Patient-reported outcomes and their associated factors at 1- and 2-year follow-up after lumbar spine surgery: a surgery registry study.

Purpose: Degenerative lumbar conditions are a leading cause of disability worldwide, often requiring surgery when conservative treatments fail. Data on surgical outcomes from patients' perspectives and influencing factors remain limited. This study aimed to assess 1-year and 2-year Patient-Reported Outcomes (PROs) following lumbar spine surgery and identify factors associated with these outcomes.

Methods: This surgery registry study included 1,195 adult patients who underwent lumbar spine surgery between 2017 and 2022 at a tertiary hospital in Singapore. Patients completed the EQ-5D-3L and Oswestry Disability Index before surgery, as well as one year (n = 741) and two years (n = 440) after surgery. Multivariable logistic regression identified factors influencing PRO improvements at the dimension level.

Results: The mean age of the patients was 58.1 years (SD 16.1). From baseline to 1-year, patients experienced the largest improvements in pain/discomfort (δ = 0.55-0.56) and social functioning (δ = 0.48-0.53), while improvements in activities of daily living and functional tasks were smaller, with negligible change in lifting (δ = 0.04); these effects largely persisted at the 2-year follow-up. Patients with poorer baseline PROs consistently improved across all PROs at the 1-year follow-up. Higher education and conditions affecting only the L4/5 spinal level were associated with better outcomes in activities of daily living, pain/discomfort, and social functioning. Higher education and a prolapsed disc diagnosis were associated with functional task improvements. At year two, poorer baseline PROs remained influential, while the absence of comorbidities emerged as a significant factor.

Conclusions: Substantial improvements in pain/discomfort and social functioning domains occurred within the first year and persisted into year two, while physically demanding tasks such as lifting remained difficult to restore. Patients with poorer baseline PROs and higher education derived the greatest benefit, emphasising tailored pre-operative interventions to optimise outcomes.