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Minimum acceptable outcomes after lumbar spinal fusion.

Eugene J Carragee1, Ivan Cheng

  • 1Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Stanford University School of Medicine, Redwood City, CA 94063, USA. carragee@stanford.edu

The Spine Journal : Official Journal of the North American Spine Society
|April 6, 2010
PubMed
Summary

Patients undergoing spinal fusion surgery have high expectations for pain relief and functional improvement, defining their minimum acceptable outcome. Achieving these patient-defined goals strongly correlates with satisfaction, though psychosocial factors can influence reported satisfaction independently of outcomes.

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Area of Science:

  • Spine surgery outcomes research
  • Patient-reported outcome measures
  • Clinical trial methodology

Background:

  • Defining surgical success, particularly for spinal fusion, is challenging.
  • Current metrics like the minimal clinically important difference (MCID) often disregard patient-specific risk and morbidity perceptions.
  • Patient-reported minimum acceptable outcomes offer a personalized metric for surgical success.

Purpose of the Study:

  • To introduce a novel method for assessing spinal surgery success using prospective, patient-defined minimum acceptable outcomes.
  • To compare preoperatively set patient goals with actual 2-year postoperative outcomes.
  • To evaluate the correlation between met patient goals and overall satisfaction.

Main Methods:

  • A descriptive clinical study involving 165 patients undergoing lumbar fusion for isthmic spondylolisthesis or degenerative disc disease.

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  • Patients preoperatively completed questionnaires defining their minimum acceptable pain intensity, Oswestry Disability Index (ODI) improvement, medication use, and return to work.
  • Outcomes and satisfaction were assessed at a 2-year follow-up.

    • Main Results:

    • Both patient groups established high thresholds for minimum acceptable outcomes, including significant pain reduction (≤3/10), substantial ODI improvement (≥20 points), cessation of opioids, and return to work.
    • Achieving these patient-defined minimum acceptable outcomes strongly predicted 2-year postoperative satisfaction.
    • Psychosocial factors, such as compensation claims and psychological distress, were associated with higher satisfaction even when minimum acceptable outcomes were not met.

    Conclusions:

    • Patients undergoing spinal fusion for spondylolisthesis and degenerative disc disease have demanding expectations for surgical success.
    • Commonly proposed MCIDs for pain and function are often insufficient to meet patient-defined acceptable outcomes.
    • While patient-defined goals align well with satisfaction, psychosocial factors can independently influence satisfaction levels, highlighting the complexity of assessing surgical success.