Preoperative Expectations in Patients Undergoing Lumbar and Cervical Spine Surgery

STUDY DESIGN: Cross-sectional analysis of prospectively collected registry data. OBJECTIVE: To better understand the distribution of patient expectations for lumbar and cervical spine surgery and examine the relationship between preoperative patient expectations and patient demographic/clinical characteristics and patient-reported measures. SUMMARY OF BACKGROUND DATA: Patient expectations is a critical determinant of recovery after spine surgery. The Hospital for Special Surgery (HSS) Lumbar and Cervical Spine Surgery Expectations surveys are promising tools for spine surgery. Additional research is needed to establish the utility and generalizability of these multidimensional surveys. METHODS: Patients undergoing lumbar (N=641) and cervical (N=516) spine surgery completed the 20-item HSS surveys. Disability and pain were measured with the Oswestry/Neck Disability Index and an 11-point Numeric Rating Scale. The PROMIS-29 evaluated physical function and depression. Descriptive statistics examined the distribution of item responses. Univariate tests and multivariable linear regression models examined associations between preoperative expectations and demographic/clinical factors and patient-reported measures. RESULTS: The items most frequently endorsed as expecting complete improvement were related to condition getting worse, need for pain medications, control spine condition has on life, and fulfilling job responsibilities. Higher leg/arm pain was significantly associated with higher preoperative expectations in multivariable models, whereas lower depression was associated with higher expectations in the cervical model only ( P <0.05). Significant demographic/clinical factors varied for the lumbar and cervical models, with planned posterior decompression versus ACDF associated with lower preoperative expectations ( P <0.05). CONCLUSIONS: Results support the use of spine-specific multidimensional HSS Expectations surveys for lumbar and cervical spine surgery. Overall, the study underscores the importance of leg/arm pain and depression to preoperative expectations. A better understanding of preoperative expectations and the factors influencing them can help surgeons set realistic expectations with their patients.