Fear Avoidance Beliefs and Outcome After Surgery for Degenerative Lumbar Spine

Abstract

Study Design: This was a prospective cohort study. Objective: The aim of this study is to question the influence of fear avoidance beliefs on functional outcome following surgery for degenerative lumbar spine. Background: Fear avoidance beliefs are well-studied modifiers of low back pain. Nonetheless, the influence of fear avoidance beliefs on the outcome of spinal surgery remains controversial. Methods: We conducted a prospective cohort study including patients undergoing surgery for degenerative lumbar discopathy, spondylolisthesis, and stenosis. Patients completed a preoperative questionnaire including the Fear Avoidance Beliefs Questionnaire (FABQ) as well as Visual Analog Scales for radicular and lumbar pain (VAS-R/L), Oswestry Disability Index (ODI), and Short-Form 36 health survey (SF36). Functional outcome was measured at least 6 months after surgery using ODI. Results: Sixty-three patients with a mean follow-up of 254 days (8.5\u2009mo, minimum=179\u2009d, maximum=534\u2009d) were included in the study. Women showed stronger work-related fear avoidance beliefs but there was no other difference in baseline characteristics and functional outcome between patients with low or high (>75th percentile) baseline FABQ-P or FABQ-W scores. Individual variables associated with whether patients reached minimal clinically important difference for ODI were: working status [odds ratio (OR)=0.13; 95% confidence interval (95% CI), 0.03–0.62; P=0.01], American Society of Anesthesiologists classification score (OR=0.32; 95% CI, 0.11–0.92; P=0.03), preoperative duration of symptoms (OR=0.94; 95% CI, 0.89–0.99; P=0.03), and preoperative ODI (OR=1.03; 95% CI, 1.00–1.07; P=0.05). Neither physical nor work-related preoperative FABQ scores were predictors of functional results. Conclusions: In our study, the FABQ was not associated with functional outcome following surgery for degenerative lumbar spine. Other psychological patient-reported measures are needed to refine selection of patients undergoing spine surgery in order to ensure better outcomes.