Abstract
OBJECTIVE: Longitudinal changes in functional levels can provide valuable information regarding patient-reported outcome measures (PROMs). However, the longitudinal outcomes of lumbar fusion surgery in patients with metabolic syndrome (MetS) have not been well-documented, which could offer appropriate management strategies and insights for individuals with MetS. Therefore, the primary objective of this study was to investigate the 24-month longitudinal trajectory of PROMs in patients with MetS following lumbar fusion surgery. METHODS: This study retrospectively included patients who underwent lumbar fusion surgery for degenerative lumbar diseases from January 2021 to February 2023. The presence of MetS was determined according to the International Diabetes Federation (IDF) criteria. The Short Form-36 for physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) and the North American Spine Society (NASS) scale at baseline, 3, 6, 12, and 24 months after surgery were collected. The Wilcoxon signed-rank test and paired t-test were used to analyze differences in functional measurements across follow-up periods. Additionally, a generalized mixed-effects model was employed to analyze the longitudinal trajectories of PCS and MCS. RESULTS: A total of 238 patients were included, with a mean age of 62.5 (4.2) years, and 143 (60.1%) were female. Among them, 74 (31.1%) patients had MetS, while 164 (68.9%) did not. In patients without MetS, NASS distribution improved gradually until 6-month follow-up, and then plateaued. In contrast, for patients with MetS, the NASS distribution reached a plateau at 12 months. Regarding PCS, patients without MetS showed gradual improvement from 3 months (47.5 ± 11.3) to 12 months postoperatively (67.9 ± 7.9), and then plateaued. In contrast, patients with MetS exhibited gradual improvement from 3 months (42.3 ± 8.9) to 24 months postoperatively (66.8 ± 11.4). Concerning MCS, regardless of MetS, patients' MCS improved gradually until 12 months postoperatively, and then plateaued. For patients without MetS, MCS scores were 49.1 (± 14.3) at 3 months and 65.3 (± 12.4) at 12 months postoperatively. For patients with MetS, MCS scores were 46.2 (± 13.7) at 3 months and 63.9 (± 13.5) at 12 months postoperatively. CONCLUSIONS: This study evaluated the longitudinal trajectory of functional outcomes in patients with MetS undergoing lumbar fusion surgery, providing precise information on recovery patterns and emphasizing the importance of appropriate management and rehabilitation for both patients and physicians to achieve optimal outcomes.