Study Assesses Outcomes in Spinal Surgeries Performed in 2002

Approximately 4.6 million Americans will need back surgery at some point in their lives, and neurosurgeons currently perform more spine procedures than any other procedure type. According to the American Association of Neurological Surgeons (AANS), 533,839 spine procedures were performed in 1999 (the latest year for which comprehensive statistics are available.) Neurosurgeons recently studied blinded outcome assessments in 622 of 847 patients treated in calendar year 2002. Surgeries were performed by four neurosurgeons and three orthopedic surgeons, with many of the more complex cases handled by a surgical team. The results of this study, Prospective Blinded Outcome Assessments in Spinal Surgery were presented by Thomas B. Ducker, MD, 5:00 to 5:10 p.m. on Wednesday, April 20, 2005, during the 73rd Annual Meeting of the AANS in New Orleans.

Patients ranged in age from 16 to 88 and were treated by seven surgeons. The patients had standard pathologies and operations, utilizing appropriate preoperative screening and evaluations. Upon admission to the hospital, patients provided pain and disability evaluations, body mass indices (BMIs), smoking history, current litigation history, and other medical problems. Demographic evaluations included diagnosis-related groups (DRG) codings, ICD diagnoses, visual analog scale (VAS) pain scores, neck disability indices (NDI), and Owestry disability scores. Litigation was directly related to the condition/injury for which the patient required spinal surgery.

An independent nursing coordinator was given the option of following up with patients via direct phone conversations, by mail, or by email at six months to one year after surgery. Basic outcomes were scored by VAS pain and disability scores, as well as by asking questions about relief of pain, numbness, and weakness; return to work; narcotic usage; additional care needs; and overall outcome. The independent outcome scales were assigned four grades: excellent, good, fair, and poor.

The results in the full group were as follows:

•70 percent returned to work or full activities
• 85 percent rarely or ever used any narcotic medications
• 85 percent rated their overall outcome as excellent or good
• Only 7 percent required additional care, with about one half of those being rehospitalized
• Overall, 66 percent graded relief of pain, numbness, and weakness as excellent or good

"Interestingly, this survey demonstrated that patient demographics influenced the outcome of spinal surgery considerably more than the surgeon, surgical procedure, or disease specifics," stated Dr. Ducker.

Below are figures illustrating excellent and good outcomes in pain relief:

• Non-Smoker/Normal BMI patients: 77 percent
• Normal BMI - all patients: 74 percent
• Obese with a BMI greater than 30: 59 percent
• Active Smokers: 58 percent
• Obese and litigator: 53 percent
• Obese, active smoker and litigator: 41 percent

"Both overall outcome and relief of pain showed significant differences among nonsmoking patients with a healthy BMI, and those with any or all of the other factors: smoking, obesity, and/or litigation. For instance, there were no patients in the obese/active smoker/litigator category that rated overall outcome excellent, and only 33 percent of those rated it good," said Dr. Ducker. These data further reinforce the stance that a patient's overall health and personal circumstances should be taken into consideration before undergoing surgery," added Dr. Ducker.

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