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21.08.2018 | Original Article | Ausgabe 10/2018

European Spine Journal 10/2018

Gender differences in degenerative spine surgery: Do female patients really fare worse?

European Spine Journal > Ausgabe 10/2018
Alessandro Siccoli, Victor E. Staartjes, Marlies P. de Wispelaere, Marc L. Schröder
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00586-018-5737-3) contains supplementary material, which is available to authorized users.



Prior data has set the precedent that female patients fare somewhat worse than men after spine surgery. We aimed to evaluate the effect of gender on patient-reported outcomes after lumbar spine surgery for degenerative pathologies.


We identified a consecutive cohort of patients from a prospective registry. Absolute values, as well as change scores for back and leg pain severity (numeric rating scale [NRS]), functional disability (Oswestry disability index [ODI]), and health-related quality of life (HRQOL) as assessed by EQ-5D were compared among male and female patients.


Of the 3279 included patients, 1543 (47%) were female. At baseline, women reported higher NRS for back and leg pain, higher ODI, but equal HRQOL (all p < 0.05). Otherwise, both groups had comparable baseline data. The absolute differences in patient-reported outcomes persisted at the 6-week, 12- and 24-months follow-up, with women now additionally reporting worse HRQOL as assessed by EQ-5D (all p < 0.05). For all outcome measures, change scores were equal among male and female patients, as were the incidences of complications and reoperations (all p > 0.05). Clinical success was achieved in 82% of men and 79% of women (p = 0.34).


Female patients are generally scheduled for surgery with a more advanced disease state. While women seem to report more severe symptoms at long-term follow-up, the degree of improvement is equal among men and women. Female patients may thus fare worse in terms of absolute scores, but enjoy the same benefit from surgery in relative terms.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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