Skip to main content

Advertisement

SpringerLink
Log in

Comparison between patient and surgeon perception of degenerative spine disease outcomes—a prospective blinded database study

  • Experimental research - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Few have studied the correlation between patients’ and spine surgeons’ perception on outcomes, or compared these with patient-reported outcome scores. Outcomes studies are increasingly important in evaluating costs and benefits to patients and surgeons, and in developing metrics for payer evaluation and health care policy-making.

Objective

To compare patients’ and surgeons’ assessment of spine treatment outcome in a prospective blinded patient-driven spine surgery outcomes registry, and to correlate perceived outcomes ratings to validated outcomes scores.

Methods

Patients filled out surveys at baseline, 3 months and 6 months postoperatively, including Visual Analog Scale (VAS), and Neck Disability Index (NDI) or Oswestry Disability Index (ODI). Outcome was rated independently by patients and surgeons on a 7-point Likert-type scale.

Results

Two-hundred and sixty-five consecutive adult patients were surgical candidates. Of these, 154 (58.1 %) opted for surgery, with 69 (44.8 %) cervical and 85 (55.2 %) lumbar patients. One hundred and thirty-five (87.7 %) had both patient and surgeon postoperative ratings. Surgeons’ and patients’ ratings correlated strongly (Spearman rho = 0.53, p < 0.0001, 45.9 % identical, 88.2 % +/− 1 grade). The surgeon rated outcomes were better than patients in 29.8 % and worse in 21.15 %. Patient rating correlated better with the most recent NDI/ODI and pain scores than with incremental change from baseline. In multivariate analysis, age, location (cervical vs lumbar), pain ratings, and functional scores (NDI, ODI) did not have significant impact on the discrepancy between patient and surgeon ratings.

Conclusions

Patients’ and surgeons’ global outcome ratings for spinal disease correlate highly. Patients’ ratings correlate better with most recent functional scores, rather than incremental change from baseline.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, Singer DE (1996) The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine (Phila Pa 1976) 21:1787–1794, discussion 1794–1785

    Article  CAS  Google Scholar 

  2. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976) 30:936–943

    Article  Google Scholar 

  3. Bertalanffy H, Eggert HR (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien) 90:127–135

    Article  CAS  Google Scholar 

  4. Brokelman RB, van Loon CJ, Rijnberg WJ (2003) Patient versus surgeon satisfaction after total hip arthroplasty. J Bone Joint Surg Br 85:495–498

    PubMed  CAS  Google Scholar 

  5. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine (Phila Pa 1976) 28:1913–1921

    Article  Google Scholar 

  6. Carreon LY, Glassman SD, Campbell MJ, Anderson PA (2010) Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 10:469–474

    Article  PubMed  Google Scholar 

  7. Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt MJ, Lee MJ (2011) Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976) 36:S54–S68

    Article  Google Scholar 

  8. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:968–974

    Article  PubMed  Google Scholar 

  9. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23:2003–2013

    Article  CAS  Google Scholar 

  10. Epstein NE, Hood DC (1997) A comparison of surgeon’s assessment to patient’s self analysis (short form 36) after far lateral lumbar disc surgery. An outcome study. Spine (Phila Pa 1976) 22:2422–2428

    Article  CAS  Google Scholar 

  11. Eriksen EF, Buhl M, Fode K, Klaerke A, Kroyer L, Lindeberg H, Madsen CB, Strange P, Wohlert L, Espersen JO (1984) Treatment of cervical disc disease using Cloward’s technique. The prognostic value of clinical preoperative data in 1,106 patients. Acta Neurochir (Wien) 70:181–197

    Article  CAS  Google Scholar 

  12. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  13. Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25:2940–2952, discussion 2952

    Article  CAS  Google Scholar 

  14. Glassman SD, Carreon LY, Dimar JR, Campbell MJ, Puno RM, Johnson JR (2007) Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J 7:547–551

    Article  PubMed  Google Scholar 

  15. Goebel S, Nabavi A, Schubert S, Mehdorn HM (2010) Patient perception of combined awake brain tumor surgery and intraoperative 1.5-T magnetic resonance imaging: the Kiel experience. Neurosurgery 67:594–600, discussion 600

    Article  PubMed  Google Scholar 

  16. Grob D, Mannion AF (2009) The patient’s perspective on complications after spine surgery. Eur Spine J 18(Suppl 3):380–385

    Article  PubMed  Google Scholar 

  17. Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20

    PubMed  CAS  Google Scholar 

  18. Hamburger C, Festenberg FV, Uhl E (2001) Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients. Spine (Phila Pa 1976) 26:249–255

    Article  CAS  Google Scholar 

  19. Haro H, Maekawa S, Hamada Y (2008) Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis. Spine J 8:380–384

    Article  PubMed  Google Scholar 

  20. Howe J, Frymoyer JW (1985) The effects of questionnaire design on the determination of end results in lumbar spinal surgery. Spine (Phila Pa 1976) 10:804–805

    Article  CAS  Google Scholar 

  21. Lattig F, Grob D, Kleinstueck FS, Porchet F, Jeszenszky D, Bartanusz V, O’Riordan D, Mannion AF (2009) Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree? Eur Spine J 18(Suppl 3):386–394

    Article  PubMed  Google Scholar 

  22. Lozano-Alvarez C, Perez-Prieto D, Salo G, Molina A, Llado A, Ramirez M (2012) Usefulness of the core outcome measures index in daily clinical practice for assessing patients with degenerative lumbar disease. Adv Orthop 2012:474685

    PubMed  Google Scholar 

  23. Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379

    Article  PubMed  Google Scholar 

  24. McGee MA, Howie DW, Ryan P, Moss JR, Holubowycz OT (2002) Comparison of patient and doctor responses to a total hip arthroplasty clinical evaluation questionnaire. J Bone Joint Surg Am 84-A:1745–1752

    PubMed  Google Scholar 

  25. McGrory BJ, Morrey BF, Rand JA, Ilstrup DM (1996) Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 11:47–57

    Article  PubMed  CAS  Google Scholar 

  26. Porchet F, Lattig F, Grob D, Kleinstueck FS, Jeszenszky D, Paus C, O’Riordan D, Mannion AF (2010) Comparison of patient and surgeon ratings of outcome 12 months after spine surgery: presented at the 2009 Joint Spine Section Meeting. J Neurosurg Spine 12:447–455

    Article  PubMed  Google Scholar 

  27. Ragab AA (2003) Validity of self-assessment outcome questionnaires: patient-physician discrepancy in outcome interpretation. Biomed Sci Instrum 39:579–584

    PubMed  Google Scholar 

  28. Ronnberg K, Lind B, Zoega B, Halldin K, Gellerstedt M, Brisby H (2007) Patients’ satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery. Spine (Phila Pa 1976) 32:256–261

    Article  Google Scholar 

  29. Sasso RC, Smucker JD, Hacker RJ, Heller JG (2007) Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine (Phila Pa 1976) 32:2933–2940, discussion 2941–2932

    Article  Google Scholar 

  30. Smith AM, Barnes SA, Sperling JW, Farrell CM, Cummings JD, Cofield RH (2006) Patient and physician-assessed shoulder function after arthroplasty. J Bone Joint Surg Am 88:508–513

    Article  PubMed  Google Scholar 

  31. Taylor VM, Deyo RA, Ciol M, Farrar EL, Lawrence MS, Shonnard NH, Leek KM, McNeney B, Goldberg HI (2000) Patient-oriented outcomes from low back surgery: a community-based study. Spine (Phila Pa 1976) 25:2445–2452

    Article  CAS  Google Scholar 

  32. Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14:409–415

    PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, IL, USA

    Ben Z. Roitberg, Bart Thaci, Brenda Auffinger, Laura Kaplan, Jingjing Shen, Frederick D. Brown & Sandi Lam

  2. Section of Neurosurgery, Department of Neurosurgery, University of Chicago, 5841 South Maryland Ave, MC3026, J341, Chicago, IL, 60637, USA

    Sandi Lam

Authors
  1. Ben Z. Roitberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bart Thaci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brenda Auffinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jingjing Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frederick D. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sandi Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandi Lam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roitberg, B.Z., Thaci, B., Auffinger, B. et al. Comparison between patient and surgeon perception of degenerative spine disease outcomes—a prospective blinded database study. Acta Neurochir 155, 757–764 (2013). https://doi.org/10.1007/s00701-013-1664-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1664-6

Keywords

Search

Navigation