title: The effect of previous low back surgery on general health status: results from the National Spine Network initial visit survey of patients with low back pain.
abstract: METHODS
  A cross-sectional study on 18,325 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 to April 2000.
  
  
  OBJECTIVE
  To examine whether patients who had previous low back surgeries had poorer general health status than patients with no surgery.
  
  
  BACKGROUND
  Several studies have described the role of psychological abnormalities in patients with chronic low back pain. Some of these patients have had previous spinal surgeries performed. No study has examined the effects of previous low back surgery on the general health status.
  
  
  METHODS
  The Short Form Health Survey 36 was administered to the initial visit NSN patients. Of the 18,325 patients enrolled, 3,632 had previous low back surgeries.
  
  
  RESULTS
  Patients who had previous lumbar surgeries fared significantly poorly in all 10 scores of the SF-36 health survey, even after adjustment for confounding factors. Among these patients, decompression achieved significantly higher scores for General Health, Role-Physical, and Mental Component Summary scales. Patients who had decompression as their most recent surgery had higher scores for General Health, Role-Physical, Role-Emotional, and Mental Component Summary scales, when compared to those who had other surgeries. Patients who had instrumentation as their most recent surgery had higher scores for Bodily Pain and Physical Component Summary scores. There is a positive correlation between time since last surgery and the SF-36 outcomes.
  
  
  CONCLUSIONS
  Previous back surgery is associated with significantly worse general health status than those without surgery. Among patients who had previous surgeries, decompression seems to exert better effects on SF-36 health status. There is a positive correlation between time since last surgery and the SF-36 outcomes, although the SF-36 scores are significantly lower than those without previous surgery.
authors.affiliation: Tulane University Medical Center, New Orleans, LA, USA. hwantak@hotmail.com
authors.forename: Hwan T
authors.initials: HT
authors.lastname: Hee
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Whitecloud
authors.forename: Leann
authors.initials: L
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D019299:Decompression, Surgical; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D016268:Internal Fixators; D017116:Low Back Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011184:Postoperative Period; D011788:Quality of Life; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013123:Spinal Fusion; D017211:Treatment Failure