Research shows that between 5 and 18 percent of patients who undergo lumbar spine surgery require a reoperation. Failure of lumbar spinal surgery, leading to further surgery, contributes to significant patient disability. Because few studies have examined the effects of previous low back surgery on the health status of patients presenting with low back pain, the authors of this study sought to examine whether such patients had poorer general health status, as assessed via the Short Form Health Survey (SF-36), than patients with no prior history of spine surgery. The study group included more than 18,000 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998-April 2000. Of those patients, 3,632 had a history of low back surgery. Data were derived from a first-visit questionnaire and the SF-36, both of which were completed by all patients when first evaluated for back pain.
Results showed that patients with a history of lumbar spine surgery fared significantly worse on all 10 SF-36 Subscores (such as physical functioning, general health, mental health) compared with patients with no prior history of spine surgery. These results were maintained even after accounting for variables, including age, education, ethnicity, comorbid conditions, body mass index, and marital status. Patients with a history of surgical decompression (e.g., discectomy, laminectomy) seemed of better health than patients with a history of other surgical spine procedures- particularly fusion, which was associated with significantly lower SF-36 scores.
Conclusion: “Previous back surgery is associated with significantly worse general health status than those without surgery among patients with low back pain who first presented at the various NSN spine centers.” The authors suggest potential clinical relevance to their findings, noting that “active rehabilitation intervention strategies designed to improve physical and mental well-being should be promoted, as they could have an impact on enhancing positive health outcomes.”
