gms | German Medical Science

Objective: Various diseases can lead to spinal 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 crucial. Expectations can be quantified using standardized tools (e.g., VAS, mJOA score, NDI). It is unclear to what extent expectations measured by means of these tools correlate with postoperative symptom burden and satisfaction and how this depends on the primary diagnosis. The goal of this study is to measure the preoperative clinical status, expectations and outcome of patients undergoing cervical stabilization surgery.

Methods: This was a prospective monocentric observational study including patients undergoing cervical spine stabilization surgery. Preoperatively, we measured the clinical status using VAS, mJOA and NDI. In addition, patients specified, by means of these tools, the condition they expected at least to be satisfied with the outcome. Six and twelve months after surgery, scores were measured again, and patients specified whether they were satisfied with the outcome.

Results: 105 patients (57 male, 48 female) were included. Preoperative neck pain was 4.9±3.4 (mean±s.d.) and arm pain was 3.9±3.6 on the VAS. The values expected for postoperative satisfaction were 1.1±1.4 and 0.8±1.1. Preoperative NDI was 39.0±22.4%; patients expected 8.5±11.7%. Preoperative mJOA was 13.7±3.0; patients expected 15.9±1.8. At six (80% follow up rate) and twelve (75% follow up rate) months after surgery, there was substantial improvement of perceived pain and disability. Neck pain at six months was 2.3±2.9 (twelve months: 2.6±3.2), arm pain was 1.2±2.3 (1.1±2.4), NDI was 19.0±22.8 (19.1±22.8), and mJOA was 14.8±3.0 (14.4±3.3). Overall, the high expectations were not met in many cases, especially with regards to NDI (60% did not meet their expectation), mJOA (57%) and neck pain (44%). Yet, satisfaction with the outcome was high (73% at six months and 80% at twelve months). Patients with radiculopathy had higher expectations, better outcome and were more likely to be satisfied than patients with myelopathy (satisfaction rate at six months: 75 vs. 47%; at twelve months: 87 vs 61%).

Conclusion: Patient expectations are high ahead of cervical spine stabilization surgery. NDI and mJOA achievement, more than pain achievement, underestimate success; pain reduction is more important than disability improvement for most patients. However, there are indication-specific differences. These results provide the basis for a better appreciation of preoperative patient expectations, improved patient information, optimized surgery indication, and higher patient satisfaction.