Introduction: Patient filled questionnaires, such as Short Form-36 (SF-36), have become the mainstay in evaluation of treatment outcomes in DSD. Lumbar and cervical patients’ outcomes are sometimes reported together with the assumption that they represent comparable dynamics in SF-36 values and have similar minimal clinically important difference (MCID) scores. In this study we compare changes in quality of life between lumbar and cervical DSD patients, evaluating all eight physical and mental outcome scales of SF-36.
Methods: All patients referred to the neurosurgery clinic between 9/8/09 and 11/1/2011 were offered enrollment in a prospective patient-driven spine surgery outcomes database. 337 patients (47% females, mean age 57) were prospectively assessed using the Short Form-36 (SF-36) questionnaire at baseline, and at 3-6 months intervals. From all patients enrolled, 134 (40%) had cervical spine disease, 195 (58%) had lumbar spine disease and 8 patients (2%) had both.
Results: Based on eight different scales of the SF-36, we observed that at baseline the physical self-assessment score of lumbar patients is 27% lower than that of cervical patients (p<0.05). Mental scores are similar between the two groups except for their Social Functioning (SF) measurement, which is 13% lower in lumbar patients (p<0.05). At last follow up between 3 and 6 months, both groups of patients had improvement in their scores. Lumbar patients improved on average 61% (34,37 to 55) their physical health scores, while cervical patients improved 18% (41 to 49). Both mental health scores improved 17% at last follow up (p<0.01).
Conclusions: Important differences are observed between SF-36 self-assessments of lumbar spine surgery and cervical spine surgery patients. These differences warrant further study, and illustrate a simple but important point: MCID may not be as meaningful when all spine patients are grouped together. Rational approaches to subgroup analysis such as lumbar versus cervical populations may yield important insights.
Patient Care: It contributes to developing a holistic vision of patient physical and mental outcomes in DSD, allowing for future better treatment approaches that focus on patient quality of life. It also raises important questions about current assessment scales for changes in quality of life between lumbar and cervical DSD patients.
Learning Objectives: (1) Compare changes in quality of life between lumbar and cervical DSD patients through a self-assessment questionnaire (SF-36); (2) Develop a holistic vision of patient physical and mental outcomes, allowing for future better treatment approaches that focus on patient quality of life.