Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom

Table 1 Information used to predict post surgery outcomes

Patient characteristics and history

Patient personality and expectations1, including motivation

Age, occupation/unemployment, social issues, smoking, weight

Presence or absence of personal injury or yellow flags

Diabetes, other medical co-morbidities

Clinical information including patient history, e.g., symptoms duration

Use of outcome data, e.g., DRAM, GAD7, ODI, PHQ9, SF36, SRS, VAS pain, walking

Response to previous approaches, e.g., physiotherapy, facet joint injections, discogram, disc block

Pathology or degree of deformity

Number of levels predominant leg pain; more leg than back pain

Performance based outcome measures

Neurological examination

Imaging: CT scans, CT with 3D reconstruction, discography, MRI scans, X-ray

Evidence

Audit of data from past patients

Literature or empirical evidence

Experiential clinical experience

Other

Pathology: segmental instability, single level, spondylolisthesis, central disc protrusion

Pain mechanism: no features of chronic regional pain syndrome (allodynia, non-anatomical pain), stenosis

¹Realistic expectations (VAS 4/10 end result would be satisfactory). DRAM: Distress Risk Assessment Method; GAD7: Generalized Anxiety Disorder 7-item scale; ODI: Oswestry Disability Index; PHQ9: Patient health questionnaire - depression component; VAS: Visual analogue scale; SRS: Session rating scale.