Prospective assessment of outcomes improvement following fusion for low back pain.

Abstract

This prospective study was performed to improve the quality of outcomes data in patients undergoing spinal fusion for low back pain. There is an accepted deficiency of this form of outcomes assessment in the literature. The aim was to determine the effectiveness of the surgical procedure in terms of patient satisfaction, outcome scores, and third-party measures. The measures of outcomes assessment included patient satisfaction, pain scores, low back outcome and Prolo scores, medication use, and employment status. Data collection was prospective prior to and at final follow-up. Eighty percent of 35 patients were followed for a mean of 31 months. Patient satisfaction was 71%; however, only 28.6% of patients followed achieved good or excellent low back outcome scores. Yet significant improvement occurred: 46.4% achieved a good or excellent outcome using the Prolo score. There was a 75% reduction in medication usage, and 75% of nonworking compensation patients returned to gainful employment. Patient satisfaction was markedly higher than improvement measured by the outcome scores. Dramatic improvements in medication usage and return to work were achieved, despite less than spectacular outcome scores. These findings support cautious use of posterior spinal fusion. Patients must appreciate improvement rather than normality as a realistic aim.