Preoperative Predictors of Low Back Surgery Outcome: Preliminary Six-Month Review Findings

Abstract

Research has shown that for patients undergoing low back surgery preoperative physical, psychological, and demographic and social information are predictive of outcome. However, some of the research findings have been conflicting, difficult to replicate and made questionable because of major methodological shortcomings. This study attempts to clarify further which preoperative variables best predict low back surgery outcome, using refined methodology. The sample comprised 140 patients (87 males, 53 females; age range 19 to 84 years; mean ± SD, 48.5±15.4 years) scheduled to undergo first-time low back surgery. Before surgery, patients were interviewed, and completed a comprehensive psychometric test battery. Perioperative information was collected on every patient. Outcome was assessed at six months following surgery, and surveyed patient pain levels, perceived pain relief, level of disability, return to work and analgesic use. Outcome was evaluated in terms of pain relief, and pain relief in conjunction with the level of disability, return to work status and analgesic use. Outcome was correlated with preoperative psychosocial variables alone. The variables found to be predictive of outcome included: compensation involvement; previous serious illness; having close family members who had experienced chronic pain; childhood hospitalization for serious illness; a nonorganic pain drawing; catastrophizing; depression; psychological maladjustment and psychological issues suspected by the interviewer. The preliminary findings suggest that preoperative psychosocial assessment is of great importance for first-time low back surgery outcome. Further follow-up of the study sample is required to confirm the reliability of findings.