The impact of elective spine surgery in Canada for degenerative conditions on patient reported health-related quality of life outcomes

Abstract

The impact of spine surgery on Health-Related Quality-of-Life (HRQoL) outcomes across common spinal degenerative diagnoses is not well characterised. A prospective observational study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) registry was performed. Baseline and 1-year post-operative Short Form-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were collated and compared to normative values from the Canadian General Population (CGP). The percentage of patients achieving the PCS Minimum Clinically Important Difference (MCID) was quantified. 5049 patients were included in the analysis. The mean pre-operative SF-12 PCS was 29.5 and MCS was 44.1. This improved to a mean PCS of 40.5 (p < 0.001) and MCS of 49.3 (p < 0.0001) at 1-year post-operatively. The mean pre-operative PCS was over 2 standard deviations (SD) lower than the normative mean of the CGP; this improved to being close to 1-SD from the normative CGP mean at 1-year post-operatively. Findings were similar across age- and sex-stratified subgroups. Across all conditions, 70-75% of patients achieved the PCS MCID. Fewer patients with cervical myelopathy achieved the PCS MCID (59%). In a surgical cohort, patients with degenerative spinal conditions demonstrate a profound reduction in PCS compared to their peers in the CGP. Spinal surgery was impactful in improving physical function HRQoL outcomes in the majority, but not typically to average population norms.

Keywords: Degenerative spinal conditions; Spinal health-related quality of life outcomes; Spine surgery.

Fig. 1

Flow diagram of the study cohort development. CSORN = The Canadian Spine Outcomes & Research Network. HRQoL = Short Form-12 Physical Component Score and Mental Component Score Health Related Quality of Life data.

Fig. 2

SF PCS & MCS histograms pre- and post-surgery compared to the normal Canadian population (25 + years).

Fig. 3

Percentage of patients with PCS at or above the CGP mean, within 1 SD below the mean, more than 1 but less than 2 SDs below the mean, and more than 2SDs below the mean. Values are provided pre- and post-surgery, and by age and sex subgroups.

Fig. 4

Charts depict the pre-op and post-op PCS and MCS by surgical region, age and sex, primary symptom, and diagnoses with the standard deviation provided as an error bar. The CGP mean is provided as the vertical red line for PCS and MCS respectively with the CGP standard deviation as a transparent grey box. Spondy = spondylolithesis, DDD = degenerative disc disease.