Preoperative patient expectations and pain improvement after adult spinal deformity surgery

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  • Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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OBJECTIVE

Patients’ expectations for pain relief are associated with patient-reported outcomes after treatment, although this has not been examined in patients with adult spinal deformity (ASD). The aim of this study was to identify associations between patients’ preoperative expectations for pain relief after ASD surgery and patient-reported pain at the 2-year follow-up.

METHODS

The authors analyzed surgically treated ASD patients at a single institution who completed a survey question about expectations for back pain relief. Five ordinal answer choices to “I expect my back pain to improve” were used to categorize patients as having low or high expectations. Back pain was measured using the 10-point numeric rating scale (NRS) and Scoliosis Research Society–22r (SRS-22r) patient survey. Preoperative and postoperative pain were compared using analysis of covariance.

RESULTS

Of 140 ASD patients eligible for 2-year follow-up, 105 patients (77 women) had pre- and postoperative data on patient expectations, 85 of whom had high expectations. The mean patient age was 59 ± 12 years, and 46 patients (44%) had undergone previous spine surgery. The high-expectations and low-expectations groups had similar baseline demographic and clinical characteristics (p > 0.05), except for lower SRS-22r mental health scores in those with low expectations. After controlling for baseline characteristics and mental health, the mean postoperative NRS score was significantly better (lower) in the high-expectations group (3.5 ± 3.5) than in the low-expectations group (5.4 ± 3.7) (p = 0.049). The mean postoperative SRS-22r pain score was significantly better (higher) in the high-expectations group (3.3 ± 1.1) than in the low-expectations group (2.6 ± 0.94) (p = 0.019).

CONCLUSIONS

Despite similar baseline characteristics, patients with high preoperative expectations for back pain relief reported less pain 2 years after ASD surgery than patients with low preoperative expectations.

ABBREVIATIONS ASD = adult spinal deformity; NRS = numeric rating scale; ODI = Oswestry Disability Index; SRS-22r = Scoliosis Research Society–22r.

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Contributor Notes

Correspondence Khaled M. Kebaish: The Johns Hopkins University, Baltimore, MD. editorialservices@jhmi.edu.

INCLUDE WHEN CITING Published online June 12, 2020; DOI: 10.3171/2020.3.SPINE191311.

M.R. and A.B.H. contributed equally to this work and share first authorship.

Disclosures Dr. Neuman: support of non–study-related clinical or research effort from DePuy Synthes and educational speaker for Medtronic.

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