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I saw a neurosurgeon about some possible spinal surgery I am thinking about having. As part of the interview, the staff in his office asked me, What is the minimum acceptable result you expect from this surgery? In other words, they were asking me what point would I consider not having the operation because the results weren't good enough. I'm kinda stumped on this one. What do other people say?
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When faced with surgery to fuse the spine, patients with low back pain should weigh the risks against the benefits in deciding to go ahead with the procedure. But what is the patient's minimum acceptable change in symptoms and/or function before having the operation?
Is a drop in pain levels enough to make it worth it? Would you have the surgery even if it meant you still weren't going to get back to work? Anything less than the minimum acceptable outcome means it's not worth having the procedure done.
There are different ways to measure this. The most common factors used to measure patient satisfaction usually include pain intensity, function, use of narcotic medications, and return-to-work status. There are many other ways to assess success of spine surgery. Some surgeons use scales that measure patient satisfaction or patient goals.
Others rely on X-rays to show the biologic success (healing) as a means of measuring success. Pain, function, medication usage, and return-to-work status may be the most practical when measuring minimum acceptable outcomes after spinal surgery.
In a recent patient survey study from Stanford Medical School, patients wanted at least a four-point improvement in pain when pain was measured on a 10-point scale (zero for no pain, 10 for maximum pain). They wanted to be free of the need for any narcotic medication. And they considered being disabled, unable to work, or only able to work part-time or with work restrictions as unacceptable.
Overall, the minimum expectation was for a high level of improvement in pain and function. The group did not think it was worth having the surgery if they couldn't get back to work within two years of the operation. In fact, more than 90 per cent of the group said they wouldn't have the surgery if they weren't sure they would be working again.
And it turned out that those patients who did meet their own minimum expectations were, indeed, satisfied with the results. The patients who indicated satisfaction even though their goals weren't met tended to be those who had other problems with chronic pain, psychologic distress, or who were on Worker's Comp.
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