Abstract
Purpose
A new approach to the reporting of health outcomes involves assessing the proportion of patients achieving a level of symptoms that they feel they could live with. We evaluated the acceptable level of pain in patients after surgery for lumbar disc herniation (LDH).
Methods
12 mo after first-time surgery for LDH, patients completed 0–10 scales for back pain and leg pain and a question: “if you had to spend the rest of your life with the symptoms you have now, how would feel about it?,” answered on a 5-point Likert scale from “very satisfied” to “very dissatisfied”. This was dichotomised and used as the external criterion in receiver operating characteristics (ROC) analysis to derive the cut-off score for pain that best indicated being at least “somewhat satisfied” with the symptom state.
Results
1,209 (91%) patients returned a questionnaire, of which 611 (51%) reported being at least somewhat satisfied with their symptom state. The area under the curve for the ROC analysis was 0.91 (95% CI, 0.89–0.92), indicating a good ability of the pain score to discriminate between being in a satisfactory state or not. The cut-off indicating a satisfactory symptom state was ≤2 points on the pain scale (sens, 76% and spec 89%).
Conclusion
Most spine interventions are aimed at decreasing pain but only rarely do they totally eliminate it. Determination of the % patients achieving an acceptable symptom state for pain may represent a useful and more stringent target for denoting surgical success in the treatment of painful spinal disorders.
