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Changes in Health Utility, Disability, and Health-Related Quality of Life in Patients After Spinal Fusion

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STUDY DESIGN Prospective longitudinal database study. OBJECTIVE To evaluate changes in health utility, disability, and health-related quality of life (HRQOL) in patients undergoing spinal fusion. SUMMARY OF BACKGROUND DATA Recently, measuring disability, HRQOL, and health utility has become important when defining the value of surgical interventions. METHODS Data of spinal fusion patients from a prospective longitudinal database were analyzed. Health utility was captured by SF-6D (six dimensional health state classification from the 36-dimensional Short Form Health Survey) score, disability by Oswestry Disability Index, and HRQOL by the 36-Item Short Form Health Survey. The changes in these scores were compared between the groups during the 2-year follow-up. RESULTS Altogether 242 patients were stratified into 5 groups according to the surgical indication: degenerative spondylolisthesis (n = 140), isthmic spondylolisthesis (n = 39), spinal stenosis (n = 23), disc pathology (n = 15), and postoperative conditions (n = 25). The mean age varied from 48 years in isthmic spondylolisthesis group to 66 years in the groups with degenerative spondylolisthesis or spinal stenosis. Preoperatively, the surgical indication subgroups differed significantly from each other according to utility, disability, and the physical component summary score of the HRQOL. Isthmic spondylolisthesis group had the best and the group of postoperative conditions the worst preoperative values. Nevertheless, the SF-6D, the Oswestry Disability Index, and the physical component summary in all diagnostic groups had improved significantly already by 3 months of follow-up, and the improvement remained stable until 2 years of follow-up. Interestingly, the biggest improvement in Oswestry Disability Index (-27), physical component summary (13) and SF-6D (0.19) was found in a group with disc pathology. The mental component summary score values were similar preoperatively (P = 85), and the improvement in the mental component summary was significant in the groups with degenerative olisthesis, spinal stenosis, and postoperative conditions. CONCLUSION The 5 surgical indication groups showed significantly different scores preoperatively in health utility, disability, and the physical aspect of HRQOL. At 2 years, however, all groups benefitted from the fusion surgery significantly. LEVEL OF EVIDENCE 3.