Abstract
BACKGROUND CONTEXT
Fulfillment of expectations is a patient-centered outcome that has not been assessed
based on fusion status for lumbar degenerative spondylolisthesis (LDS).
PURPOSE
To compare preoperatively cited expectations and 2-year postoperative fulfillment
of expectations between patients undergoing decompression alone (no-fusion) vs. decompression
plus fusion (fusion) for LDS.
STUDY DESIGN
Longitudinal cohort.
PATIENT SAMPLE
A total of 357 patients.
OUTCOME MEASURES
Postoperative version of Lumbar Spine Surgery Expectations Survey, Oswestry Disability
Index (ODI), satisfaction with surgery.
METHODS
Preoperatively patients completed the 20-item Expectations Survey measuring amount
of ‘improvement expected’ for symptoms, physical function, and psychosocial well-being
(score range 0-100); two years postoperatively patients completed the follow-up survey
measuring ‘improvement received’. The proportion of expectations fulfilled was calculated
as ‘improvement received’ divided by ‘improvement expected’ (<1 some expectations
fulfilled, >1 expectations surpassed). Patients also completed the ODI, SF-12 mental
health subscale, satisfaction with surgery, and measures of comorbidity and psychosocial
status, including social support (ie, help at home) and prior orthopedic surgery (ie,
hip/knee arthroplasty).
RESULTS
Patients’ mean age was 67 years, 61% were women, 82% had single-level LDS, 73% had
fusion, and mean follow-up was 26.2 months. Compared to patients with no-fusion, patients
with fusion had more pain, spinal instability, use of opioids, disability, and greater
preoperative Expectations Survey scores (69 vs 74, p=.008). The proportion of expectations
fulfilled postoperatively was high and similar for both groups (.82 vs. .79, p=.40),
but more variable for fusion (IQR .32 vs. .40). In multivariable analysis with the
proportion as the dependent variable, fulfilled expectations was associated with better
mental well-being (coeff=1.1, 95% CI 0.6-1.7, p=.0001) and more social support (coeff=3.3,
95% CI 1.1-5.6, p=.004) and unfulfilled expectations was associated with prior arthroplasty
(coeff=-8.6, 95% CI -15.4-(-1.9), p=.01) and subsequent lumbar surgery (coeff=-15.6,
95% CI -25.2-(-6.0), p=.002). Similar associations were found for change in ODI and
satisfaction.
CONCLUSIONS
Patients had high preoperative expectations of surgery with greater expectations for
decompression-fusion compared to decompression-alone. Although more variable for the
fusion group, both groups had high proportions of expectations fulfilled. This study
highlights the spectrum of clinical and psychosocial variables that impacts fulfillment
of expectations for both decompression-alone and decompression-fusion for LDS surgery.
Keywords
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References
Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N. Engl. J. Med. 374;15:1413-23.
Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N. Engl. J. Med. 374;15:1424-34.
Mummaneni PV, Bydon M, Alvi MA, Chan AK, Glassman SD, Foley KT, et al. Predictive model for long-term patient satisfaction after surgery for grade I degenerative spondylolisthesis: insights from the quality outcomes database. Neurosurg Focus 2019;46:E12.
- Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence.Curr Rev Musculoskeletal Med. 2017; 10: 521-529
- Surgical treatment of degenerative spondylolisthesis.Ortho Trauma Surg Res. 2017; 103: S11-S20
- What are the patient-reported outcomes, complications, and radiographic results of lumbar fusion for degenerative spondylolisthesis in patients younger than 50 years?.Clin Ortho Rel Res. 2020; 478: 1880-1888
- Assessing outcomes in terms of fulfillment of patient expectations is complementary to traditional measures including satisfaction.Arthroscopy. 2022; 38: 1876-1878
- Patients’ expectations of spine surgery for degenerative conditions: result from the Canadian Spine Outcomes and Research Network (CSORN).Spine J. 2020; 20: 399-408
- Development and testing of an expectations survey for patients undergoing lumbar spine surgery.J Bone Joint Surg. 2013; 95: 1793-1800
- Patients’ expectations of lumbar spine surgery.Euro Spine J. 2015; 24: 2362-2369
- CORR insights: what are the patient-reported outcomes, complications, and radiographic results of lumbar fusion for degenerative spondylolisthesis in patients younger than 50 years?.Clin Ortho Rel Res. 2020; 478: 1889-1891
- Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse.Spine J. 2021; 21: 821-828
- Improvement in pain after lumbar spine surgery: the role of preoperative expectations of pain relief.Clin. J. Pain. 2017; 33: 93-98
- Unfulfilled expectations after surgery for adult lumbar scoliosis compared to other degenerative conditions.Hosp Spec Surg J. 2020; 16: S452-S460
- Low back pain versus back-related leg pain: how do patient expectations and outcomes of lumbar spine surgery compare?.HSS J. 2022; 18: 83-90
- Expectations of lumbar surgery outcomes among opioid users compared with non-users.Asian Spin J. 2020; 14: 663-672
- Proportion of expectations fulfilled: a new method to report patient-centered outcomes of spine surgery.Spine (Phila Pa 1976). 2016; 41: 963-970
- Fulfillment of patients’ expectations of lumbar and cervical spine surgery.Spine J. 2016; 16: 1167-1174
- A revised Oswestry disability questionnaire. Back Pain: New Approaches to Rehabilitation and Education.Manchester University Press, Manchester1989: 187-204
- The oswestry disability index.Spine (Phila Pa 1976). 2000; 25: 2940-2953
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical rating scale.Pain. 2001; 94: 149-158
- RAND-36 Health Status Inventory. San Antonio: The Psychological Corporation.Hartcourt Brace & Company, 1998
Duculan R, Fong AM, Carrino JA, Cammisa FP, Sama AA, Hughes AP, et al. Quantitative CT for preoperative assessment of lumbar degenerative spondylolisthesis: The unique impact of L4 bone mineral density on single-level disease. HSS J 2022;18:469-477.
Fong AM, Duculan R, Endo Y, Carrino JA, Cammisa FP, Sama AA, et al. Girardi Instability missed by flexion-extension radiographs subsequently identified by alternate imaging in L4-5 lumbar degenerative spondylolisthesis. Spine (Phila Pa 1976). 2023;48:E33-E39
- Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.N. Engl. J. Med. 2007; 356: 2257-2270
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- Development of an index to characterize the “invasiveness” of spine surgery: validation by comparison to blood loss and operative time.Spine (Phila Pa 1976). 2008; 33: 2651-2661
- Concordance between patients’ and surgeons’ expectations of lumbar surgery.Spine (Phila Pa 1976). 2021; 46: 249-258
- Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms.Spine J. 2018; 18: 606-613
- Follow-up, change score or percentage change score fordetermining clinical important outcome following surgery? An observational study from the Norwegian registry for spine surgery evaluating patient reported outcome measure in lumbar spinal stenosis and lumbar degenerative spondylolisthesis.BMC Musculoskel Dis. 2019; 20: 31
- Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients.Bone Joint J. 2013; 95-B: 960-965
- Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1,624 patients.Spine J. 2015; 15: 638-646
- Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study.Can. J. Surg. 2014; 57: E126-E133
- Rationale for the surgical treatment of lumbar degenerative spondylolisthesis.Spine (Phila Pa 1976). 2015; 40: E1161-E1166
- Long-term results of surgery compared with nonopeative treatment for lumbar degenerative spondylolisthesis in the Spine Patient Outcomes Research Trail (SPORT).Spine (Phila Pa 1976). 2018; 23: 1619-1630
- Social relationships and mortality risk: a meta-analytic review.PLoS Med. 2010; 7e100031
- Perceived adequacy of tangible social support and associations with health outcomes among older primary care patients.J. Gen. Intern. Med. 2019; 34: 2368-2373
- Links between the hip and the lumbar spine (Hip Spine Syndrome) as they relate to clinical decision making for patients with lumbopelvic pain.Physical Med Rehabil. 2019; 11: S64-S72
- Differential diagnosis of hip disease versus spine disease.Clin. Orthop. Relat. Res. 2004; 419: 280-284
Article info
Publication history
Published online: January 12, 2023
Accepted:
January 3,
2023
Received in revised form:
December 18,
2022
Received:
September 22,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: RD: Nothing to disclose. AMF: Nothing to disclose. FPC: Nothing to disclose. AAS: Nothing to disclose. APH: Nothing to disclose. DRL: Nothing to disclose. CAM: Nothing to disclose. FPG: Nothing to disclose.
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