Publication

Sex differences in lumbar degenerative disc disease

Journal Paper/Review - Apr 8, 2016

Units
PubMed
Doi

Citation
Gautschi O, Smoll N, Corniola M, Joswig H, Schaller K, Hildebrandt G, Stienen M. Sex differences in lumbar degenerative disc disease. Clin Neurol Neurosurg 2016; 145:52-7.
Type
Journal Paper/Review (English)
Journal
Clin Neurol Neurosurg 2016; 145
Publication Date
Apr 8, 2016
Issn Electronic
1872-6968
Pages
52-7
Brief description/objective

OBJECTIVES
A growing number of studies focus on sex differences in the pre- and postoperative setting in patients with degenerative disc disease (DDD). The exact pathomechanism behind this phenomenon, however, remains unclear. The objective of this study was to investigate pre- and postoperative sex differences in patients with lumbar DDD.

PATIENTS AND METHODS
In a prospective two-center study, back and leg pain (Visual Analogue Scale (VAS)), functional disability (Oswestry Disability Index (ODI) and Roland-Morris Disability Index) and health-related quality of life (HRQoL) (EuroQol 5D and Short-Form (SF12)) were collected for patients scheduled for lumbar spine surgery. In addition to the subjective functional impairment (SFI), objective functional impairment (OFI) was estimated using age- and sex-adjusted cut-off values for the timed-up-and-go (TUG) test. The 6-week responder status was defined using minimally clinically important differences of the ODI, SF12 PCS, VAS back and leg pain in all patients. Six months and one year follow-up (FU) was available in n=127 and n=87 patients, respectively.

RESULTS
The patient cohort comprised of n=214 patients (41.6% females). Preoperatively, female patients scored significantly worse on VAS back and leg pain, ODI and SF12 PCS (p<0.033), while OFI was similar (p=0.334). At the 6 week FU, sex-related differences had resolved for SFI and OFI was similar as well (p=0.333). There were no sex differences in the mean improvement after 6 weeks for all measures of pain intensity, functional impairment and HRQoL (p>0.182). Male and female patients profited equally on measures of SFI and HRQoL up to six months and one year after surgery (p>0.091).

CONCLUSION
Preoperatively, female patients scored worse in terms of SFI, while OFI was similar. Consecutively, OFI appears to be less prone to sex bias and may thus serve as a valuable surrogate-marker of disability. The disadvantageous preoperative SFI-status did not translate into worse postoperative results, as no sex differences were present at the 6-week, 6-months and 1-year follow-up.