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Weight, smoking history, injury-related litigation and other patient-specific characteristics have a big impact on the success or failure of spinal surgery for back pain, researchers report.The study, presented Monday at the annual meeting of the American Association of Neurological Surgeons in New Orleans, examined outcomes of 622 people in the United States who had spinal surgery in 2002.

Patients were assessed six months to a year after their surgery. As part of the assessment, each patient was questioned as to his or her level of post-surgery pain relief, numbness, weakness, ability to return to work, narcotic pain reliever usage, additional care needs and overall outcomes. The results:

70 percent of patients said they returned to work or full activities;
85 percent rarely or ever used any narcotic medications;
85 percent rated their overall outcome as excellent or good;
7 percent required additional care, with about half those patients requiring re-hospitalization;
66 percent graded relief, numbness and weakness as excellent or good.
Interestingly, this survey demonstrated that patient demographics influenced the outcome of spinal surgery considerably more than the surgeon, surgical procedure, or disease specifics, researcher Dr. Thomas B. Ducker said in a prepared statement.

Both overall outcome and relief of pain showed significant differences among nonsmoking patients with a healthy BMI (body mass index), and those with any or all of the other factors: smoking, obesity, and/or litigation. For instance, there were no patients in the obese/active smoker/litigator category that rated overall outcome excellent, and only 33 percent of those rated it good, Ducker said.

Litigation was directly related to the condition/injury that led to the patient’s need for spinal surgery.The following figures show excellent and good outcomes in pain relief among different groups of patients:

Non smoker/normal BMI patients — 77 percent
Normal BMI – all patients — 74 percent
Active smokers — 58 percent
Obese and litigator — 53 percent
Obese, active smoker and litigator — 41 percent.
These data further reinforce the stance that a patient’s overall health and personal circumstances should be taken into consideration before undergoing surgery, Ducker said.

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