• Carol A Mancuso, Roland Duculan, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, and Federico P Girardi.
• Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Weill Cornell Medical College, 1600 York Ave, New York, NY 10021, USA. Electronic address: mancusoc@hss.edu.
• Spine J. 2016 Oct 1; 16 (10): 1167-1174.

Background ContextFulfillment of expectations is an important outcome of spine surgery.PurposeThe study aimed to compare fulfillment of expectations after surgery with preoperatively stated expectations.Study DesignThis is a prospective cohort study.Patient SampleThe sample included patients who had lumbar and cervical spine surgeries.Outcome MeasuresThe outcome measures were self-report valid surveys-[blinded] Lumbar Spine Surgery Expectations Survey and [blinded] Cervical Spine Surgery Expectations Survey-Oswestry Disability Index (ODI), and Neck Disability Index (NDI).MethodsPatients preoperatively completed a valid 20-item lumbar or cervical spine surgery Expectations Survey measuring the amount of improvement expected for symptoms, physical function, and mental well-being. Two years postoperatively, patients were asked about fulfillment of each expectation; a proportion was calculated as the amount of improvement received versus the amount of improvement expected. The proportion ranges from 0 (no expectations fulfilled) to 1 (all expectations fulfilled as expected), to >1 (expectations surpassed). Patients also completed the ODI or NDI, as well as questions about 2-year interval events, such as subsequent surgery.ResultsAmong the 366 patients who had lumbar surgery, 90% had at least some of their expectations fulfilled (15% expectations surpassed, 9% expectations fulfilled as expected, and 66% expectations fulfilled somewhat) and 10% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .66. In multivariable analysis, variables that were associated with a lower proportion of expectations fulfilled were more preoperative expectations, not working full-time, previous spine surgery, surgery for more vertebral levels, subsequent spine surgery, and less improvement in pre- to postoperative ODI and pain scores (p≤.05 for all variables). Among the 133 patients who had cervical surgery, 91% had at least some of their expectations fulfilled (23% expectations surpassed, 8% expectations fulfilled as expected, and 60% expectations fulfilled somewhat) and 9% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .78. In multivariable analysis, variables that were associated with a lower proportion of expectations fulfilled were more preoperative expectations and less improvement in pre- to postoperative NDI and pain scores (p≤.05 for all variables).ConclusionsFulfillment of expectations after spine surgery is associated with multiple pre- and postoperative variables, including the amount of improvement expected preoperatively.Copyright © 2016 Elsevier Inc. All rights reserved.

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