Oral Posters: Values and Outcomes in Spine Surgery

Presented by: F. Marcelino - View Audio/Video Presentation (Members Only)

Author(s):

V. Amaral(1), H. Martim(1), L. Marchi(1), R. Amaral(1), J. Nogueira-Neto(1), L. Oliveira(1), E. Coutinho(1), N. Faulhaber(1), F. Marcelino(1), R. Jensen(1), L. Pimenta(1,2)

(1) Instituto de Patologia da Coluna, Sao Paulo, Brazil
(2) UCSD, Neurosurgery, San Diego, CA, United States

Abstract

Objectives: Low back pain is caused by several pathologies and can be modified by external factors, as some psychosocial issues. The aim of this study was to analyze the results of spinal surgery in two groups of patients: with and without psychosocial issues.

Methods: Retrospective comparative study. All patients were preoperatively evaluated in a psychological semi structured model. The patients were divided in favorable (green group) and favorable with reservation (yellow group) were compared in relation to psychosocial parameters and results of clinical demographic data and disease, depression (HAD-D), anxiety (HAD-A), referred pain (EVA) and physical constraint (ODI), quality of life (EQ-5D) in the preop and periods of 6 to 12 months.

Results: Total 136 cases included, 66 male and 70 female, 63% of cases in the green and 38% in the yellow group. The green and yellow group showed similar average pain values preoperatively, but with lower values in the postoperative period (p=0.003). In ODI and EQ-5D, the green group had better values preoperatively (p=0.009 and p=0.003, respectively), as well as in the final point (p=0.049 and p=0.017). Despite the differences among the groups, both cohorts experienced clinical benefit from surgery with results superior than the minimally important clinical difference.

Conclusion: The study shows that patients with psychosocial issues tend to have worse clinical presentations before and after surgery. Factors such as depression, anxiety and personal problems are related to a poorer postop outcome, but even patients with these factors can experience benefit from spinal surgery. It can be very useful for the surgeon to identify such patients in order to be aware of the cases that may evolve with poorer surgical results. Psychosocial factors correlate to different degrees of clinical involvement and life quality in the preoperative period and influence the magnitude of the surgical results.

Clinical outcomes per study group