Suffering and Disability as a Predictor of Outcome After Lumbar Spinal Fusion Surgery in Real-World Practice

This prospective study from three Belgian hospitals followed 693 adults having lumbar fusion for degenerative disease and used a statistical clustering method to split them into two groups by baseline pain, disability, quality of life and pain catastrophizing. The high-burden group (n = 356) improved significantly at 9 to 12 months (ODI change -7.01, VAS back -2.67, EQ-5D +0.27), while the lower-burden group (n = 337) showed no significant change. The between-cluster difference in ODI change was 7.50 points (95% CI 1.74 to 13.27). Return to work, reduction in pain medication and satisfaction did not differ significantly between groups.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersSelecting patients for lumbar fusion is a recurring clinical and exam theme, and this study suggests that patients with more preoperative disability and catastrophizing show larger measured gains, although regression to the mean, heavy imputation and the lack of a nonoperative comparison limit interpretation.

Presenting this at rounds? Start here

• ?If a patient with moderate back and leg pain but low ODI and low catastrophizing scores asks about fusion, how would you counsel them about the likely change in pain and function compared with a highly disabled patient?
• ?Given that the high-burden group's ODI improvement fell short of the cited MCID of 12.4 points, how should you set expectations with highly disabled, catastrophizing patients and decide whether to add rehabilitation or psychological support around surgery?