Abstract
Results
A total of 168 patients completed surveys for this study. The median age of all patients was 60. Nearly 30% of lumbar and
16% of cervical patients were aged 65 or older. Approximately 96% of patients were men. Sixty percent of patients were currently
receiving or had pending disability compensation. Nearly 60% of patients were current smokers, approximately 26% reported
alcoholism or intravenous drug use, and 26% self-reported post-traumatic stress disorder. The most common lumbar spine diagnoses
were disk herniation (36.6%) and stenosis (34.8%), and most common cervical spine diagnoses were stenosis (50.0%) and disk
herniation (23.2%). Back pain was reported by 93.8% of lumbar patients and leg pain by 83.0%. Neck pain was reported by 96.4%
of cervical patients and arm pain by 69.6%. Median SF-12 physical component scores were more than two standard deviations
below the US average. Ninety percent of patients had at least moderate physical disability. Sixty-four percent met criteria
for depressive symptoms. Visual analog pain score was the strongest predictor of SF-12 physical (β = −1.32, P < 0.001) and mental (β = −1.63, P < 0.001) HRQOL and was the prime determinant of depressive symptoms (β = 1.52, P < 0.001) and disability index score (β = 4.39, P < 0.0001). Charlson Comorbidity Score and smoking status had no significant impact on HRQOL or disability scores. Age was
negatively correlated with depressive symptoms and positively correlated with SF-12 mental component scores.
16% of cervical patients were aged 65 or older. Approximately 96% of patients were men. Sixty percent of patients were currently
receiving or had pending disability compensation. Nearly 60% of patients were current smokers, approximately 26% reported
alcoholism or intravenous drug use, and 26% self-reported post-traumatic stress disorder. The most common lumbar spine diagnoses
were disk herniation (36.6%) and stenosis (34.8%), and most common cervical spine diagnoses were stenosis (50.0%) and disk
herniation (23.2%). Back pain was reported by 93.8% of lumbar patients and leg pain by 83.0%. Neck pain was reported by 96.4%
of cervical patients and arm pain by 69.6%. Median SF-12 physical component scores were more than two standard deviations
below the US average. Ninety percent of patients had at least moderate physical disability. Sixty-four percent met criteria
for depressive symptoms. Visual analog pain score was the strongest predictor of SF-12 physical (β = −1.32, P < 0.001) and mental (β = −1.63, P < 0.001) HRQOL and was the prime determinant of depressive symptoms (β = 1.52, P < 0.001) and disability index score (β = 4.39, P < 0.0001). Charlson Comorbidity Score and smoking status had no significant impact on HRQOL or disability scores. Age was
negatively correlated with depressive symptoms and positively correlated with SF-12 mental component scores.
Conclusions
Spinal disorders have a severe impact on both physical and emotional HRQOL of Veterans and are associated with severe disability
and an unusually high prevalence of depressive symptoms. Therapeutic interventions should be targeted to reduce pain, which
is a prime determinant of HRQOL, disability, and depressive symptoms. Given high prevalence of multiple risk factors for poor
outcomes, studies of spine surgery outcomes in Veterans are needed.
and an unusually high prevalence of depressive symptoms. Therapeutic interventions should be targeted to reduce pain, which
is a prime determinant of HRQOL, disability, and depressive symptoms. Given high prevalence of multiple risk factors for poor
outcomes, studies of spine surgery outcomes in Veterans are needed.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s11136-012-0121-y
- Authors
- Maxwell Boakye, Outcomes Research Lab, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Ryan Moore, Section of Neurosurgery, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Maiying Kong, Department of Bioinformatics and Biostatistics, SPHIS, University of Louisville, 485 E Gray Street, Louisville, KY 40202, USA
- Stephen L. Skirboll, Department of Neurosurgery, Stanford University Medical Center, 3801 Miranda Ave, M-112, Palo Alto, CA 94304, USA
- Robert T. Arrigo, Department of Neurosurgery, Stanford University Medical Center, 3801 Miranda Ave, M-112, Palo Alto, CA 94304, USA
- Journal Quality of Life Research
- Online ISSN 1573-2649
- Print ISSN 0962-9343