Healio
Healio
May 12, 2009
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Pain intensity impacts patients’ acceptance of lumbar fusion complications

MIAMI — The more lower back pain that a patient feels, the more willing he or she is to accept the complication risks associated with lumbar fusion, according to a study presented here.

Investigators surveyed 127 patients at three Massachusetts spine clinics to determine how patients ranked their pain and understanding of the risks associated with fusion surgery. The patients all had low back pain and no prior spinal surgery, Christopher M. Bono, MD, said at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine, here.

The questionnaire included 24 scenarios illustrated on a series of flash cards, each detailing a combination of risks of 3 complications (ie, infection, nerve injury and additional surgery) and the potential for symptom relief. For each scenario, patients indicated whether they would or would not consent to fusion surgery for their low back pain.

“We totaled the different scenarios that patients said they would elect to have surgery and analyzed the data using bivariate and multivariate regression analyses,” he said.

Patients had a medium number of 9 scenarios in which they said they would elect to have lumbar fusion (range, 0-23 scenarios). There was a moderate correlation between patients’ Visual Analog Scale back pain score and the total number of scenarios they accepted, Bono said.

In multivariate analyses, “We noticed that the [degree of] low back pain was the most influential factor affecting patients’ decision to accept the risks of complications from fusion surgery and symptom persistence,” Bono said. “This relationship could potentially change the manner in which patients are counseled to make informed decisions about whether they are willing to undergo lumbar spinal surgery.”

The investigators also discovered that women were less likely to accept the risks of surgery compared to men. Likewise, white patients were more “risk tolerant” than non-whites and were more willing to undergo the fusion procedure, he said. However, age, leg pain and pain duration were not associated with a greater acceptance of surgery.

A patient’s low back pain can also vary on a daily or weekly basis, which adds another variable to the treatment decision process, he said.

“I have had patients who, on a bad day, would agree to have surgery even after I told them that there was a 50% infection risk,” Bono said. “I could ask them the same question on a day when they were feeling really good and tell them that there’s a 1% chance of nerve damage, and they would tell me, ‘No way, I don’t want you to cut me!’ Hopefully, these findings will give us insight into better ways to counsel our patients.”

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