Optimizing Surgical Treatment for Chronic Low Back Pain Evaluating Prognostic Tests for Patient Selection in Lumbar Spinal Fusion: A Cohort Study

Abstract

Background: Chronic low back pain (CLBP) is a major cause of disability and a substantial economic burden worldwide. Lumbar spinal fusion is a common surgical intervention for CLBP when conservative treatments fail. The decision to proceed with spinal fusion relies heavily on prognostic tests, such as MRI, CT scans, and dynamic X-rays, to predict surgical outcomes. The study aimed to estimate the performance of prognostic tests in selecting patients for lumbar spinal fusion.

Methods: A cohort study was carried out over four years. The study included 112 patients with CLBP who underwent MRI, CT scan, and/or dynamic X-rays before lumbar spinal fusion. Postoperative outcomes were assessed at regular intervals up to 2.5 years. Data were analyzed using SPSS version 26.0, with logistic regression used to identify significant predictors of successful surgical outcomes.

Results: MRI demonstrated the highest sensitivity (85.3%) and PPV (82.1%) among the prognostic tests. CT scan and dynamic X-rays had lower sensitivity and specificity. Significant predictors of successful outcomes included positive MRI findings (OR: 2.5, p=0.005), pain duration less than 24 months (OR: 3.2, p=0.002), and absence of comorbid conditions (OR: 2.1, p=0.01). Complications occurred in 8.9% of patients but were managed effectively.

Conclusion: MRI is the most reliable prognostic test for predicting successful outcomes in lumbar spinal fusion for CLBP. Shorter pain duration and absence of comorbidities also significantly contribute to positive surgical outcomes.

Recommendations: The use of MRI, along with consideration of pain duration and patient comorbidities, should be integrated into the decision-making process for lumbar spinal fusion to optimize patient outcomes. Further research is recommended to standardize prognostic criteria and improve patient selection.

Keywords: Chronic Low Back Pain, Lumbar Spinal Fusion, MRI, Prognostic Tests, Surgical Outcomes.