ArticleNorth American Spine Society journal2026
Cluster analysis identifies high-risk phenotypic groups for revision following 1-3 level lumbar fusion in a disadvantaged inner-city population.
Article in North American Spine Society journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The number of patients undergoing single- and multilevel lumbar fusion continues to rise. Although prior studies suggest that radiographic factors and preoperative patient-reported outcomes may predict surgical results, evidence regarding the predictive value of patient demographics on perioperative and postoperative outcomes remains limited. Using cluster analysis to define distinct demographic-based patient phenotypes, this study examines how patient demographics influence surgical outcomes in a disadvantaged, inner-city population. Methods: This is a retrospective, single-center cohort study including 459 patients who underwent a 1-3 level lumbar fusion between 2022 and 2024. The primary outcome was revision surgery at maximum follow-up. A 2-step cluster analysis was performed using SPSS 30 (IBM). Comparisons were performed between clusters using Chi-squared test for categorical variables and a one-way ANOVA with Tukey's posttest for continuous variables. Intra-cluster analysis was run using multivariate regression. p < .05 was considered significant. Results: A total of 459 patients underwent 1-3 level lumbar fusion (mean age 62.1 ± 10.9 years; 69.0% female; mean body mass index (BMI) 31.3 ± 5.6), with 92.4% identifying as non-white and 29.3% as non-English speaking. Mean operative time was 286 minutes, blood loss 206 mL, and hospital stay 4.7 days. Within 90 days, 19.2% visited the ER, 10.2% were readmitted, and 4.1% returned to the operating room (OR); 5.5% of patients ultimately required revision fusions, and 12.1% remained on chronic opioids at final follow-up. Cluster analysis identified 3 patient subgroups differing significantly by age, language, race, insurance, substance use, psychiatric medication, and prior laminectomy (all p < .001). Cluster 1 (younger, psychiatric/substance use) had higher revision rates (9.1% vs. 2.0-3.1%, p = .01). Conclusions: Distinct patient groups show differing lumbar fusion risks; younger patients with psychiatric and substance-use factors face higher revision rates and potentially worse recovery.
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