2013 Pilot Study 3

Pain as a Covariate in Lumbar Spine Surgery Outcomes

Investigator: Carol Mancuso, MD, FACP-  Co-Director of the Masters Degree Program in Clinical Epidemiology and Health Services Research, Weill Cornell Graduate School of Medical Sciences; Associate Professor of Medicine, Hospital for Special Surgery

Low back pain is a prevalent condition due mainly to injury and degenerative changes that becomes more prevalent with aging.  Low back pain limits mobility not only in older adults with comorbidity but also in older adults who are otherwise physically and mentally fit.  Back surgery is increasingly sought by patients who expect relief of pain, restoration of function, and preservation of mental well-being.  Patients’ expectations are major considerations in the decision to operate and patients’ assessments of fulfillment of expectations are important outcomes.  However, unlike other orthopedic procedures, back surgery often is accompanied by residual pain due to the index condition or new pain from other pathology.  The specific aim of this study is to assess fulfillment of expectations in an established cohort of patients who underwent lumbar spine surgery at the Hospital for Special Surgery (HSS) and to assess the effects of persistent pain on fulfillment of expectations.  All patients preoperatively completed the HSS Lumbar Spine Surgery Expectations Survey, a 21-item valid and reliable survey addressing amount of improvement expected for pain, daily and integrated functions, and psychological well-being.  For this proposed follow-up study, patients will be interviewed 2-3 years after surgery to ascertain how much improvement has been attained for each expectation. The within- patient change in expectations score (i.e. postop amount of improvement attained versus preop amount of improvement expected) will be compared to clinical characteristics, residual and new pain, depression and anxiety, and pre-existing and new comorbidity.  Additional analyses will include information obtained from surgeons and medical records and will consider function, participation in rehabilitation, and repeat surgery.  This proposal leverages an existing cohort of patients for whom comprehensive preop data have been rigorously obtained for pain, function, psychological well-being, and orthopedic characteristics.  The current proposal will address fulfillment of expectations which is a novel patient-centered outcome.  The large volume of spine patients at HSS and the multidisciplinary expertise of the investigative team will guarantee the success of this study and will lead to future proposals to national agencies and spine foundations.