title: The impact of spinal problems on the health status of patients: have we underestimated the effect?
abstract: METHODS
  A prospective study of 17,774 patients who consulted spine centers in which the impact of spinal disorders and comorbidities on physical functional status were evaluated.
  
  
  OBJECTIVE
  To quantify the effect spinal diagnoses have on patients' physical functional status (SF-36 Physical Component Summary [PCS] score) compared with other common conditions and to quantify the effects of comorbidities on physical functional status in spine patients.
  
  
  BACKGROUND
  The burden of spinal conditions on a patient's function and the role that comorbidities play in this affliction are poorly quantified in the literature.
  
  
  METHODS
  Data from the Health Survey Questionnaire were prospectively gathered through the National Spine Network, a nonprofit consortium of spine-focused practices. Each patient's SF-36 score was summarized into a single PCS score. The correlation between diagnosis and comorbidity and PCS score was assessed using multivariate linear regression.
  
  
  RESULTS
  The study patients were a mean of 47.5 years of age, 54.7% were female, 52.3% had lumbosacral diagnoses, and 82.0% had had 3 or more months of pain. The population had a mean PCS score of 30.4 +/- 9.95 (SD) compared with 50.0 +/- 10.00 for the general United States population. The more comorbidities in a patient, the lower the PCS score (Spearman rank correlation = -0.27). The five comorbid conditions that lowered the PCS the most included congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), renal failure, rheumatoid arthritis, and lupus (all P <0.001). In multiple linear regression analysis, age, gender, diagnosis, and comorbidity explained 12.1% of the variance in PCS score.
  
  
  CONCLUSIONS
  The PCS score is greatly affected in patients with spinal problems. The study population's PCS (30.4) was lower or similar to the PCS for patients with other illnesses reported in the literature: CHF (31.0), COPD (33.9), SLE (37.1), cancer (38.4), primary total hip arthroplasty (29.0), primary total knee arthroplasty (32.6), and glenohumeral degenerative joint disease (35.2). Further, the presence of comorbidity in spine patients adds to the burden of spinal conditions on functional status.
authors.affiliation: Department of Surgery, Section of Orthopaedics, and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Fanuele
authors.forename: N J
authors.initials: NJ
authors.lastname: Birkmeyer
authors.forename: W A
authors.initials: WA
authors.lastname: Abdu
authors.forename: T D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: J N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology* / Q000534:rehabilitation; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013122:Spinal Diseases / Q000453:epidemiology* / Q000534:rehabilitation; D014481:United States / Q000453:epidemiology