Investigation and analysis of the quality of life in patients before and after lumbar fusion

English Keywords:Lumbar internal fixation and fusion  Lumbar stiffness  Quality of life  Evaluation of efficacy  Patient-reported outcome

English Abstract:

  【Abstract】 Objectives: To investigate and analyze the quality of life of patients before and after lumbar internal fixation and fusion, and to evaluate the influence of postoperative lumbar stiffness on the quality of life and the correlations between factors. Methods: 209 patients with lumbar degenerative disease treated in our hospital were selected for investigation, including patients who were about to receive lumbar internal fixation and fusion(48 cases), at half a year after the surgery(42 cases), 1 year after the surgery(38 cases), 2 years after the surgery(41 cases), and 3 years or more after the surgery(40 cases). There were 89 men and 120 women, averaged 62.2±10.1 years old(27-82 years). All participants were required to complete Oswestry disability index(ODI), numeric rating scale(NRS), Japanese Orthopaedic Association(JOA) score, and a new questionnaire designed by the authors. The main contents of the questionnaire included the impact of pain/discomfort, neurological dysfunction, impaired mental health, limited work ability, and functional limitations of activities of daily living(ADL) on patients′ quality of life, and patient satisfaction and recovery after surgery. The main factors affecting the quality of life of patients were counted, and the correlations between the improvements of ODI, NRS, and JOA score and patient satisfaction and recovery were analyzed. Results: The ODI, NRS of low back pain, and NRS of buttock or lower limb of patients before surgery were significantly higher than those of each postoperative groups(P<0.001), while JOA score before was lower than that after surgery(P<0.001). 96.27%(155/161) of the patients after surgery reported that the quality of life was improved. The excellent and good recovery rate was 67.70%, and the satisfaction rate was 73.91%, and there was a strong correlation in between(r=0.701, P<0.001). The main factors reported by patients affecting their quality of life were pain/discomfort, neurological dysfunction, and functional limitations of ADL in all groups. The limited activities of daily living that impacted the quality of life of preoperative patients greatly included walking, outdoor activities, and standing, and those that had great impacts on the quality of life of postoperative patients included walking, bending/squatting, and outdoor activities. The improvement values of ODI, NRS, and JOA score, and JOA improvement rate were low-to-moderately related with the degree of recovery and satisfaction, and the correlation coefficients ranged from 0.310 to 0.627. Conclusions: Pain/discomfort, neurological dysfunction, and functional limitations of activities of daily living are the main factors affecting the quality of life of patients undergoing lumbar internal fixation and fusion. Besides the limitation of walking and going out/outdoor activities, the limitation of standing has a great impact on the quality of life of preoperative patients, and the limitation of bending and squatting has a great impact on the quality of life of postoperative patients. The correlations between the improvements of ODI, NRS, and JOA score and the degree of recovery and satisfaction are not strong. The impacts of low back or limbs soreness, numbness, lower limb weakness, and lumbar stiffness on quality of life should also be considered besides the low back and leg pain when evaluating comprehensively the impact of lumbar fusion surgery on patients` quality of life.