Investigating and Predicting Early Lumbar Spine Surgery Outcomes

OBJECTIVE: To examine short-term changes in patients' clinical status following lumbar spine surgery (LSS) and to explore presurgical variables that predict surgical outcomes. METHODS: Prospective cohort study. A total of 46 patients underwent LSS. Patients completed the following questionnaires 1 week before LSS and 2 weeks after discharge from the hospital: back and leg visual pain analogue scale, Ronald Morris questionnaire (RMQ), Modified Somatic Perception questionnaire (MSPQ), SF-36, Fear-Avoidance Beliefs Questionnaire, Beck's Depression Inventory, EuroQol questionnaire, and patient-perception of improvement. Regression models were constructed to examine predictors of pain, function, quality of life, and patient-perception of improvement at 2 weeks postsurgery. RESULTS: Patients demonstrated significant improvement in back and leg pain and function. MSPQ and symptom duration were significant predictors of back pain, while type of diagnosis and use of opioids were significant predictors of leg pain. Preoperative MSPQ and RMQ were significant predictors of postoperative RMQ. MSPQ, gender, and back pain were significant predictors of quality of life. Back pain, leg pain, depression, smoking, and worker's compensation were significantly associated with patient-perception of improvement. CONCLUSIONS: This preliminary study could be viewed as a directory to identify potential risk factors for unfavorable outcomes at early stages following LSS. J Allied Health 2015; 44(2):83-90.SPINAL DISORDERS are one of the most common health problems globally, causing significant impact on individuals, the community, and health care system.1,2 Lumbar spine surgery (LSS) is usually considered a treatment of certain spinal disorders when conservative management fails. Lumbar spinal stenosis is the most common reason for spinal surgery.3 Spinal stenosis is a narrowing of the central vertebral canal or lateral foramina, affecting one or multiple levels of lumbar vertebra/e, either one side or both sides of spinal foramina.4 Lumbar disc herniation, prolapse, protrusion, or extrusion accounts for less than 5% of all low back problems but are one of the most common causes of nerve root pain resulting in surgical interventions.5 Spondylolisthesis, defined as the anterior shifting of one vertebra in comparison to adjacent vertebrae, is another condition that may require surgery if conservative approaches fail to resolve symptoms of displacement and if neural compression is manifested.Several studies have suggested that the gain from surgery is limited6-18 despite LSS being reported as more efficient treatment option than nonsurgical treatment,19-21 possibly due to the complexity and variability of spinal pathology and variation in surgery selection criteria. Therefore, more unified selection criteria should be considered for spinal surgeries to optimize surgical outcomes that may be identified by studying multiple possible predators influencing clinical outcomes.Several factors have been used to measure the success of surgery, such as postsurgical pain, function/disability, return to work, and quality of life (QOL).6-11,22 In addition, patient-perception is important to define success from the patients' perspective regarding improvement of symptoms and achievement of their goals.10,23 Because clinical outcomes are multidimensional, a comprehensive assessment of clinical outcomes after LSS could lead to a more accurate assessment.Studies have shown positive benefits in optimizing the outcomes of spinal surgeries when outpatient rehabilitation following LSS is implemented.24,25 Patients who underwent active rehabilitation following LSS had better improvement in pain and function in comparison to usual care.26,27 However, prescription of outpatient rehabilitation services following LSS is not a standard care and is based on surgeons' preference and practice pattern.28,29 This discrepancy could be related to the variability in patient recovery. …