High Preoperative Expectations May Not Need to be Feared

Area of Science:

• Spine surgery outcomes research
• Patient-reported outcome measures
• Cervical spine disorders

Background:

• Limited data exists on the relationship between patient expectations and outcomes after anterior cervical spine surgery.
• Understanding this relationship can help identify patients who may benefit most from surgical intervention.

Purpose of the Study:

• To evaluate the correlation between preoperative expectations for pain relief and 12-month functional outcomes and patient satisfaction following primary anterior cervical surgery.
• To explore the predictive value of preoperative expectations on surgical success.

Main Methods:

• Retrospective study of 1-2 level primary anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDR) patients (2016-2021).
• Preoperative pain relief expectations (5-point Likert) and satisfaction (7-point Likert) were assessed.
• Linear regression models analyzed the association between expectations, 12-month Neck Disability Index (NDI) change, minimum clinically important difference (MCID) achievement, and satisfaction, controlling for covariates.

Main Results:

• No significant correlation was found between preoperative pain relief expectations and 12-month NDI improvement or MCID achievement.
• Preoperative expectations were not associated with 12-month patient satisfaction.
• Greater preoperative dissatisfaction significantly correlated with greater 12-month NDI improvement.

Conclusions:

• Preoperative expectations for pain relief do not predict functional outcomes or satisfaction after 1-2 level primary ACDF or CDR at 12 months.
• Preoperative patient dissatisfaction is associated with greater functional improvement, suggesting it may be a better indicator of surgical benefit.
• Assessing preoperative satisfaction, rather than expectations, may help identify patients most likely to benefit from cervical spine surgery.