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Decreased disability is associated with improved perceived quality of life following spinal fusion

Purpose: To assess the disability and relationship between functional status and health related quality of life (HRQoL) in patients in the early recovery phase following spinal fusion. Methods: This is a prospective cohort study. Since 2008 data of spinal fusion patients have been collected prospectively in two Finnish hospitals. In August 2009, complete data of 173 patients were available. The measurement tool of disability was the Oswestry Disability Index (ODI) and it was also examined in the framework of International Classification of Functioning, Disability and Health (ICF) using body functions and structures, activities and participation components. Results: Preoperatively the mean total ODI was 45 (SD17) and mean (95% confidence interval) change to 3 months postoperatively was −19 (−22 to −17). When the ODI was linked to the ICF, there was a 55% improvement in the body structure and functions component and a 44% improvement in both the activities and the participation components. However, 25% of the patients still had the total ODI score over 40 three months postoperatively. Preoperatively, the mean (95% CI) Physical Component Summary Score (PCS) of the Short Form 36-questionnaire (SF-36) was 27 (26 to 28) and the mean Mental Component Summary Score (MCS) of SF-36 was 47 (45 to 49). Postoperatively the improvement was 9 (95% CI: 8 to 11) in PCS and 6 (95% CI: 4 to 7) in MCS (p < 0.001). Conclusions: Spinal fusion is successful in the early recovery period in terms of reduction of pain and disability. The significant changes in the ODI were seen in all three components of the ICF model. In addition, improvement in functioning was significantly related to positive change in HRQoL. Still there is a subgroup of patients having marked disability needing more intensive rehabilitation and follow-ups. Implications for Rehabilitation Spinal fusion The focus in assessing the outcome of spinal fusion operations has shifted towards patient-based health status and quality of life scales in recent years. When the patient’s self-rated Oswestry Disability Index (ODI) was examined in the framework of International Classification of Functioning, Disability and Health (ICF) it was competent to distinguish different domains of functioning from each other. However, the ODI does not cover earlier published comprehensive core set for low back pain completely and thus more comprehensive assessment is needed in clinical settings. This study showed that in the early recovery phase 3 months after the spinal fusion operation the positive changes in disability, health related quality of life and pain were significant. However, 25% of the patients still had the ODI score 40 or more at 3 months after the spinal fusion and these patients should be identified to be given additional attention to provide appropriate rehabilitation.