How successful is spinal surgery?

A July 2022 study examined the “complex relationship” between pre-operative expectations, fulfillment of those pre-surgery expectations, post-surgical outcomes, and satisfaction after spine surgery to help determine, what is a successful spianl surgery.

This study was conducted as a Canadian national study of patients undergoing elective surgery for degenerative spinal conditions

  • Fifty-eight percent of patients were extremely satisfied, and 3% were extremely dissatisfied.
  • Pre-surgery outcome expectations were variable and generally high.
    • 17.3% of patients reported that none of their expectations were met,
    • 49.8% reported that their most important expectation in the majority disability or pain improvement was met,
    • and 32.9% reported that their most important expectation was not met but others were.

The study further noted: “A large proportion of patients reported unfulfilled expectations of outcomes secondary to spine surgery, such as improvements in mental well-being. This may reflect unrealistic expectations that are ultimately unattainable and leading to patients’ dissatisfaction with surgery. It has also been shown that there is a large discrepancy between surgeons’ and patients’ expectation across different expectation dimensions. (The surgeons idea of successful surgery did not match what the patient’s idea of successful surgery was. However, “Despite this disparity, most patients (85%) were satisfied with the results of the surgery. ”

A December 2020 (2) study included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. But did this translate to a better situation for the patient?  One aspect that the researchers questioned was how pain was reported. In fact, how patients reported their pain may lead to skewed satisfaction scoring. The study notes: “pain-related outcome measures may serve as better predictors of patients’ satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.

Failure to return to work and physical activity is one aspect

This was also alluded to in an October 2020 paper (3) which wrote: “Studies have found that most patients are satisfied after spine surgery, with rates ranging from 53% to 90%. Patient satisfaction appears to be closely related to achieving clinical improvement in pain and disability after surgery. While the majority of the literature has focused on patients who report both satisfaction and clinical improvement in disability and pain, there remains an important subpopulation of patients who have clinically relevant improvement but report being dissatisfied with surgery.” The researchers then asked why were the patient’s dissatisfied? They found: “Several modifiable factors, including psychological distress, current smoking status, and failure to return to work and physical activity, helped explain why patients report being dissatisfied with surgery despite clinical improvement in disability or pain.”

1 Rampersaud YR, Canizares M, Perruccio AV, Abraham E, Bailey CS, Christie SD, Evaniew N, Finkelstein JA, Glennie RA, Johnson MG, Nataraj A. Fulfillment of Patient Expectations After Spine Surgery is Critical to Patient Satisfaction: A Cohort Study of Spine Surgery Patients. Neurosurgery. 2022 May 17:10-227.
2 Rabah NM, Khan HA, Levin JM, Winkelman RD, Mroz TE, Steinmetz MP. The association between patient rating of their spine surgeon and quality of postoperative outcome. Journal of Neurosurgery: Spine. 2020 Dec 18;34(3):449-55.
3. Sivaganesan A, Khan I, Pennings JS, Roth SG, Nolan ER, Oleisky ER, Asher AL, Bydon M, Devin CJ, Archer KR. Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful?. The Spine Journal. 2020 Oct 1;20(10):1535-43.

 

 

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