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

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.