Patient-reported outcomes after posterior surgical stabilization for thoracolumbar junction fractures: A pilot study with combined patient-reported outcome measure methodology

• Published in: Journal of craniovertebral junction and spine Vol. 14; no. 2; pp. 149 - 158
• Main Authors: Demetriades, Andreas K, Chowdhury, Sirajam Munira, Mavrovounis, Georgios
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.04.2023; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Clinical outcomes; combined patient-reported outcome measure methodology; Fracture fixation; Fractures; Methods; Original; Outcome and process assessment (Health Care); Patient outcomes; patient-reported outcome measures; Patients; Pilot projects; Spine; spine fractures; Surgery; thoracolumbar junction fractures; visual analog scale; United Kingdom; spine fractures; thoracolumbar junction fractures; visual analog scale; Combined patient-reported outcome measure methodology; patient-reported outcome measures
• ISSN: 0974-8237; 0976-9285
• DOI: 10.4103/jcvjs.jcvjs_38_23

Thoracolumbar junction fractures (TLJFs) attract controversy for several parameters, including surgery versus conservative treatment, fusion versus stabilization, open versus percutaneous surgery, construct length, and downstream metalwork extraction. The aim of this pilot study was to assess the effectiveness of surgical treatment in patients with burst (AO Classification Type A4) TLJFs using patient-reported outcome measures (PROMs) and evaluate and compare different PROMs in this clinical scenario. Patient records of consecutive patients who underwent posterior stabilization surgery for TLJFs were retrospectively reviewed. Data were collected on demographics, medical and social history, neurological examination, and postoperative complications. Telephone interviews and a combined PROM methodology (Numerical Rating Scale [NRS], EuroQol [EQ]-5D-5L, and Oswestry Disability Index [ODI]) were utilized to assess the effectiveness of intervention. Descriptive statistics were used to analyze exposure variables and outcome measures. Spearman's rank correlation was used for the outcome measures. Thirteen patients were included. The mean age was 42 ± 16 years; the male: female ratio was 8:5; the mean follow-up was 18.9 ± 6.4 months. The mean NRS score was 3.3 ± 2.5, in line with a median score of 2 (2) on EQ-5D-5L pain/discomfort scale. Statistically significant correlations were found between several PROMs: pain-EQ-5D-5L and NRS (rs = 0.8, P = 0.002), pain-EQ-5D-5L and ODI (rs = 0.8, P = 0.001), usual anxiety/depression-EQ-5D-5L, and ODI (rs = 0.7, P = 0.008). A combined PROM methodology showed supportive evidence for safety and efficacy in the surgical stabilization of burst TLJFs. This alleviated significant pain and prevented neurological deficit and major disability. The preliminary widespread correlation between these PROMs supports further larger studies of their combined use in clinical practice, to measure the outcomes of spine trauma patients.