Grundnes Ingrid Bergerud, Alhaug Ole Kristian, Reis Joao André Barroso Pereira Roque Dos, Jakobsen Rune Bruhn
Faculty of Medicine, University of Oslo. Klaus Torgårds vei 3, PO Box 1078, Blindern, 0372 Oslo, Norway.
Orthopedic Department, Akershus University hospital, PO Box 1000, N-1478 Loerenskog, Norway; Innlandet Hospital Trust, The Research Center for Age-related Functional Decline and Disease, PO Box 68, N2313 Ottestad, Norway.
Spine J. 2024 Dec;24(12):2224-2231. doi: 10.1016/j.spinee.2024.09.004. Epub 2024 Sep 19.
Defining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery.
To examine patients' expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself?
STUDY DESIGN /SETTING: Prospective single-center study.
Patients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease.
Modified and standard version of ODI and NRS (back and leg pain).
Preoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients' expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics.
A total of 93 patients completed the preop questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2-42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81-6.88), and leg pain was 6.67 (6.08-7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5-13.5), mean (95%CI) NRS back pain of 2.5 (2.1-3.0), and NRS leg pain of 1.8 (1.5-2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0-26.5), NRS back pain of 3.4 (2.8-4.1), and leg pain of 2.8 (2.0-3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE.
Patients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.
脊柱手术成功的定义缺乏标准化方法，所有现有概念均基于术后登记。
通过改良的奥斯维斯特里功能障碍指数（ODI）和数字评分量表（NRS）评估脊柱手术前患者的期望。作者提出疑问：期望与实际结果如何匹配，患者的个人期望本身能否用作成功标准？
研究设计/地点：前瞻性单中心研究。
在阿克什胡斯大学医院（AHUS）计划进行脊柱手术的患者纳入本研究。他们接受了以下三种手术之一：腰椎管狭窄减压术、腰椎间盘突出症椎间盘切除术或退变性椎间盘疾病脊柱融合术。
改良版和标准版ODI以及NRS（腰背痛和腿痛）。
术前，患者接受改良的ODI和NRS问卷，被要求记录他们预期术后可接受的最低功能障碍和疼痛程度。将患者的期望与挪威脊柱手术登记处（NORspine）3个月和12个月随访数据中的ODI、NRS和总体感知效果（GPE）量表进行比较。我们使用了简单描述性统计。
共有93名患者完成了术前问卷。其中，65名患者对3个月随访做出回应，53名患者对12个月随访做出回应。术前ODI的均值（95%CI）为38.3（34.2 - 42.3），术前NRS腰背痛均值（95%CI）为6.34（5.81 - 6.88），腿痛均值为6.67（6.08 - 7.26）。患者预期ODI均值（95%CI）为10.5（7.5 - 13.5），NRS腰背痛均值（95%CI）为2.5（2.1 - 3.0），NRS腿痛均值为1.8（1.5 - 2.2）。12个月后的实际临床结果为ODI均值（95%CI）为21.7（17.0 - 26.5），NRS腰背痛为3.4（2.8 - 4.1），腿痛为2.8（2.0 - 3.5）。只有12名（30.8%）患者达到了预期的ODI，而26名（65.0%）患者根据GPE将自己归类为明显好转。
患者在脊柱手术前似乎期望较高，且期望可能超过临床结果。只有30.8%的患者达到了ODI期望，但感知到的益处更高。高期望可能是由于术前信息不足和/或ODI不适用于捕捉期望。
