Background & Aims
Lumbar microdiscectomy is considered an effective and safe procedure for people with lumbar radiculopathy who do not respond to conservative treatment 1,2. However, the recovery process varies widely among patients, emphasizing the need for personalized clinical decisions rather than relying on group averages 3-6. Existing prediction models for post-microdiscectomy outcomes often exhibit low explained variance, poor discriminative ability, and lack of external validation, making them inadequate for use in clinical practice 7-10. The primary objective was to develop and test the accuracy of the ‘people-like-me’ approach at 12-months outcomes of leg pain, and disability in people undertaking lumbar microdiscectomy. The secondary objective was to demonstrate the clinical utility of the prediction tool via case vignettes.
Methods
This 12-month prospective cohort study took place within a multidisciplinary clinic setting. A total of 655 patients scheduled for lumbar microdiscectomy were screened, with 618 meeting the inclusion criteria for analysis. Patients underwent lumbar microdiscectomy followed by postoperative physical therapy. Outcome measurements, including leg pain intensity assessed by the Visual Analogue Scale, and disability measured with the Roland-Morris Disability Questionnaire, were recorded 12 months post-surgery. Matching characteristics were selected from routine practice data collected both before and after lumbar microdiscectomy. Predictive models were developed using preoperative and 3-months postoperative data. The performance of the ‘people-like-me’ approach was evaluated using metrics like mean squared error, bias, coverage, and precision through leave-one-out-cross-validation.
Results
The ‘people-like-me’ approach demonstrated minimal bias and consistent 50% coverage pre- and postoperatively, ensuring reliability. Incorporating postoperative data from three months led to a substantial improvement in prediction precision, with 23% for disability and 43% for leg pain when compared to the sample mean. The effectiveness of this approach was convincingly illustrated through two cases, showcasing its applicability in similar patient scenarios.
Conclusions
The ‘people-like-me’ approach generated an accurate prognosis of 12 months outcomes following lumbar microdiscectomy. The uncertainty of the prognosis decreased when postoperative data were incorporated.
References
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Presenting Author
Stijn Willems
Poster Authors
stijn willems
MSc.
VU medical centre
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Other