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Posterior Lumbar Interbody Fusion: Association Between Disability and Psychological Disturbance in Noncompensation Patients

Tandon, Vineet, MSOrth*; Campbell, Fiona, MSc; Ross, E. R. S., FRCS

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Study Design. An observational study of the relation between disability and psychological distress in patients with no on-going compensation claim who underwent posterior lumbar interbody fusion for chronic low back pain.

Objectives. To study the change in the relation between disability and psychological distress after surgical management for low back pain.

Summary of Background Data. Patient-related factors such as an on-going compensation claim and patient psychology are thought to influence the outcome of low back pain management.

Methods. Of the 58 patients who underwent posterior lumbar interbody fusion for low back pain between 1990 and 1995, 53 were observed for a mean duration of 2.7 years after surgery. Oswestry Disability scores and Distress and Risk Assessment Method scores were collected before surgery and at the follow-up examination.

Results. Improvement of 10 points on the Oswestry Disability Score was observed in 52.8% of the patients. However, the results in patients who were distressed before surgery were similar to the results observed in healthy patients. The difference in the Oswestry Disability Scores was 3.1 (95% confidence intervals [−9.9, 16.2], P = 0.297). The change in Distress and Risk Assessment Method scores showed a significant relation to change in the Oswestry Disability Scores (P = 0.033).

Conclusions. Postoperative improvement in disability was not found to be related to preoperative psychology as measured by the Distress and Risk Assessment Method score. Change in disability is significantly related to change in distress.

From the *Royal Manchester Children’s Hospital, Manchester, and the †Hope Hospital, Salford, United Kingdom.

Acknowledgment date: April 1, 1998.

First revision date: August 3, 1998.

Acceptance date: October 21, 1998.

Address reprint requests to

E. R. S. Ross, MSOrth

Consultant Orthopaedic and Spinal Surgeon

Hope Hospital

Stott Lane, Salford M6 8HD

United Kingdom

Device status category: 2.

© 1999 by Lippincott Williams & Wilkins