Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain: Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A Review of the Literature.
OBJECTIVE
Despite widespread use of lumbar spinal fusion as a treatment for back pain, outcomes remain variable. Optimizing patient selection can help to reduce adverse outcomes. This literature review was conducted to better understand factors associated with optimal postoperative results after lumbar spinal fusion for chronic back pain and current tools used for evaluation.


METHODS
The PubMed database was searched for clinical trials related to psychosocial determinants of outcome after lumbar spinal fusion surgery; evaluation of commonly used patient subjective outcome measures; and perioperative cognitive, behavioral, and educational therapies. Reference lists of included studies were also searched by hand for additional studies meeting inclusion and exclusion criteria.


RESULTS
Patients' perception of good health before surgery and low cardiovascular comorbidity predict improved postoperative physical functional capacity and greater patient satisfaction. Depression, tobacco use, and litigation predict poorer outcomes after lumbar fusion. Incorporation of cognitive-behavioral therapy perioperatively can address these psychosocial risk factors and improve outcomes. The 36-Item Short Form Health Survey, European Quality of Life five dimensions questionnaire, visual analog pain scale, brief pain inventory, and Oswestry Disability Index can provide specific feedback to track patient progress and are important to understand when evaluating the current literature.


CONCLUSIONS
This review summarizes current information and explains commonly used assessment tools to guide clinicians in decision making when caring for patients with lower back pain. When determining a treatment algorithm, physicians must consider predictive psychosocial factors. Use of perioperative cognitive-behavioral therapy and patient education can improve outcomes after lumbar spinal fusion.
Department of Surgery, Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio, USA. Electronic address: daniel.gaudin@utoledo.edu.
Daniel
D
Gaudin
University of Toledo College of Medicine, Toledo, Ohio, USA.
Brianna M
BM
Krafcik
University of Toledo College of Medicine, Toledo, Ohio, USA.
Tarek R
TR
Mansour
Department of Surgery, Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
Ahmed
A
Alnemari
D001416:Back Pain / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery*; D059350:Chronic Pain; D015928:Cognitive Behavioral Therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D010147:Pain Measurement; D017060:Patient Satisfaction; D059035:Perioperative Period / Q000193:education*; D039781:PubMed / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
Cognitive-behavioral therapy; Disease-specific disability scales; Health-related quality of life; Lumbar spinal fusion; Socioeconomic factors