Patientsʼ Expectations and Satisfaction in Lumbar Spine Surgery

Toyone, Tomoaki; Tanaka, Tadashi; Kato, Daisuke; Kaneyama, Ryutaku; Otsuka, Makoto

doi:10.1097/01.brs.0000187876.14304.15

Cited by 145 publications

(140 citation statements)

References 24 publications

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“…In the group without depressive symptoms, a desire to improve pain was the most frequent reason for undergoing surgery. These results differ from those of Toyone et al 24 in 2005, in which reducing leg pain was the main reason to undergo surgery among patients with lumbar spinal stenosis and disc herniation.…”

Section: -19contrasting

confidence: 56%

Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

Urban-Baeza¹,

Zárate-Kalfópulos²,

Romero-Vargas³

et al. 2015

SPI

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OBJECT This prospective cohort study was designed to determine the influence of depressive symptoms on patient expectations and the clinical outcomes of the surgical management of lumbar spinal stenosis. METHODS Patients with an age > 45 years, a diagnosis of lumbar spinal stenosis at one level, and an indication for decompressive surgery were included in this study. Data for all of the following parameters were recorded: age, sex, highest level of education, and employment status. Depression symptoms (Beck Depression Inventory), disability (Oswestry Disability Index), and back and leg pain (visual analog scale) were assessed before surgery and at 12 months thereafter. The reasons for surgery and patient expectations (North American Spine Society lumbar spine questionnaire) were noted before surgery. The global effectiveness of surgery (Likert scale) was assessed at the 1-year follow-up. RESULTS Fifty-eight patients were divided into two groups based on the presence (Group 1) or absence (Group 2) of depressive symptoms preoperatively; each group comprised 29 patients. Demographic data were similar in both groups before surgery. The main reason to undergo surgery was “fear of a worse situation” in 34% of the patients in Group 1 and “to reduce pain” in 24% of the patients in Group 2. The most prevalent expectation was to improve my social life and my mental health in both groups. Surgery had a relieving effect on the depressive symptoms in 14 patients (48%). Thus, in the postoperative period, the number of patients who were free of depressive symptoms was 43 compared with the 15 who were depressed (p = 0.001). The 15 patients with persistent depression symptoms after surgery had a worse clinical outcome compared with the 43 patients free of depression symptoms at the 1-year follow-up in terms of severe back pain (20% vs 0%, respectively), severe leg pain (40% vs 2.3%, respectively), and severe disability (53% vs 9.3%, respectively). Only 33% of patients with persistent depression symptoms after surgery chose the option “surgery helped a lot” compared with 76% of patients without depression symptoms. Moreover, in terms of expectations regarding improvement in back pain, leg pain, walking capacity, independence, physical duties, and social activities, fewer patients were “completely satisfied” in the group with persistent depression symptoms after surgery. CONCLUSIONS Surgery for spinal stenosis had a relieving effect on preoperative depression symptoms at the 1-year follow-up. The persistence of depressive symptoms after surgery correlated with a worse clinical outcome and a higher rate of unmet expectations. Screening measures to detect and treat depression symptoms in the perioperative period could lead to better clinical results and increased patient satisfaction.

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Section: -19contrasting

confidence: 56%

Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

Urban-Baeza¹,

Zárate-Kalfópulos²,

Romero-Vargas³

et al. 2015

SPI

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“…Also, regarding the patients' expectations and satisfactions after surgery, depressed patients tended to have lower expectations and, consequently, lower satisfaction 13 . Therefore, it is very important for spine surgeons to verify the presence of depression in the preoperative period for degenerative spinal disorders 3 .…”

Section: Discussionmentioning

confidence: 94%

“…In patients who have chronic low back pain and undergo lumbar fusion, psychological and emotional stress negatively affect the postoperative outcome 12 . Also, regarding patients' expectations and satisfaction after surgery, the depressed ones tended to have lower expectations and, consequently, lower satisfaction 13 .…”

mentioning

confidence: 93%

Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

Falavigna

Righesso²,

Teles

et al. 2012

Arq. Neuro-Psiquiatr.

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Depression and anxiety are mood disorders that are commonly related to chronic illnesses. The overall frequency in hospitalized patients has an index of variation between 20 and 60% 1-3 , and they are not recognized in one third of patients 4 . Their frequency can be higher in patients without mood disorders presenting symptoms caused by physical illness or preoperative anxiety, which range from 11 to 80% in adults 5 . This variation is related to the sociodemographic characteristics of the population studied, type of disease, degree of involvement, chronicity, and variability of the methodological definitions used in the studies, such as the cutoff point, the search tools, and the case definition. The literature offers different scales for the assessment of anxiety and depression, such as Beck Depression Inventory (BDI), Hospital Palavras-Chave: cirurgia da coluna, depressão,

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“…Por outro lado, são considerados fatores de mau prognóstico para o resultado do tratamento cirúrgico: idade avançada, doença de fundo emocional e expectativas irreais de cura. 20,21 O resultado clínico do tratamento cirúrgico, no entanto, nem sempre está relacionado ao sucesso na obtenção de uma artrodese sólida, pois mesmo na presença de uma união fibrosa (pseudartrose) do segmento, os resultados podem ser tão bons quanto nos casos em que ocorre a união sólida. A união fibrosa pode permitir estabilização suficiente do segmento instrumentado e, com isso, uma melhora da dor lombar e da dor irradiada para os membros inferiores causadas pela instabilidade da coluna.…”

Section: Resultsunclassified

Evolução dos questionários Oswestry 2.0 e do componente físico (PCS) do SF-36 durante o primeiro ano de pós-operatório de artrodese da coluna lombar em doenças degenerativas

et al. 2013

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RESUMOObjetivo: Avaliar a melhora clínica dos pacientes submetidos a descompressão e artrodese lombar póstero-lateral por doença degenerativa, avaliando a evolução dos escores do questionário Oswestry 2.0 e pelo componente físico (PCS) da escala SF-36. Métodos: Estudo prospectivo com 19 pacientes consecutivos com diagnóstico de doença degenerativa de disco (hérnia de disco, estenose lombar ou espondilolistese degenerativa) submetidos à descompressão e artrodese póstero-lateral. Todos os pacientes incluídos em nosso estudo responderam aos questionários Oswestry 2.0 e SF-36 em cinco momentos diferentes: no período pré-operatório e após 45, 90, 180 e 360 dias de cirurgia. Resultados: Os escores dos questionários Oswestry 2.0 e do componente físico (PCS) do SF-36 dos 19 pacientes mostraram melhora significativa (p<0,001 e p=0,004 respectivamente) ao longo de um ano de seguimento pós-operatório. Não houve diferença significativa de melhora desses escores quando feita comparação entre os diagnósticos (hérnia de disco, estenose lombar ou espondilolistese degenerativa), o sexo dos pacientes e entre os indivíduos com idade até cinquenta anos e aqueles acima de cinquenta anos. Conclusão: Houve uma melhora dos escores nos questionários de Oswestry 2.0 e do componente físico (PCS) do SF-36 nos pacientes com doença degenerativa da coluna lombar sem resposta ao tratamento conservador, que foram submetidos a tratamento cirúrgico com descompressão e artrodese após um ano de seguimento pós-operatório.

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Patientsʼ Expectations and Satisfaction in Lumbar Spine Surgery

Abstract: Even if the clinical expectations were met, some patients were still dissatisfied. Patients with spinal stenosis (Group 2) seem to have more unrealistic expectations than patients with disc herniation (Group 1).

Cited by 145 publications

References 24 publications

Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

Evolução dos questionários Oswestry 2.0 e do componente físico (PCS) do SF-36 durante o primeiro ano de pós-operatório de artrodese da coluna lombar em doenças degenerativas

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