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Risk Factors for Poor Patient-Reported Quality of Life Outcomes After Posterior Lumbar Interbody Fusion: An Analysis of 2-Year Follow-up

Makino, Takahiro MD, DMSc*; Kaito, Takashi MD, PhD*; Fujiwara, Hiroyasu MD; Honda, Hirotsugu MD, PhD; Sakai, Yusuke MD*; Takenaka, Shota MD, DMSc*; Yoshikawa, Hideki MD, PhD*; Yonenobu, Kazuo MD, DMSc§

doi: 10.1097/BRS.0000000000002137
Outcomes
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Study Design. A retrospective review of prospectively collected data.

Objective. The present study aimed to identify risk factors for poor patient-reported quality of life (QOL) outcomes, based on five categories (pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, and psychological disorders) of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), after posterior lumbar interbody fusion (PLIF) at the 2-year follow-up.

Summary of Background Data. Many studies have been reported on patient QOL outcomes after lumbar surgery; however, few reports have focused on risk factors for poor postoperative QOL outcomes in terms of the various disabilities and dysfunctions after PLIF.

Methods. One hundred consecutive patients (39 men and 61 women; mean age 69.6 [44–84] yr) who underwent single- or two-level PLIF for degenerative spondylolisthesis and/or foraminal stenosis with a 2-year follow-up were included. The effectiveness of surgery in each category of the JOABPEQ was evaluated. Demographic and clinical data and radiographic parameters were reviewed. Risk factors for poor postoperative QOL outcomes in each category of the JOABPEQ were investigated by multivariate logistic regression analysis.

Results. Older age and spinopelvic malalignment (preoperative high pelvic tilt or postoperative decrease in lumbar lordosis [=postoperative increase in the mismatch between pelvic incidence and lumbar lordosis]) were risk factors for poor postoperative QOL outcomes in all categories of the JOABPEQ, except for lumbar spine dysfunction. In contrast, increase in number of PLIF segments, non-union, and radiographic adjacent segment degeneration were risk factors for poor postoperative QOL outcomes in lumbar spine dysfunction and gait disturbance.

Conclusion. The risk factors for poor QOL outcomes after PLIF differed among the five categories of the JOABPEQ. In particular, surgery-related factors (e.g., increase in number of PLIF segments, nonunion, and radiographic adjacent segment degeneration) had a negative effect on the improvement of lumbar spine dysfunction and gait disturbance.

Level of Evidence: 4

*Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

Department of Orthopedic Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan

Department of Orthopedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan

§Jikei Institute Graduate School of Health Sciences, Osaka, Japan.

Address correspondence and reprint requests to Takashi Kaito, MD, PhD, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; E-mail: takashikaito@gmail.com

Received 29 December, 2016

Revised 25 January, 2017

Accepted 1 February, 2017

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lectures.

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