Social factors associated with lumbosacral fusion

The relationship between the end results of operative fusion of the lumbosacral spine and social and occupational factors was investigated. The series consisted of 133 patients operated on in 1968--75. The social background of 116 patients was clarified by the use of questionnaires in connection with the follow-up examination period 4.8 years postoperatively, on an average. The data were classified as far as possible according to the same principles as were used in the Finnish census of 1970. This made it possible to compare the present series with the total population. The average educational level and social status were found to be lower in this series, divorcees were more frequent, and the households were larger than in the population at large. Moreover, the age groups 30--39 and 40--49 years were overrepresented. The end-results, postoperative working capacity in particular, correlated to a statistically significant extent with educational level, the kind of pre-operative work, occupational group, social group, number of children and size of the place of residence. It is concluded that social factors ought to be considered when selecting patients for lumbosacral fusion, even if an operation appears to be warranted on medical grounds alone. In addition, the importance of comprehensive rehabilitation for patients with low back pain is emphasized.