title: Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion.
abstract: BACKGROUND
  Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis; however, little attention has been given to quality of life and functional outcomes. Studies suggest that psychosocial factors may be important modifiers of low back surgical outcomes.
  
  
  OBJECTIVE
  To depict outcomes of ICLF surgery across multiple dimensions and to investigate presurgical biopsychosocial predictors of these outcomes.
  
  
  METHODS
  A retrospective-cohort research design was used that involved completion of presurgical medical record reviews and postsurgical telephone outcome surveys at least 18 months after surgery. Presurgical variables included in a regression model were age at the time of surgery, spinal pathophysiology rating, smoking tobacco, depression, and pursuing litigation.
  
  
  METHODS
  Seventy-three patients received ICLF, and of those 56 patients completed the outcome survey an average of 2.6 years after surgery.
  
  
  METHODS
  Outcome measures consisted of arthrodesis status, patient satisfaction, back-specific functioning, disability status, and quality of life.
  
  
  RESULTS
  Although arthrodesis occurred in 84% of the patients, nearly half were dissatisfied with their current back condition. Functional status was worse than expected, and 38% were totally disabled at follow-up. Regression analyses revealed tobacco use, depression, and litigation were the most consistent presurgical predictors of poorer patient outcomes.
  
  
  CONCLUSIONS
  Overall, despite a high rate of arthrodesis, ICLF was not associated with substantial improvements in patient functioning. Presurgical biopsychosocial variables predicted patient outcomes, which may help improve patient selection and possible targeted interventions.
authors.affiliation: Department of Psychology, Utah State University, 487 Education Bldg., 2810 Old Main Hill, Logan, UT 84322-2810, USA. lacai001@mc.duke.edu
authors.forename: Rick A
authors.initials: RA
authors.lastname: LaCaille
authors.forename: M Scott
authors.initials: MS
authors.lastname: DeBerard
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Masters
authors.forename: Alan L
authors.initials: AL
authors.lastname: Colledge
authors.forename: William
authors.initials: W
authors.lastname: Bacon
mesh_terms: D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011581:Psychological Tests; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome