Disability and health-related quality of life in patients undergoing spinal fusion: a comparison with a general population sample.

This is an elec onic ep in o he o iginal a icle. This ep in may di e om he o iginal in pagina ion and ypog aphic de ail. Au ho (s): Ti le: Yea : Ve sion: Please ci e he o iginal e sion: All ma e ial supplied ia JYX is p o ec ed by copy igh and o he in ellec ual p ope y igh s, and duplica ion o sale o all o pa o any o he eposi o y collec ions is no pe mi ed, excep ha ma e ial may be duplica ed by you o you esea ch use o educa ional pu poses in elec onic o p in o m. You mus ob ain pe mission o any o he use. Elec onic o p in copies may no be o e ed, whe he o sale o o he wise o anyone who is no an au ho ised use . Disabili y and heal h- ela ed quali y o li e in pa ien s unde going spinal usion: a compa ison wi h a gene al popula ion sample. Liisa, Pekkanen; Ma ko, Ne a; Hannu, Kau iainen; Joos , Dekke ; Ki si, Pii ulainen; Ma ko, Wahlman; Häkkinen, A ja Liisa, P., Ma ko, N., Hannu, K., Joos , D., Ki si, P., Ma ko, W., & Häkkinen, A. (2013). Disabili y and heal h- ela ed quali y o li e in pa ien s unde going spinal usion: a compa ison wi h a gene al popula ion sample.. BMC Musculoskele al Diso de s, 14(211), 1-8. h ps://doi.o g/10.1186/1471-2474-14-211 2013 RESEARCH ARTICLE Open Access Disabili y and heal h- ela ed quali y o li e in pa ien s unde going spinal usion: a compa ison wi h a gene al popula ion sample Liisa Pekkanen 1* , Ma ko H Ne a 2 , Hannu Kau iainen 3,4 , Joos Dekke 5 , Ki si Pii ulainen 6 , Ma ko Wahlman 2 and A ja Häkkinen 6,7 Abs ac Backg ound: The aim o he p esen s udy was o compa e one-yea - ollow-up da a on disabili y and heal h- ela ed quali y o li e (HRQoL) be ween spinal usion pa ien s and age- and sex-ma ched gene al popula ion. Me hods: The da a on usion pa ien s we e collec ed p ospec i ely using a spinal usion da a base in wo Finnish hospi als. A gene al popula ion sample ma ched o age, sex and esiden ial a ea was d awn om he Finnish Popula ion Regis e . All pa icipan s comple ed a ques ionnai e and he main ou come measu es we e he Oswes y Disabili y Index (ODI) and he Sho Fo m-36 ques ionnai e (SF-36). Resul s: Al oge he 252 (69% emales) usion pa ien s and 682 (67% emales) popula ion sample subjec s pa icipa ed in he s udy. In gene al popula ion he mean ODI was 15 (SD 17) in emales and 9 (SD 13) in males. The co esponding p eope a i e ODI alues we e 47 (SD16) and 40 (SD 15) and one yea ollow-up alues 22 (SD 17) and 23 (SD 20). In bo h sexes he ODI dec eased signi ican ly a e su ge y bu emained highe han in he gene al popula ion, p < 0.001. The physical componen summa y sco e (PCS) o he SF-36 was lowe in he pa ien s han gene al popula ion sample bo h p eope a i ely and a one-yea ollow-up (p < 0.001). The men al componen summa y sco e (MCS) was lowe p eope a i ely (p < 0.001), bu eached he gene al popula ion le el a e one yea in bo h men (p = 0.42) and women (p = 0.61). Conclusions: Disabili y and HRQoL imp o ed signi ican ly a e spinal usion su ge y du ing a one- yea ollow-up. Howe e , he pa ien s did no each he le el o he gene al popula ion in he ODI o in he physical componen o HRQoL a ha ime, al hough in he men al componen he di e ence disappea ed. Keywo ds: Spinal usion, Oswes y disabili y index, Heal h- ela ed quali y o li e, Gene al popula ion sample Backg ound Wi h he ageing o he popula ion, an inc ease in degen- e a i e spine condi ions and he numbe o su gical pa- ien s can be expec ed [1]. Al hough ins umen ed spinal usions ha e been pe o med since he ea ly 1960s, hese p ocedu es emain con o e sial owing o inconsis en esponses o he ea men [2,3]. In he ield o spinal u- sion ou come esea ch, mos ea lie ials ha e com- pa ed su gical me hods and assessed he success o he su gical p ocedu e i sel . Howe e , o e he las ew decades he e has been a end owa ds he use o pa ien - epo ed ou comes (PROs) in e alua ing he ou - come o usion su ge y in addi ion o physical examina- ions, imaging o clinical ou come scales. Recen ly, he ou ine adminis a ion o ce ain ins umen s in connec- ion wi h low back pain and su gical ea men has been ecommended [4,5]. Condi ion-speci ic disabili y mea- su es like he Oswes y Disabili y Index (ODI) should be used be o e and a e su gical ea men s. When e alua - ing su gical ou comes in he clinical- esea ch se ing, Heal h Rela ed Quali y o Li e (HRQoL) ools, such as he Sho -Fo m 36 (SF-36), Sho Fo m 12 (SF-12) o Eu oQol G oup (EQ-5D) should be used [4]. * Co espondence: [email p o ec ed] 1 Depa men o O hopaedics and T auma ology, Jy äskylä Cen al Hospi al, Jy äskylä, Finland Full lis o au ho in o ma ion is a ailable a he end o he a icle © 2013 Pekkanen e al.; licensee BioMed Cen al L d. This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/2.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 h p://www.biomedcen al.com/1471-2474/14/211 In o ma ion on whe he he ope a ion p o ides e ec - i e elie o symp oms and disabili y con inues o be lacking [3]. In de ining success a e spinal usion ope a- ions, calcula ion o he minimum clinically impo an di e ence (MCID) in PROs has been sugges ed. This me hod has limi a ions; o example he MCID alues may di e acco ding o mul iple ac o s, such as o igi- nal spine pa hology, he me hod o ea men , sample size and pa ien -cha ac e is ics, e.g. baseline sco es [6]. Ano he me hod ha has been p oposed is based on p ospec i e minimum goals es ablished by indi idual pa- ien s hemsel es. In he s udy by Ca agee e al. is hmic spondylolis hesis pa ien s and degene a i e disc disease pa ien s p eope a i ely indica ed hei expec a ions conce ning le el o unc ion (ODI), wo k capaci y, pain in ensi y and medica ion equi emen [7]. One o mos ecen a emp s o sol e he di icul y in de ining clinical success a e spinal usion ope a ions is o analyze whe he he pa ien s each he le el o he gene al popu- la ion in ce ain PROs. To ou knowledge only one s udy by Mokh a e al. [1]. has used his me hod. P ospec i e da a on 100 pa ien s unde going spinal usion we e col- lec ed using he SF-12 ques ionnai e, and he esul s we e compa ed o hose ob ained o a sample o he gene al popula ion. No disease-spesi ic disabili y meas- u emen was used in his s udy. As only limi ed amoun o in o ma ion exis s on he use o his me hod, so he e is a clea need o u he s udies. The aim o he p esen s udy was o compa e disabili y and HRQoL among spinal usion pa ien s wi hin one-yea ollow-up wi h he alues o an age- and sex-ma ched popula ion esiden in he same dis ic . Me hods Since he beginning o 2008, all pa ien s unde going spinal usion su ge y in Tampe e Uni e si y Hospi al o Jy äskylä Cen al Hospi al ha e been ec ui ed o a p o- spec i e ollow-up s udy. In Augus 2010, he spinal da abase comp ised 285 pa ien s wi h he 6 mos common diagnoses o elec- i e spinal usion. These diagnoses we e degene a i e spondylolis hesis, spondylolysis, spinal s enosis, disc he - nia ion o degene a ion, pos ope a i e condi ions and degene a i e scoliosis. Disabili y and HRQoL measu es we e a ailable p eope a i ely and 3 and 12 mon hs pos - ope a i ely o 252 o hese pa ien s (88%) all o whom we e included in his s udy. Six su geons had pe o med he ope a ions, and in mos cases in eams o wo su geons. The coho o spinal usion pa ien s was compa ed o a gene al popula ion sample ma ched acco ding o age, sex and esiden ial a ea. Fou con ols o each o hese usion pa ien s was d awn om he Finnish Popula ion Regis e and he sampling was pe o med by he S a is ics Finland. A ques ionnai e was mailed o 1 140 con ols in Sep embe 2010, and one eminde le e was sen wo mon hs la e . A e one eminde le e , he pe cen age o e u ned answe s was 61% (n = 691) and he numbe o accep able answe s 682. One o wo weeks p io o he usion ope a ion, he pa ien s illed in a ques ionnai e eques ing sociode- mog aphic and clinical in o ma ion, o example weigh , heigh , p esence o co-mo bidi ies, exe cise habi s, smoking and employmen s a us. The main ou come measu es we e he Oswes y Disabili y Index (ODI) and he Sho Fo m-36 Ques ionnai e (SF-36). The ODI is one o mos widely used back-speci ic disabili y meas- u emen ools in bo h clinical wo k and esea ch.[8,9] Acco ding o he o iginal publica ion, he sco es a e g ouped in o i e ca ego ies: 0–20 minimal, 20–40 mo- de a e, 40–60 se e e disabili y; 60–80 c ippled and 80–100 indica es ha he pa ien is ei he bed-bound o exagge a ing his o he symp oms [8]. The Finnish ali- da ed e sion 2.0 o he ODI was used [10]. The SF-36 is a gene ic pa ien -assessed heal h ou come measu e o heal h- ela ed quali y o li e wi h eigh dimensions e lec ing pa ien s’heal h and wel a e. The SF-36 sco e also di ides in o wo summa y measu es: he physical componen summa y sco e (PCS) and he men al com- ponen summa y sco e (MCS). The dimensions Physical Func ioning, Role Physical, Bodily Pain and Gene al Heal h o m he PCS, and Men al Heal h, Vi ali y, Social Func ioning and Role-Emo ional he MCS. Ve sion 1 o he SF-36 qus ionnai e was used on his s udy. The e hical commi ees in Tampe e Uni e si y Hos- pi al and Jy äskylä Cen al Hospi al app o ed he s udy plan and all he pa icipa ing pa ien s signed a w i en consen . S a is ics Resul s a e exp essed as mean and s anda d de ia ion (SD). S a is ical compa ison be ween he g oups was pe o med by - es , boo s ap- ype - es (5000 eplica- ions), o chi-squa e es , whe e app op ia e. Di e ences in he ODI and HRQoL be ween he g oups we e de e - mined using gene alized linea models. Repea ed measu es we e analyzed using linea mixed models. Resul s The demog aphical and clinical da a o he usion pa- ien s and gene al popula ion is shown in Table 1. Six y- nine pe cen o he 252 usion pa ien s and 67% o he 682 gene al popula ion subjec s we e emales. In he popula ion sample, he mean age o emales was highe han in he pa ien g oup: 66 (SD 11) s. 63 (SD 12) yea s (p = 0.014). The mean age o males was 60 (SD 13) yea s in he gene al popula ion and 58 yea s in he pa- ien s (p = 0.43). In bo h sexes he body mass index Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 2 o 8 h p://www.biomedcen al.com/1471-2474/14/211 (BMI) was signi ican ly highe in he usion pa ien s han in he gene al popula ion. The numbe o ca diological (p < 0.001) and heuma oid co-mo bidi ies (p = 0.012) was highe in he emale pa ien s han in he emale popula ion subjec s and he emale pa ien s we e also less physically ac i e. In he gene al popula ion, 5.7% o he emales and 8.0% o he males had spinal diso de s. In he gene al popula ion, emales had highe ODI (15 (SD17)) han males (9 (SD 13)), (p < 0.001). In he pa ien s, he p eope a i e ODI alues we e 47 (SD16) in emales and 40 (SD 15) in males (p < 0.001) (Figu e 1). One yea pos usion he mean change in ODI was −25 (95% CI −28 o −22) in emales and −17 (95% CI −21 o −13) in males. Howe e , in bo h sexes, he age-adjus ed ODI sco es a baseline and a one-yea we e signi ican ly highe han he mean ODI alues in he gene al popula- ion (p < 0.001). The pos ope a i e change in ODI be- ween h ee mon hs and one yea was mino and no signi ican in males while in emales he change was signi ican . All he SF-36 dimensions in he gene al popula ion we e signi ican ly be e han he p eope a i e alues o he pa ien s, bo h in emales and males, (p < 0.001). (Table 2). In bo h sexes he p eope a i e mean a io be- ween he pa ien s and he gene al popula ion subjec s was bigges in he dimension Role-Physical. A he one- yea ollow-up he emale pa ien s eached he popula- ion le el in Vi ali y, Men al Heal h and Role-Emo ional, while male pa ien s eached he popula ion le el only in Vi ali y and Men al Heal h. In he gene al popula ion, he PCS o he SF-36 was 44 (SD 11) in emales and 48 (SD 10) in males (Figu e 2). Among he pa ien s he p eope a i e PCS was 26 (SD 7) in emales and 29 (SD 6) in males. A 12 mon hs pos su ge y, he change in he PCS was 11 (95% CI 10 o 13; p < 0.001) in emales and 10 (95% CI 7 o 12; p < 0.001) in males. In u n he MCS o he SF-36 was 52 (SD 11) in e- males and 53 (SD 10) in males in he gene al popula ion. The p eope a i e MCS was 46 (SD 13) in he emale pa- ien s and 48 (SD 12) in he male pa ien s. The posi i e change in he MCS om he p eope a i e o 12-mon h alues was 7 (95% CI 5 o 8; p < 0.001) in emales and 4 (95% CI 1 o 6; p < 0.001) in males (Figu e 3). In he MCS, bo h he emale (p = 0.42) and male (p = 0.61) pa- ien s had eached he le el o he gene al popula ion a one yea pos su ge y, al hough, he di e ence in PCS be ween he pa ien s and he gene al popula ion emained signi ican (bo h sexes p < 0.001). In he pa- ien s, he changes in PCS and MCS be ween h ee mon hs and one yea a e su ge y, we e mino and s a- is ically non signi ican . Discussion Ou main pu pose was o s udy he eco e y o he spinal usion pa ien s du ing a one-yea ollow-up and Table 1 Demog aphical and clinical da a Va iables Female p- alue Male p- alue Pa ien s Popula ion Pa ien s Popula ion n = 174 n = 458 n = 78 n = 224 Body mass index, mean (SD) 28.1 (4.5) 26.9 (4.7) 0.0046 28.0 (3.8) 26.8 (3.8) 0.021 Co-mo bidi ies, n (%) Ca diological 100 (59) 197 (43) <0.001 37 (48) 81 (36) 0.065 Respi a o y 24 (14) 51 (11) 0.29 4 (5) 15 (7) 0.64 Neu ological 7 (4) 26 (6) 0.45 2 (3) 10 (4) 0.47 Rheuma oid 21 (12) 29 (6) 0.012 2 (3) 3 (1) 0.46 Diabe es 15 (9) 60 (13) 0.15 14 (18) 27 (12) 0.18 Psychia ic 7 (4) 18 (4) 0.90 2 (3) 7 (3) 0.82 Musculoscele al 10 (6) 48 (10) 0.080 1 (1) 7 (3) 0.39 Educa ion, yea s, mean (SD) 11.3 (3.5) 11.6 (4.2) 0.33 11.5 (3.4) 11.7 (3.7) 0.78 Tobacco use, n (%) 17 (10) 46 (10) 0.99 13 (17) 42 (19) 0.72 Employmen si ua ion, n (%) 0.71 0.38 Employed 50 (29) 140 (31) 37 (47) 98 (44) Unemployd 4 (2) 15 (3) 2 (3) 15 (7) Re i ed 120 (69) 303 (66) 39 (50) 111 (49) Leisu e ime physical ac i i y hou s pe week, mean (SD) 3.3 (3.7) 4.4 (3.9) 0.0019 4.7 (4.2) 4.6 (6.2) 0.95 Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 3 o 8 h p://www.biomedcen al.com/1471-2474/14/211 compa e ou pa ien s epo ed ou comes (PRO) o he alues o a ma ched gene al popula ion sample. The e- sul s showed ha despi e conside able imp o emen du ing he ollow-up he pa ien s did no each he le el o he ma ched gene al popula ion in ei he disabili y o he physical componen o he HRQoL. To ou knowledge, his is he i s s udy whe e he PROs o spinal usion pa ien s ha e been compa ed o gene al popula ion alues. The gene al popula ion sub- jec s showed minimal disabili y in he mean ODI sco es acco ding o he o iginal sco ing, while he usion pa- ien s’mean ODI sco es we e p eope a i ely se e e and a one yea a e he spinal usion su ge y emained mode a e [8]. The e o e, inspi e o eco e y he disabili y acco ding o he ODI did no dec ease o he le el o gene al popula ion in ou ollow-up in males o in e- males. One explana ion o his migh be, ha he pa- ien s unde going usion ope a ion ha e o en su e ed om longs anding spinal symp oms which may ha e caused pe manen changes o hei li e and beha io . In e es ingly he change in he ODI be ween 3 mon hs and one yea was minimal. This inding sugges s ha al eady he ea ly eco e y a h ee mon hs may p obably ha e qui e high p ognos ic alue when assessing he suc- cess o he ea men , also o e a longe pe iod. This e- sul is suppo ed by a inding in he ea lie li e a u e [11]. In a s udy o 96 pa ien s unde going spinal usion, pain measu emen s we e conduc ed a 6 mon hs and hen yea ly o e a o al ollow-up o 5 yea s. An in e es - ing inding was ha he imp o emen in he pain scale was bigges a 6 mon hs and in he ODI a one yea . The imp o emen s seen in his ea ly phase we e main ained h oughou he emainde o he ollow-up pe iod [11]. In he p esen s udy, one o he main indings conce ning disabili y was ha he mean le els o he ODI had no eached he alues o he gene al popula- ion in ei he sex a one yea pos su ge y. In com- pa ison wi h he esul s in disabili y epo ed in he li e a u e, in a ial implemen ed a 5 spine cen e s wi h 497 pa ien s ecei ing one o wo le el spinal u- sion, he mean ODI imp o ed by 22 poin s a one yea pos ope a i ely. The p eope a i e le el o he ODI a - ied in di e en subg oups om 48 o 56 [12]. In he Time, mon hs 03 12 ODI 0 10 20 30 40 50 60 70 Women Time, mon hs 03 12 ODI 0 10 20 30 40 50 60 70 Men Figu e 1 The mean Oswes y Disabili y Index (ODI, wi h 95% Con idence In e al ) in he pa ien s (■) and in he popula ion (□, dashed line). Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 4 o 8 h p://www.biomedcen al.com/1471-2474/14/211 Swedish Lumba Spine S udy, which was a mul icen- e andomized con olled ial whe e pa ien s we e andomized in o a su gical o a con ol g oup, 222 pa ien s ecei ed spinal usion ei he by non- ins umen ed usion, by ins umen ed pos e ola e al usion o by ci cum e en ial usion. In he su gical g oup, he mean ODI imp o ed om 47 o 36 (p < 0.0001), a wo-yea ollow up [13]. In a p ospec i e andomized con olled s udy o 111 pa ien s wi h adul is hmic spondylolis hesis he p eope a i e ODI sco es we e no epo ed bu a wo yea s in he su gical g oup he mean ODI sco e was 26 (95% CI 18.1 o 31.6) [14]. In ou s udy a one yea he mean posi i e change o he ODI in emale pa ien s was 25 (95% CI 22 o 28) and in male pa ien s 17 (95% CI 13 o 21) and he co esponding mean ODI sco es we e 22 (SD 17) and 23 (SD 20). In he p esen s udy, he spinal usion pa ien s eached he alues o hei ma ched popula ion sample in he men al componen (MCS) o SF-36 bu no in he phys- ical componen (PCS). P eope a i ely, he alue o Role Physical was highes in pa ien s in bo h sexes in he mean a io analysis. A 12 mon hs, Vi ali y, Men al Heal h and Role-Emo ional we e he only dimensions in he emale pa ien s ha eached gene al popula ion alues. In males, his was ue only o Vi ali y and Men- al Heal h. In e es ingly, he Pain dimension was s ill sig- ni ican ly wo se in pa ien s a he one-yea ollow-up compa ed o he gene al popula ion. This p omp s he ques ion: how should we manage he physical aspec in he long e m eco e y. The ea lie li e a u e includes a mul icen e s udy wi h 497 pa ien s unde going one- o wo-le el spinal usion wi h se e al echniques. The e- sul s showed an imp o emen in mean PCS o 9.9 poin s o e a one-yea ollow up [12]. This inding is con i med by ou s udy in which he mean PCS imp o ed by 11 (95% CI 10 o 13) poin s in emales and 10 (95% CI 7 o 12) in males in one-yea ollow-up. Ano he s udy wi h 100 p ima y spinal usion pa ien s who ecei ed decom- p ession and single-le el pos e io lumba in e body u- sion epo ed HRQoL sco es in bo h he PCS-12 and MCS-12 ha app oached he Aus alian popula ion no m o e a ollow-up a ying om 12 mon hs o 5 yea s [1]. The mean pos ope a i e PCS-12 sco e was 39 (95% CI 37 o 42) and MCS-12 sco e 52 (95% CI 50 o 55) as compa ed wi h he co esponding popula ion no m alues o 44 (95% CI 43 o 46) and 54 (95% CI 53 o 55) [1]. To ou knowledge no o he s udies ha e used Table 2 Heal h- ela ed quali y o li e in popula ion and pa ien s p eope a i ely s a i ied by sex Popula ion Pa ien s Mean a io* (95% CI) SF-36 dimensions Mean (SD) P eope a i e mean (SD) 12 mon hs mean (SD) P eope a i e p- alue pa ien s s popula ion p eope a i e 12 mon hs p- alue pa ien s s popula ion 12 mon hs Female Physical unc ioning 70 (28) 28 (19) 58 (29) 2.6 (2.3 o 3.0) <0.001 1.3 (1.2 o 1.4) <0.001 Gene al heal h 60 (22) 53 (20) 56 (21) 1.1 (1.1 o 1.2) <0.001 1.1 (1.0 o 1.1) 0.022 Vi ali y 65 (23) 45 (22) 64 (23) 1.5 (1.3 o 1.6) <0.001 1.0 (1.0 o 1.1) 0.41 Men al heal h 77 (19) 63 (21) 77 (19) 1.2 (1.2 o 1.3) <0.001 1.0 (1.0 o 1.0) 0.79 Role physical 64 (42) 9 (21) 44 (43) 7.9 (2.7 o 13.0) <0.001 1.5 (1.3 o 1.7) <0.001 Role emo ional 71 (39) 46 (43) 67 (41) 1.6 (1.4 o 1.8) <0.001 1.1 (1.0 o 1.2) 0.17 Social unc ioning 82 (25) 46 (28) 76 (28) 1.8 (1.7 o 2.0) <0.001 1.1 (1.0 o 1.1) 0.004 Bodily pain 67 (27) 24 (15) 56 (25) 2.8 (2.4 o 3.3) <0.001 1.2 (1.1 o 1.3) <0.001 Male Physical unc ioning 84 (22) 39 (20) 62 (26) 2.2 (1.9 o 2.4) <0.001 1.3 (1.2 o 1.5) <0.001 Gene al heal h 65 (21) 56 (21) 55 (23) 1.2 (1.1 o 1.3) <0.001 1.2 (1.1 o 1.3) <0.001 Vi ali y 71 (22) 53 (23) 66 (24) 1.4 (1.2 o 1.5) <0.001 1.1 (1.0 o 1.2) 0.072 Men al heal h 81 (18) 68 (21) 76 (19) 1.2 (1.1 o 1.3) <0.001 1.1 (1.0 o 1.2) 0.074 Role physical 74 (38) 12 (21) 44 (43) 6.3 (2.1 o 10.5) <0.001 1.7 (1.3 o 2.0) <0.001 Role emo ional 79 (35) 44 (43) 65 (42) 1.8 (1.5 o 2.2) <0.001 1.2 (1.1 o 1.4) 0.003 Social unc ioning 87 (20) 62 (27) 75 (36) 1.4 (1.3 o 1.5) <0.001 1.2 (1.1 o 1.3) <0.001 Bodily pain 75 (23) 30 (16) 55 (29) 2.5 (2.1 o 3.0) <0.001 1.4 (1.2 o 1.5) <0.001 *Adjus ed age. Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 5 o 8 h p://www.biomedcen al.com/1471-2474/14/211 a popula ion-based me hod when explo ing he success o usion ope a ions. A e spinal usion ope a ions i is seldom a ealis ic goal o expec ha all o he disabili y will disappea . I is also ob ious ha he le el o disabili y, and hence quali y o li e, depends on a ious ac o s such as pa- ien ’s age, possible ch onic neu opa hic pain, and o he possible diseases in addi ion o spinal diso de s. How- e e , in he p esen s udy, he p e alence o diabe es o mos o he o he co-mo bidi ies, was simila in pa ien s and in he gene al popula ion. In e es ingly only ca dio- ascula and heuma oid diseases in emales we e mo e o en p esen in pa ien s han in he gene al popula ion. Pa ien s who ha e unde gone spinal usion may also ge o he sou ces o pain like os eoa h i is o hip o knee and hese easons may con use he answe s in he ques ionnai es. Fu he mo e, in spinal usion su ge y, complica ions and ailed usions may wo sen he esul s. Finally, in he e alua ion o disabili y o he pa ien s i is essen ial o unde s and he le el o disabili y in he gene al popula ion o same age and sex. This da a is im- po an in e alua ing he in luence o su ge y o he pa- ien s and also in su gical decision making in indi idual cases. S udy s eng hs and limi a ions The p esen s udy includes egis e based, no selec ed, consecu i e pa ien ma e ial. The main s eng h o his s udy is he compa ison be ween pa ien s and he gene al popula ion in disabili y and HRQoL sco es. To ou knowledge, his is he only s udy in which he PROs o usion pa ien s ha e been compa ed o hose o a Time, mon hs 03 12 Physical Componen Sco e 20 25 30 35 40 45 50 55 60 Women Time, mon hs 03 12 Physical Componen Sco e 20 25 30 35 40 45 50 55 60 Men Figu e 2 The change in he Physical Componen Summa y Sco e o SF-36 in pa ien s ( ■) compa ed wi h he popula ion sample (□, dashed line). Resul s a e mean wi h 95% Con idence In e al. Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 6 o 8 h p://www.biomedcen al.com/1471-2474/14/211 ma ched gene al popula ion sample. An addi ional s eng h is he accu a e iming o he da a collec ion. The p eope a i e da a we e collec ed one o wo weeks p io o he ope a ion and he da a collec ion imepoin s du ing he ollow-up we e s ic . In addi ion, he popu- la ion based da a we e collec ed om he same esiden- ial a ea compa ed o he pa ien s. In he analyses, e- males and males ha e been sys ema ically s a i ied. This is because he majo i y o he pa ien s ope a ed on we e emales and because he e was a signi ican gende di - e ence in he ODI in he gene al popula ion be ween e- males and males. A limi a ion in his s udy is he lack o analyses s a i ied by su gical diagnos ic indica ion o he usion ope a ion. This is due he numbe o pa ien s in his ma e ial, which could ha e led o a oo small sample size in some o he diagnos ic subg oups and lack o s a is ical ep esen a ion o he phenomenon. 3Ano he limi a ion is ha as a pa o he su gical p o- cedu e in ou pa ien s, also decomp ession h ough laminec omy was pe o med whene e app op ia e. This migh cause di icul y o de e mine how much o he o al imp o emen o HRQoL is caused by he usion alone and how much by he coexis ing decomp ession p ocedu e. Fu he , a limi a ion is also he possible bias in answe ing o he gene al popula ion ques ionnai e. Would hose gene al popula ion indi iduals who ha e back pain, eply mo e eage ly, making he obse ed di - e ence be ween gene al popula ion and pa ien s smalle han he ue alue? In he li e a u e i has been shown, ha he li e- ime p e alence o back-pain in no mal popula ion is e en 84% [15]. This leads o hinking, ha e en hough he e migh be a bias in answe ing p o ile, i is no a ec ing he esul s be ween he pa ien s and gene al popula ion signi ican ly. The ollow-up in ou s udy was 12 mon hs. This pe iod o ime seemed o be su icien o show, ha esul s in disabili y and quali y o li e s abilized a e h ee mon hs. Al hough a one-yea o ollow-up indica ed a end owa ds eco e y, u he ollow-ups o se e al yea s a e needed o e alua e he longe e m ou come. Conclusions In his s udy he da a o 252 spine usion pa ien s was analyzed and compa ed wi h gene al popula ion. Despi e he signi ican imp o emen du ing he one-yea ollow- up in bo h disabili y and HRQoL, he pa ien s did no each he le el o gene al popula ion in he ODI o in he PCS. In he MCS, howe e , bo h emale and male pa ien s eached he le el o gene al popula ion. Time, mon hs 03 12 Men al Componen Sco e 20 25 30 35 40 45 50 55 60 Women Time, mon hs 03 12 Men al Componen Sco e 20 25 30 35 40 45 50 55 60 Men Figu e 3 The change in he Men al Componen Summa y Sco e o SF-36 in pa ien s (■) compa ed wi h he popula ion sample (□, dashed line). Resul s a e mean wi h 95% Con idence In e al. Pekkanen e al. BMC Musculoskele al Diso de s 2013, 14:211 Page 7 o 8 h p://www.biomedcen al.com/1471-2474/14/211 Abb e ia ions CI: Con idence in e al; EQ-5D: The Eu oQol g oup-5D; HRQol: Heal h- ela ed quali y o li e; MCS: Men al componen summa y sco e; ODI: Oswes y disabili y index; PCS: Physical componen summa y sco e; PRO: Pa ien - epo ed ou come; SD: S anda d de ia ion; SF-36: Sho - o m-36. Compe ing in e es s The au ho s decla e ha hey ha e no compe ing in e es s. Au ho s’con ibu ions LP: co esponding au ho ,pa icipa ed in he design o he s udy, pa icipa ed in he pa ien collec ion, d a ed he manusc ip , inished he manusc ip , ead and app o ed he inal manusc ip . MHN: pa icipa ed in he design o he s udy, pa icipa ed in he pa ien collec ion, e ised he manusc ip c i ically, ead and app o ed he inal manusc ip . HK: pe o med he s a is ical analysis, e ised he manusc ip c i ically, ead and app o ed he inal manusc ip . JD: pa icipa ed in he design o he s udy, ead and app o ed he inal manusc ip . KP: pa icipa ed in o he pa ien collec ion, ead and app o ed he inal manusc ip . MW: pa icipa ed in he pa ien collec ion, ead and app o ed he inal manusc ip. AH: pa icipa ed in he design o he s udy, helped o d a he manusc ip , e ised he manusc ip c i ically, ead and app o ed he inal manusc ip Acknowledgemen s The au ho s would like o hank Nina Hy önen and he Spine Regis e Team in Jy äskylä and Tampe e o da a collec ion. This s udy was suppo ed by he Medical Resea ch Founda ion o Jy äskylä Cen al Hospi al and Tampe e Uni e si y Hospi al, Finland. 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