A Prospective Assessment of Patient Expectation and Satisfaction in Spinal Fusion Surgery
Eugene Carragee, MD; Todd Alamin, MD, Stanford University, Stanford, CA
We have undertaken a prospective study of patient “expectations” and “minimum acceptable” goals before spinal fusion surgery for LBP and compared these against the eventual outcomes and satisfaction ratings at two- to four-year follow-up.
In particular, return to full-time work in the discogenic pain group was rated as an “expected outcome” in 77% and as a ‘minimal acceptable outcome’ in 64% of the patients, but was achieved in only 23% of the group. Similarly, normal function (ODI <15 ) and decreased medication usage was highly expected (77% to 85% but unusually achieved (19% to 36%).
Patients receiving workers’ compensation benefits or having abnormal psychometric profiles had the most discordant scores between expectation and satisfaction.
Patients undergoing surgery for discogenic pain achieved their expected goals infrequently, whereas spondylolisthesis surgery was successful in meeting patient goals in most cases. Patients frequently rate discogenic pain surgery as “satisfactory” despite failing to achieve “minimum” prospective goals. This effect was not seen in spondylolisthesis surgery.
In patients who had a fusion for discogenic pain, in many cases the postoperative outcomes did not match the preoperative definition of “success.” These results question the role of lumbar fusion for discogenic pain and raise the issue about the “true cause” of pain in discogenic pain syndromes.