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Patients' Expectations and Satisfaction in Lumbar Spine Surgery

Toyone, Tomoaki MD; Tanaka, Tadashi MD; Kato, Daisuke MD; Kaneyama, Ryutaku MD; Otsuka, Makoto MD

doi: 10.1097/01.brs.0000187876.14304.15
Health Services Research

Study Design. Prospective consecutive series.

Objective. To determine patient expectations in lumbar spine surgery and assess the level of fulfillment of those expectations.

Summary of Background Data. Little has been offered in the literature in specific regards to lumbar spine surgery.

Methods. Ninety-eight patients, 49 patients who underwent discectomy for lumbar disc herniation (Group 1) and 49 patients who underwent laminotomy for lumbar spinal stenosis (Group 2), completed the self-report questionnaire. Preoperative expectations, reasons for surgery, and expected postoperative status were inquired before surgery and the satisfaction at 2 years after surgery.

Results. Concerning patients' expectations, half of the patients expected to become completely leg pain free, and more than three fourths of the patients expected to become unlimited in their walking ability in both groups. More than half of the patients expected to have a 90% or greater chance of complete success of surgery. With regard to satisfaction, 42 of the 49 patients (86%) in Group 1 and 35 of the 49 patients (71%) in Group 2 chose “Surgery met my expectations” at the follow-up. The remaining patients selected “I did not improve as much as I had hoped.” Positive expectations were associated with better satisfaction in Group 1 only. Of the patients who had achieved the expected postoperative status with respect to their no.1 reason for surgery, 2 of 34 patients in Group 1 (6%) and 5 of the 26 patients in Group 2 (19%) nonetheless reported “unfulfilled expectations.” In patients whose no. 1 concern was further progression, 3 (38%) of the 8 patients in Group 1 and 2 (40%) of the 5 patients in Group 2 demonstrated unfulfilled expectations.

Conclusions. Even if the clinical expectations were met, some patients were still dissatisfied. Patients with spinal stenosis (Group 2) seem to have more unrealistic expectations than patients with disc herniation (Group 1).

Forty-nine patients with disc herniation and 49 patients with spinal stenosis completed the self-report questionnaire, including preoperative expectations and 2-year postoperative satisfaction. Positive expectations were associated with better satisfaction in patients with lumbar disc herniation. Even if the clinical expectations were met, some patients with spinal stenosis were still dissatisfied.

From the Division of Orthopaedic Surgery, Kimitsu Chuo Hospital, Kisarazu-city, Chiba, Japan.

Acknowledgment date: October 14, 2004. First revision date: February 14, 2005. Second revision date: March 28, 2005. Third revision date: April 24, 2005. Acceptance date: April 25, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Tomoaki Toyone, MD, Department of Orthopaedic Surgery, Teikyo University School of Medicine Ichihara Hospital, 3426-3, Anesaki, Ichihara, Chiba 299-0111, Japan; E-mail: tomotomot2001@aol.com

© 2005 Lippincott Williams & Wilkins, Inc.