gms | German Medical Science

Objective: Degenerative, inflammatory, oncologic and traumatic spinal disease can lead to stabilization surgery. A main element of preoperative discussion with the patient is clarification of therapeutic goals. For this, defining the patient’s clinical condition and identifying his expectations with regard to his symptoms (such as pain, or disability) is of key importance. These expectations can be quantified using standardized tools, such as the VAS pain scale and the Oswestry Disability Index (ODI). It is unclear to what extent the expectations measured by means of these tools correlate with postoperative patient perceptions of symptom burden and patient satisfaction. The goal of this prospective, monocentric observational study is the identification and quantification of those symptom and disability improvements that are relevant to postoperative patient satisfaction.

Method: We measure the preoperative clinical status of patients undergoing stabilization surgery of the thoracic / lumbar spine using VAS and ODI. Preoperatively, patients specify the condition they expect at least to be satisfied with the outcome after six months by means of these tools. Six months after surgery, ODI and VAS are measured again, and patients report whether they are satisfied with the outcome.

Results: We analyzed the data of the first 39 patients recruited for this study (23 female, 16 male; 32 had degenerative disease, 3 had spondylodiscitis, 2 had vertebral body fractures, and 2 had metastatic disease of the thoracic / lumbar spine). The mean preoperative pain levels (VAS) were 6.4 ± 2.4 (back) and 6.3 ± 2.5 (leg). The mean pain levels expected for postoperative satisfaction were 1.8 ± 0.9 and 1.6 ± 0.8, respectively. The mean preoperative ODI was 50.9 ± 19.4%; patients expected 8.2 ± 10.1% on average. After 6 months, pain intensities were 3.0 ± 3.3 (back) and 2.5 ± 3.2 (leg), ODI was 35.1 ± 26.1%, and satisfaction rate was 67%.

Conclusions: These results indicate that patients have high expectations with regards to their symptom and disability improvement after spinal stabilization surgery. Even though these expectations were not met entirely, the majority of patients was satisfied with the outcome after six months. We are aiming at determining minimal clinically important differences of the standardized tools employed. This will be the basis for a better appreciation of preoperative patient expectations, improved preoperative patient information, optimized surgery indication, and higher patient satisfaction.