Expectations in patients undergoing spine surgery are high and unmet

Abstract

Background context: Defining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery.

Purpose: To examine patients' expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself?

Study design /setting: Prospective single-center study.

Patient sample: Patients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease.

Outcome measures: Modified and standard version of ODI and NRS (back and leg pain).

Methods: Preoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients' expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics.

Results: A total of 93 patients completed the preop questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2-42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81-6.88), and leg pain was 6.67 (6.08-7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5-13.5), mean (95%CI) NRS back pain of 2.5 (2.1-3.0), and NRS leg pain of 1.8 (1.5-2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0-26.5), NRS back pain of 3.4 (2.8-4.1), and leg pain of 2.8 (2.0-3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE.

Conclusions: Patients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.

Keywords: Modified Oswestry Disability Index; Patient expectations; Patient reported outcomes measures; Spine registry; Spine surgery.