The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study

R. Andrew Glennie MD, FRCSC1, Mayilee Canizares PhD2, Anthony V. Perruccio PhD2, Edward Abraham MD, FRCSC3,4, Fred Nicholls MD, FRCSC6, Andrew Nataraj MD, FRCSC7, Philippe Phan MD, PhD, FRCS(C)8, Najmedden Attabib MD, FRCSC3,5, Michael G. Johnson MD, FRCSC9, Eden Richardson BA4,10, Greg McIntosh MSc10, Henry Ahn MD, FRCSC11, Charles G. Fisher MD, MHSc, FRCSC12, Neil Manson MD, FRCSC3,4, Kenneth Thomas MD, FRCSC6, and Y. Raja Rampersaud MD, FRCSC1,11
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  • 1 Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia;
  • | 2 The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario;
  • | 3 Department of Surgery, Dalhousie University;
  • | 4 Canada East Spine Centre; and
  • | 5 Department of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick;
  • | 6 Department of Surgery, University of Calgary, Alberta;
  • | 7 Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta;
  • | 8 The Ottawa Hospital–Civic Campus, Ottawa, Ontario;
  • | 9 Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba;
  • | 10 Canadian Spine Outcomes and Research Network;
  • | 11 Department of Surgery, University of Toronto, Toronto, Ontario; and
  • | 12 Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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OBJECTIVE

Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients.

METHODS

Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected.

RESULTS

There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34–0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not.

CONCLUSIONS

Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.

ABBREVIATIONS

CSORN = Canadian Spine Outcomes and Research Network; NDI = Neck Disability Index; ODI = Oswestry Disability Index; PHQ-9 = Patient Health Questionnaire 9.
Illustrations from Walker et al. (pp 80–90). © Barrow Neurological Institute, Phoenix, Arizona.

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