Which functional outcome parameters correlate better with elderly patients' satisfaction after non-fusion lumbar spine surgery?

BACKGROUND: Elderly patients are increasingly operated for spinal degenerative diseases. The treatment objective is quality of life, which, in this population, is difficult to assess. Hence, patient satisfaction, although less objective, is of high importance. In this study, we have examined the relation of various functional parameters after non-fusion spinal surgery, with patient satisfaction.

METHODS: A 5-year follow-up after non-fusion lumbar spine surgery on 185 elderly patients was performed. Demographics, co-morbidity factors, type of lesion and operation performed were recorded. The Oswestry Disability Index (ODI) was calculated. Also, walking distance, use of analgesics, daily activities, social life and patient mobility were assessed by means of study-specific stratified pain-independent questionnaires. Finally, patient satisfaction was assessed by the single-item satisfaction question.

RESULTS: Postoperative ODI, and the improvement regarding ODI, analgesic use and walking distance indices were independent factors influencing patient satisfaction. The insertion of pain analog scale score into this model altered the results, and along with this score, only the walking distance improvement remained an independent statistically significant factor. When the independent from pain scales were used, the improvement of the walking distance score were independently related to the satisfaction of the elderly.

CONCLUSIONS: ODI is applicable in elderly patients, even with the exception of some of the categories assessed. Walking capacity should be assessed separately from other pain-dependent activities; its improvement should be an independent goal of lumbar spine surgery in the elderly. The level of the elderly patient subjectivity in auto-assessing the outcome of lumbar spine surgery is high, and objective outcome measurements remain important.