• Takahiro Makino, Takashi Kaito, Hiroyasu Fujiwara, Hirotsugu Honda, Yusuke Sakai, Shota Takenaka, Hideki Yoshikawa, and Kazuo Yonenobu.
• *Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan †Department of Orthopedic Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan ‡Department of Orthopedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, Osaka, Japan §Jikei Institute Graduate School of Health Sciences, Osaka, Japan.
• Spine. 2017 Oct 1; 42 (19): 1502-1510.

Study DesignA retrospective review of prospectively collected data.ObjectiveThe present study aimed to identify risk factors for poor patient-reported quality of life (QOL) outcomes, based on five categories (pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, and psychological disorders) of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), after posterior lumbar interbody fusion (PLIF) at the 2-year follow-up.Summary Of Background DataMany studies have been reported on patient QOL outcomes after lumbar surgery; however, few reports have focused on risk factors for poor postoperative QOL outcomes in terms of the various disabilities and dysfunctions after PLIF.MethodsOne hundred consecutive patients (39 men and 61 women; mean age 69.6 [44-84] yr) who underwent single- or two-level PLIF for degenerative spondylolisthesis and/or foraminal stenosis with a 2-year follow-up were included. The effectiveness of surgery in each category of the JOABPEQ was evaluated. Demographic and clinical data and radiographic parameters were reviewed. Risk factors for poor postoperative QOL outcomes in each category of the JOABPEQ were investigated by multivariate logistic regression analysis.ResultsOlder age and spinopelvic malalignment (preoperative high pelvic tilt or postoperative decrease in lumbar lordosis [=postoperative increase in the mismatch between pelvic incidence and lumbar lordosis]) were risk factors for poor postoperative QOL outcomes in all categories of the JOABPEQ, except for lumbar spine dysfunction. In contrast, increase in number of PLIF segments, non-union, and radiographic adjacent segment degeneration were risk factors for poor postoperative QOL outcomes in lumbar spine dysfunction and gait disturbance.ConclusionThe risk factors for poor QOL outcomes after PLIF differed among the five categories of the JOABPEQ. In particular, surgery-related factors (e.g., increase in number of PLIF segments, nonunion, and radiographic adjacent segment degeneration) had a negative effect on the improvement of lumbar spine dysfunction and gait disturbance.Level Of Evidence4.

54 keywords...

hide…