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Spinal fusion dramatically improves disability, but not completely

There is no question that spinal fusion surgery can greatly improve pain and function in people with certain back problems. For patients who do not benefit from conservative treatments, spinal fusion surgery can be a salvation from chronic pain and disability. On the other hand, it is not realistic to assume that every person with severe spinal problems will be fully restored with spinal fusion surgery.

 

Better versus normal

Numerous studies have shown that spinal fusion surgery results in improvements among individual patient. In other words, most people who undergo spinal fusion surgery enjoy improvements in pain symptoms, functional ability, and health-related quality of life. However, it is unclear whether spinal fusion surgery actually restores people back to “normal” health and function. New research suggests that people undergoing the surgery can expect to get better, but should not assume they will be “normal.”

Comparing people with back pain to healthy, age-matched controls

Researchers compared the records of 252 spine fusion patients with records of people without back disorders.1 The surgical patients had diagnoses that prompts elective spinal fusion, including degenerative spondylolisthesis, disc herniation or degeneration, spondylolysis, spinal stenosis, postoperative conditions and degenerative scoliosis. The medical record of each patient with a back disorder was matched to a healthy patient based on age, gender, and locality.

Prior to surgery, study participants filled out questionnaires that measured disability and health-related quality of life, namely,the Oswestry Disability Index and the Short Form-36 Questionnaire (SF-36). Study participants then filled out these questionnaires again after that healed from spinal fusion surgery. Scores on these questionnaires were also obtained from the age-matched control group.

Surgery greatly improves outcomes, but fails to achieve perfection

According to the results of the questionnaires, men and women who had spinal fusion surgery enjoyed significantly less disability after the procedure. Though after one year, disability levels were still worse than they were in the general population. Likewise, health-related quality of life improved in surgical patients one year after the procedure, but failed to reach the level of their age-matched peers. Taken together, these results suggest that people who require back surgery will see significant improvements, but will not necessarily reach to the same degree of physical health as people without back disorders.

Surgery restores mental health?

One of the most curious findings of this research was found in the data of the SF-36. The SF-36 has two major subdivisions physical functioning and mental functioning. While surgical patients did not achieve the same level of physical functioning as the general population, the mental functioning results did. As one would expect, a chronic back pain disorder negatively affects mental health; it can cause depression, anxiety, and social withdrawal. This was clear from the low scores on the mental health portion of the SF-36 prior to surgery. Unexpectedly, mental health scores of the surgical group matched those in the general population one year after surgery. While spinal fusion surgery did not restore full physical function or completely eliminate disability, it did allow patients to overcome the mental health consequences of chronic back pain.

Taken together, this means that patients who undergo spinal fusion surgery can expect substantial physical improvement, though perhaps not to the same level as people their same age. Furthermore, spinal fusion surgery appears to fully restore back pain-related mental health.

Reference

 

  1. Pekkanen L, Neva MH, Kautiainen H, et al. Disability and health-related quality of life in patients undergoing spinal fusion: a comparison with a general population sample. BMC Musculoskelet Disord. 2013;14:211. doi:10.1186/1471-2474-14-211

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