Clinical Study| Volume 23, ISSUE 6, P805-815, June 2023

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Patient's expectations of surgery for lumbar degenerative spondylolisthesis: analysis by type of surgery and patient factors from the Canadian Spine Outcomes and Research Network (CSORN)

Published:February 08, 2023DOI:



      Preoperative expectations influence postoperative outcomes. Patients with lumbar degenerative spondylolisthesis have especially high expectations of pain relief and overall functional well-being compared to patients with lumbar stenosis.


      The primary objective was to analyze preoperative expectations of lumbar DS patients with respect to the type of surgery proposed (decompression vs decompression and fusion). Secondarily, we aimed to assess the associations between preoperative expectations and patient and clinical factors as well as postoperative expectations fulfillment.


      Patients were prospectively enrolled in a multicenter, prospective cohort study evaluating the assessment and management of degenerative spondylolisthesis utilizing the infrastructure of the Canadian Spine Outcomes and Research Network (CSORN) surgical registry.


      Patients with a diagnosis of degenerative spondylolisthesis with symptoms of neurogenic claudication or radiculopathy with or without back pain, unresponsive to nonoperative management over at least 3 months were included. Patients who underwent decompression, decompression and posterolateral fusion or decompression and interbody fusion at Canadian spine centers between January 2015 and September 2021 were included.


      The North American Spine Society Lumbar Spine Questionnaire was utilized for expectations measurement. The expectation questionnaire was completed following consent and before surgery and at 1 year.


      Expectations for pain relief and improvements in overall functional well-being were rated on a scale of 0 to 100. Preoperative expectation in terms of pain relief and functional well-being score were calculated. Multivariate linear regression was used to evaluate the association between expected preoperative patient factors and pain relief and functional well-being. The factors associated with the most important expectation were evaluated using multivariable multinomial logistic regression.


      Three hundred fifty-two patients were included with 100 patients undergoing decompression and 252 patients also undergoing fusion. The seven items of preoperative expectations did not differ between the procedure groups nor did expected change. The mean pain relief and overall functional well-being expectation scores did not significantly differ between procedures.
      Higher expectations were associated with having more comorbidities [β=-2.0 (SE 0.8), p=.020], being physically active [β=8.4 (SE 3.2), p=.010] and having more leg pain [β=1.6 (SE 0.7), p=.015]. Better perceived physical health measured by SF12 PCS was associated with lower expectation of pain relief [β= -0.4 (SE 0.2), p=.039] and functional well-being [β=-0.84 (SE 0.2), p=.001]. Better perceived mental health measured by SF12 MCS was associated with lower expectation of functional well-being [β=-0.8 (SE 0.2), p=.001].
      Postoperative expectations fulfillment did not differ between procedures.


      Preoperative expectations in terms of pain relief and functional well-being were similar between the two most common procedures performed, decompression ± fusion. Secondarily, higher preoperative expectations were associated with greater pain, disability and being physically active. Expectations fulfillment did not differ between procedures.


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        • Lewin SA
        • Skea ZC
        • Entwistle V
        • Zwarenstein M
        • Dick J.
        Interventions for providers to promote a patient-centred approach in clinical consultations.
        Cochrane Database Syst Rev. 2001; CD003267
        • Witiw CD
        • Mansouri A
        • Mathieu F
        • Nassiri F
        • Badhiwala JH
        • Fessler RG.
        Exploring the expectation-actuality discrepancy: a systematic review of the impact of preoperative expectations on satisfaction and patient reported outcomes in spinal surgery.
        Neurosurg Rev. 2018; 41: 19-30
        • Soroceanu A
        • Ching A
        • Abdu W
        • McGuire K.
        Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study.
        Spine (Phila Pa 1976). 2012; 37: E103-E108
        • Beecher HK
        The powerful placebo.
        J Am Med Assoc. 1955; 159: 1602-1606
        • Auer CJ
        • Glombiewski JA
        • Doering BK
        • Winkler A
        • Laferton JAC
        • Broadbent E
        • et al.
        Patients’ expectations predict surgery outcomes: a meta-analysis.
        Int J Behav Med. 2016; 23: 49-62
        • Mondloch MV
        • Cole DC
        • Frank JW.
        Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes.
        CMAJ. 2001; 165: 174-179
        • de Groot KI
        • Boeke S
        • Passchier J.
        Preoperative expectations of pain and recovery in relation to postoperative disappointment in patients undergoing lumbar surgery.
        Med Care. 1999; 37: 149-156
        • Mancuso CA
        • Duculan R
        • Cammisa FP
        • Sama AA
        • Hughes AP
        • Lebl DR
        • et al.
        Fulfillment of patients’ expectations of lumbar and cervical spine surgery.
        Spine J. 2016; 16: 1167-1174
        • Yee A
        • Adjei N
        • Do J
        • Ford M
        • Finkelstein J.
        Do patient expectations of spinal surgery relate to functional outcome?.
        Clin Orthop Relat Res. 2008; 466: 1154-1161
        • Lurie JD
        • Berven SH
        • Gibson-Chambers J
        • Tosteson T
        • Tosteson A
        • Hu SS
        • et al.
        Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation.
        Spine (Phila Pa 1976). 2008; 33: 2663-2668
        • Canizares M
        • Gleenie RA
        • Perruccio AV
        • Abraham E
        • Ahn H
        • Attabib N
        • et al.
        Patients’ expectations of spine surgery for degenerative conditions: results from the Canadian Spine Outcomes and Research Network (CSORN).
        Spine J. 2020; 20: 399-408
        • Glennie RA
        • Canizares M
        • Perruccio AV
        • Abraham E
        • Nicholls F
        • Nataraj A
        • et al.
        The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study.
        J Neurosurg Spine. 2021; : 1-8
        • Mancuso CA
        • Duculan R
        • Cammisa FP
        • Sama AA
        • Hughes AP
        • Lebl DR
        • et al.
        Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms.
        Spine J. 2018; 18: 606-613
        • Mancuso CA
        • Duculan R
        • Stal M
        • Girardi FP.
        Patients’ expectations of cervical spine surgery.
        Spine (Phila Pa 1976). 2014; 39: 1157-1162
        • Mancuso CA
        • Duculan R
        • Stal M
        • Girardi FP
        Patients’ expectations of lumbar spine surgery.
        Eur Spine J. 2015; 24: 2362-2369
        • Daltroy LH
        • Cats-Baril WL
        • Katz JN
        • Fossel AH
        • Liang MH.
        The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests.
        Spine (Phila Pa 1976). 1996; 21: 741-749
        • Childs JD
        • Piva SR
        • Fritz JM.
        Responsiveness of the numeric pain rating scale in patients with low back pain.
        Spine (Phila Pa 1976). 2005; 30: 1331-1334
        • Fairbank JC
        • Couper J
        • Davies JB
        • O'Brien JP
        The Oswestry low back pain disability questionnaire.
        Physiotherapy. 1980; 66: 271-273
        • Kroenke K
        • Spitzer RL
        • Williams JB.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Ware J
        • Kosinski M
        • Keller SD
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Kim H-J
        • Park J-Y
        • Kang K-T
        • Chang B-S
        • Lee C-K
        • Yeom JS.
        Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process.
        Eur Spine J. 2015; 24: 339-347
        • Kløjgaard ME
        • Manniche C
        • Pedersen LB
        • Bech M
        • Søgaard R.
        Patient preferences for treatment of low back pain-a discrete choice experiment.
        Value Health. 2014; 17: 390-396
        • Kurd MF
        • Lurie JD
        • Zhao W
        • Tosteson T
        • Hilibrand AS
        • Rihn J
        • et al.
        Predictors of treatment choice in lumbar spinal stenosis: a spine patient outcomes research trial study.
        Spine (Phila Pa 1976). 2012; 37: 1702-1707
        • Ghani F
        • Khattak I
        • Aamir S
        • Azam F.
        Factors affecting decision making process on spine surgery: patients’ perspective.
        Pak J Neurol Surg. 2020; 24: 143-148
        • Aoude A
        • Litowski M
        • Aldebeyan S
        • Fisher C
        • Hall H
        • Manson N
        • et al.
        A comparison of patient and surgeon expectations of spine surgical outcomes.
        Global Spine J. 2021; 11: 331-337
        • Li ZC
        • Hou YF
        • Zhou ZW
        • Jiang L
        • Zhang S
        • Lin JH.
        [Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty].
        Beijing Da Xue Xue Bao Yi Xue Ban. 2022; 54: 170-176
        • Cody EA
        • Mancuso CA
        • Burket JC
        • Marinescu A
        • MacMahon A
        • Ellis SJ
        • et al.
        Patient factors associated with higher expectations from foot and ankle surgery.
        Foot Ankle Int. 2017; 38: 472-478
        • Swarup I
        • Henn CM
        • Gulotta LV
        • Henn RF.
        Patient expectations and satisfaction in orthopaedic surgery: a review of the literature.
        J Clin Orthop Trauma. 2019; 10: 755-760
        • Mannion AF
        • Junge A
        • Elfering A
        • Dvorak J
        • Porchet F
        • Grob D.
        Great expectations: really the novel predictor of outcome after spinal surgery?.
        Spine (Phila Pa 1976). 2009; 34: 1590-1599
        • Wilson TJ
        • Franz E
        • Vollmer CF
        • Chang KW-C
        • Upadhyaya C
        • Park P
        • et al.
        Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.
        Clin Neurol Neurosurg. 2017; 157: 11-16
        • Mancuso CA
        • Duculan R
        • Cammisa FP
        • Sama AA
        • Hughes AP
        • Lebl DR
        • et al.
        Sources of patients’ expectations of lumbar surgery.
        Spine (Phila Pa 1976). 2019; 44: 318-324