AUDITING FUNCTIONAL IMPROVEMENTS FOLLOWING LUMBAR FUSION IN PRIVATE PRACTICE – A FIVE YEAR STUDY

Abstract

This is to report an audit of outcomes improvement in Lumbar Fusion patients in a private practice setting using routine application of a robust functional outcomes instrument – the Modified Rowland Questionnaire (MRQ). The MRQ is a validated responsive disease specific functional questionnaire. It ranges from 23 points (maximum disability) to zero (no disability). Potential changes in score are 46 points (−23 to 23). A 4 point improvement is clinically significant.

Two hundred and sixteen patients undergoing lumbar fusion procedures, over a five year period completed an MRQ prior to surgery and at the routine one-year follow up. Changes to the score were documented and analysed in relation to diagnosis, Accident Compensation corporation (ACC) coverage, and revision procedures.

Data completion was 88%. Median disability improvement was 10 points on the MRM questionnaire. Benefit occurred in 80.0% of patients. Improvements were more marked in degenerative spondylolisthesis and isthmic spondylolisthesis than fusions for discogenic back pain although this was not statistically significant. There was a trend to lesser functional improvements in those on ACC and those who had undergone previous surgery.

This study reports an attempt to audit outcomes in a spinal sub specialist private practice using an instrument that can be applied preoperatively and at one year follow up without undue additional work load for the patients or staff. The data completion was acceptable. Functional improvements were significant in all diagnostic groups. Outcomes in revision and ACC patients were not significantly inferior, as they have been described in similar overseas studies.