Quality-of-Life Outcomes following Thoracolumbar and Lumbar Fusion with and without the Use of Recombinant Human Bone Morphogenetic Protein-2: Does Recombinant Human Bone Morphogenetic Protein-2 Make a Difference?
Design Retrospective study. Objectives (1) To investigate the quality-of-life (QOL) outcomes in the population undergoing lumbar spine surgery with versus without recombinant human bone morphogenetic protein-2 (rhBMP-2); (2) to determine QOL outcomes for those patients who experience postoperative complications; and (3) to identify the effect of patient characteristics on postoperative QOL outcomes. Methods A retrospective review of QOL questionnaires, including the Patient Health Questionnaire-9, Patient Disability Questionnaire (PDQ), EuroQol-5D (EQ-5D), and quality of life-year (QALY), was performed for all patients who underwent thoracolumbar and lumbar fusion surgery with versus without rhBMP-2 between March 2008 and September 2010. Individual preoperative and postoperative QOL data were compared for each patient. Demographic factors and complications were reviewed. Results We identified 266 patients, including 60 with and 206 without rhBMP-2. Questionnaires were completed an average of 10.3 ± 5 months after surgery. For all measures, average scores improved postoperatively compared with preoperatively. No differences in postoperative QOL outcomes were identified between the rhBMP-2 and the control cohorts. Median annual household income was positively associated with EQ-5D and QALY. Compared with those without, patients with postoperative complications had fewer QOL improvements. Conclusions There was no difference in QOL outcomes in the rhBMP-2 compared with the control group. Socioeconomic status and postoperative complications affected QOL outcomes following surgery. The QOL questionnaires provide the clinician with information regarding the patients' self-perceived well-being and can be helpful in the selection of surgical candidates and for understanding the effectiveness of a given surgical procedure.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States ; Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
Daniel
D
Lubelski
Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.
Matthew D
MD
Alvin
Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
Andrew
A
Torre-Healy
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Kalil G
KG
Abdullah
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States ; Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States.
Amy S
AS
Nowacki
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Robert G
RG
Whitmore
Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States.
Michael P
MP
Steinmetz
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States ; Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
Edward C
EC
Benzel
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States ; Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
Thomas E
TE
Mroz
EQ-5D; bone morphogenetic protein; pain disability questionnaire; patient health questionnaire; quality-of-life outcomes