Predicting who benefits from surgery?
Benjamin Davies, MBChB(Hons), MRCS, BSc. 18 November 2015
This is a very difficult question to answer and is a controversial topic in the world of spinal surgery. At the moment there is no absolute answer, but in order to try and consider this question we will consider a recent article by Tetreault et al.
This group from Canada have been working to develop a predictive model based on a combination of symptoms and investigation findings from patients when they arrive in hospital. They were looking to predict a good functional outcome, they didn't considered aspects such as pain.
Stopping smoking may be of benefit
They initially identified important factors from their research in Canada and then looked to see if the predictions remained correct across the globe, looking at patients from six Asian, five European, three Latin American, and two North American centres.
At the end of this process they identified a number of factors which were associated with having a good functional outcome:
- Not smoking
- Treatment soon after symptoms started
- Mild disability
- Younger age
- Walking not yet affected
Surgery is a major undertaking, with a number of significant risks involved. Knowing whether it is the right course of action would be enormously useful for patients and professionals. This research study has made a step in the right direction, but their model didn't work all of the time! The natural history of the disease remains poorly understood. A careful discussion with your surgeon will be important.