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Utility of Spine Surgery: A Comparison of Common Elective Orthopaedic Surgical Procedures

Hansson, Tommy, MD, PhD*; Hansson, Elisabeth, PhD*; Malchau, Henrik, MD, PhD

doi: 10.1097/BRS.0b013e31818e2914
Surgery
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Study Design. A 1-year prospective observational cohort study.

Objective. To compare the utility before and 1 year after elective spine surgery with some other common orthopaedic surgical procedures.

Summary of Background Data. By using global measures like EQ-5D and SF-36 for the determination of the utility, the changes in quality of life, quality of life (QoL) after an intervention different diagnoses, and treatments can be compared. Total hip replacement (THR) has become almost golden standard in this respect.

Methods. Seven hundred seventy-seven subjects with different common orthopaedic diagnoses scheduled for elective surgery were just before surgery and 1 year after surgery answering both EQ-5D and SF-36. Four groups with different spine diagnoses and procedures were formed and compared with 8 other diagnoses and treatment groups.

Results. Before surgery, subjects with spine diagnoses reported the lowest QoL of all diagnoses compared. Surgery for spinal stenosis, spondylolisthesis, and instability meant the largest improvement of all surgical interventions. Surgery for NHP gave a moderately good improvement, whereas surgery for CLBP only marginally improved those operated. Particularly THR but also TKR more or less completely normalized QoL but made it from a relatively high preoperative level. The greatest improvements after spine surgery, other surgical procedures, and different diagnoses were in the pain/discomfort domain.

Conclusion. Spinal surgery in spinal stenosis, spondylolisthesis, and instability had in comparison to other types of elective orthopaedic surgery an outstanding better ability to improve the operated subject’s health-related quality of life than other types of elective orthopaedic surgery. The utility of HNP surgery was somewhat lower and was rather marginal for those operated for nonspecific CLBP.

Determination of the utility, the quality of life before and 1 year after surgery for some of the most common elective orthopaedic diagnoses showed that THR and TKR literally normalize the patients, whereas elective spine surgery particularly in spinal stenosis gave the greatest improvements of quality of life from an initial extremely low level.

From the *Department of Orthopaedics, Sahlgrenska Academy, Göteborg, Sweden; and †Department of Orthopaedics, Massachusetts General Hospital, Boston, MA.

Acknowledgment date: October 23, 2007. First revision date: February 6, 2008. Second revision date: June 4, 2008. Acceptance date: July 25, 2008.

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

Federal, Institutional, and Foundation 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.

Supported in part by the grants from FAS, Göteborg University, and AFA.

Address correspondence and reprint requests to Dr. Tommy H. Hansson, MD, PhD, Bruna Stråket 11, SU/Sahlgrenska Academy, 413 45 Göteborg, Sweden; E-mail: tommy.hansson@orthop.gu.se

© 2008 Lippincott Williams & Wilkins, Inc.