Health-related quality of life: a comparison of outcomes after lumbar fusion for degenerative spondylolisthesis with large joint replacement surgery and population norms.
BACKGROUND
Degenerative spine disease will become an increasing health problem, and a significant number of patients will be considered for surgery. Spinal surgeries have evolved since the last decades, and there is a positive impact on the clinical outcomes. Few works in the literature have reviewed the outcome compared with large joint replacement surgery, which is considered a benchmark for operative restoration of patients' quality of life.


OBJECTIVE
The purpose of this study was to investigate if spinal fusion can return patients' health-related quality of life to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement.


METHODS
This is a prospective cohort study.


METHODS
The sample consists of 100 consecutive patients who were enrolled between December 1997 and January 2007.


METHODS
The 12-item Short Form Health Survey (SF-12) was chosen for outcome measurement.


METHODS
All patients underwent wide decompressive laminectomy and single-level posterior lumbar interbody fusion for spinal stenosis associated with degenerative spondylolisthesis.


RESULTS
The preoperative and postoperative physical component summary (PCS)-12 scores of the spinal fusion patients were comparable with those of both the total knee and hip replacement patients. The mean improvement in PCS-12 scores after spine surgery was 11 (95% confidence interval [CI]: 9-14, p<.0001). It was equal to that after total hip replacement surgery, which was 11 (95% CI: 9-13), and higher than that of total knee replacement patients, which had an improvement of 8 (95% CI: 7-9). The postoperative mean and 95% CI of the PCS-12 scores for the three surgical procedures approached the population norm value of 44 (95% CI: 43-46).There was no statistical difference between the postoperative mental component summary-12 score among all the three surgical groups, which approached similar to the population norm value of 54 (95% CI: 53-54).


CONCLUSIONS
The current study demonstrated that spinal surgery can return patients' HRQL to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement patients.
Mokhtar
Sabarul A
SA
Department of Spinal Surgery, The Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales 2109, Australia. drsam2020@yahoo.com
McCombe
Peter F
PF
Williamson
Owen D
OD
Morgan
Michael K
MK
White
Gavin J
GJ
Sears
William R
WR
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*