Comparing Patients' and Surgeons' Expectations of Lumbar Spine Surgery

Low back pain is a prevalent medical condition afflicting primarily older adults but
affecting all age groups and due to acute and non-acute diagnoses. Multiple possible
conservative therapies exist; however, their major drawback is that the time required to
advance therapy is often prolonged and accompanied by persistent disability and psychological
suffering. Thus, some patients seek surgery after exhausting other therapies and some
patients seek surgery earlier in their course. For both groups, decisions to undergo surgery
are based on personal circumstances, perspectives, and expectations of outcome. Prior studies
have shown that patients typically have high expectations of orthopedic surgery. Although
high aspirations can be motivating, they also may predispose to poor outcomes if they are
unrealistic and cause patients to become discouraged with recuperation time and ignore
recommended lifestyle changes that avert progression of disease. Expectations that are too
low, conversely, also may predispose to poor outcomes if patients lack motivation to
participate in rehabilitation and to follow postop precautions. In order to achieve maximum
benefit from surgery, patients and surgeons need to share an understanding of what is
possible, probable, and realistic, and to join together and work toward the same goals. The
primary objective of this proposed cross-sectional study is to assess the concordance between
patients and their surgeons regarding expectations of lumbar spine surgery. Patients
scheduled for lumbar surgery will be dichotomized according to whether they have acute versus
non-acute conditions. Several days before surgery patients will complete the validated Lumbar
Spine Surgery Expectations Survey measuring their physical and psychological expectations.
Also before surgery their surgeons will complete the surgeon's version of the same survey for
each patient. The main outcome will be a comparison of the concordance within each
patient-surgeon pair according to acute versus non-acute groups based on the concordance
correlation coefficient. Multivariate regression analysis based on the GEE method will be
used to assess covariates.

Inclusion Criteria:

- Patients will be eligible if they are ≥ 18 years old, speak English, and are scheduled
for non-trauma-related lumbar spine surgery.

Exclusion Criteria:

- Patients will be excluded if they have cognitive deficits and cannot provide informed
consent.