title: Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain.
abstract: Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.
  
  
  
  This study investigates whether gender affects clinical outcome after lumbar fusion.
  
  
  
  This is a national registry cohort study.
  
  
  
  Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP.
  
  
  
  Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery.
  
  
  
  Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.
  
  
  
  Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19-1.61, p<.01) and back pain (OR=1.20,95% CI:1.03-1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05-1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively.
  
  
  
  Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery.
authors.affiliation: Department of Rheumatology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063 Zürich, Switzerland; Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Triebel
authors.affiliation: Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden.
authors.forename: Greta
authors.initials: G
authors.lastname: Snellman
authors.affiliation: Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Sandén
authors.affiliation: Department of Clinical Sciences and Orthopaedics, Skåne University Hospital, 20502 Malmö, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Strömqvist
authors.affiliation: Department of Surgical Sciences, Uppsala University Hospital, 75185 Uppsala, Sweden. Electronic address: yohan.robinson@surgsci.uu.se.
authors.forename: Yohan
authors.initials: Y
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013548:Sweden
keywords: Chronic low back pain; Degenerative disc disease; Gender; Quality of life; Sex; Spinal fusion; Surgical outcome