Health-related quality of life: a comparison of outcomes after lumbar fusion for degenerative spondylolisthesis with large joint replacement surgery and population norms

Abstract 

Background context

Degenerative spine disease will become an increasing health problem, and a significant number of patients will be considered for surgery. Spinal surgeries have evolved since the last decades, and there is a positive impact on the clinical outcomes. Few works in the literature have reviewed the outcome compared with large joint replacement surgery, which is considered a benchmark for operative restoration of patients’ quality of life.

Purpose

The purpose of this study was to investigate if spinal fusion can return patients' health-related quality of life to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement.

Study design

This is a prospective cohort study.

Patient sample

The sample consists of 100 consecutive patients who were enrolled between December 1997 and January 2007.

Outcome measures

The 12-item Short Form Health Survey (SF-12) was chosen for outcome measurement.

Methods

All patients underwent wide decompressive laminectomy and single-level posterior lumbar interbody fusion for spinal stenosis associated with degenerative spondylolisthesis.

Results

The preoperative and postoperative physical component summary (PCS)-12 scores of the spinal fusion patients were comparable with those of both the total knee and hip replacement patients. The mean improvement in PCS-12 scores after spine surgery was 11 (95% confidence interval [CI]: 9–14, p<.0001). It was equal to that after total hip replacement surgery, which was 11 (95% CI: 9–13), and higher than that of total knee replacement patients, which had an improvement of 8 (95% CI: 7–9). The postoperative mean and 95% CI of the PCS-12 scores for the three surgical procedures approached the population norm value of 44 (95% CI: 43–46).There was no statistical difference between the postoperative mental component summary-12 score among all the three surgical groups, which approached similar to the population norm value of 54 (95% CI: 53–54).

Conclusions

The current study demonstrated that spinal surgery can return patients' HRQL to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement patients.

Keywords: Outcome assessment, Quality of Life, Spondylolisthesis, Spinal fusion, Arthroplasty, Replacement