODI raw score >48. These cutoffs can facilitate shared decision-making among doctors and patients, and improve quality assessment and comparison of clinical outcomes across surgical units. In addition to clinically relevant improvements, we propose that rates of failure and worsening should be included in reporting from clinical trials.
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