EXPECTATIONS AND SATISFACTION AFTER ELECTIVE CERVICAL SPINE SURGERY FOR DEGENERATIVE CONDITIONS

Purpose:

   An increasing number of patients undergo elective surgery for degenerative cervical spine conditions; however, it is unknown whether patients have realistic expectations of the outcomes. Our purpose was to determine the degree to which pre-operative expectations are consistent with postoperative perceptions of outcomes.

Method:    We prospectively enrolled adult patients undergoing their first elective cervical spine surgery for degenerative conditions in a single center. We designed/administered 2 surveys: (1) preoperative survey to determine the importance of expected outcomes in the following domains in deciding to have the procedure; pain relief; improvement in symptoms, physical function, ability to exercise/recreational activity; prevention of symptoms; quality of life (qol); and extent of satisfaction with provided preoperative information; (2) postoperative survey to determine satisfaction with expected outcomes, information/understanding their condition, and with surgery. Surveys were administered on paper before surgery and 6 and 12 months after surgery. Patients received usual clinical care without standardized counseling, and a small incentive.

Result:    Participants (n=51) had an average age of 49 years; 59% were female; and 90% were White. The majority (98%) had at least a high school education. Patient expectations of improvement were very high (>96% extremely/somewhat important) before surgery for: pain relief; improvement in symptoms, physical function, and ability to do exercise/recreational activity; prevention of symptoms; and qol. At 6 months, more than 60% were extremely/somewhat satisfied with meeting expectations for pain relief; improvement in symptoms, physical function; and qol. 53% were extremely/somewhat satisfied with their ability to do exercise/recreational activity. Satisfaction with spending the rest of life with current symptoms and with surgery improved over time (47 to 62%). Satisfaction with information/understanding of their condition was high before and after surgery (>85%). More than 80% would definitely/most likely make the same decision again.

Conclusion:       Patient preoperative expectations of improvement in symptoms and function from elective cervical spine surgery for degenerative conditions are very high. After surgery, most patients are extremely/somewhat satisfied; some improvement over time was noted in spending the rest of life with current symptoms and satisfaction with surgery, but not with meeting expectations for symptom relief and functional improvement. Future analysis will compare patient perceptions of improvement with objective measures of symptoms and function. Further study should address specific patient expectations in order to improve preoperative counseling.