Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

Abstract

Prediction studies testing a thorough range of psychological variables in addition to demographic, workrelated and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Postoperative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and postoperative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

“…Our results are consistent with previously published studies in both Southern 19 and Northern 2 European patients. In 61 Greek patients undergoing 1-level posterior lumbar spine fusion, Papaioannou et al reported that catastrophizing predicted postoperative pain intensity and analgesic use.…”

Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery : A focus on functioning and daily life

“…Preoperative psychosocial status has shown to be an important factor of outcome on lumbar spine surgery at 6 months and 2-3 year follow-ups (73,128). In the present study, there was, unfortunately, no assessment of participants' psychosocial status, either preoperatively or at early follow-ups.…”

Patients’ expectations of lumbar spine surgery

“…Patients' expectations of lumbar spine surgery have been measured in various ways, including with standard questions from comprehensive preoperative surveys [2,6,7]. Most studies, however, used ad hoc surveys developed specifically for that study and considered expectations from distinct perspectives, such as likelihood of symptom relief, anticipated time to recovery, and anticipated change in function [2,6,[8][9][10][11][12][13][14][15].…”