Presurgical biopsychosocial factors predict multidimensional patient: Outcomes of interbody cage lumbar fusion

Rick A. LaCaille, M. Scott DeBerard, Kevin S. Master, Alan L. College, William Bacon

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

Background context: Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis; however, little attention has been given to quality of life and functional outcomes. Studies suggest that psychosocial factors may be important modifiers of low back surgical outcomes. Purpose: To depict outcomes of ICLF surgery across multiple dimensions and to investigate presurgical biopsychosocial predictors of these outcomes. Study design/setting: A retrospective-cohort research design was used that involved completion of presurgical medical record reviews and postsurgical telephone outcome surveys at least 18 months after surgery. Presurgical variables included in a regression model were age at the time of surgery, spinal pathophysiology rating, smoking tobacco, depression, and pursuing litigation. Patient sample: Seventy-three patients received ICLF, and of those 56 patients completed the outcome survey an average of 2.6 years after surgery. Outcome measures: Outcome measures consisted of arthrodesis status, patient satisfaction, back-specific functioning, disability status, and quality of life. Results: Although arthrodesis occurred in 84% of the patients, nearly half were dissatisfied with their current back condition. Functional status was worse than expected, and 38% were totally disabled at follow-up. Regression analyses revealed tobacco use, depression, and litigation were the most consistent presurgical predictors of poorer patient outcomes. Conclusions: Overall, despite a high rate of arthrodesis, ICLF was not associated with substantial improvements in patient functioning. Presurgical biopsychosocial variables predicted patient outcomes, which may help improve patient selection and possible targeted interventions.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalSpine Journal
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2005

Keywords

  • Depression
  • Litigation
  • Lumbar fusion
  • Patient outcomes
  • Smoking

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