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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 517-521.
doi: 10.1302/0301-620X.91B4.21861  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The prediction of outcome in somatised patients undergoing elective lumbar surgery

T. Okoro, BSc, MBChB, MRCS, Clinical Research Fellow1; and P. Sell, BM, MSc, FRCS, Consultant Orthopaedic Surgeon1

1 Department of Orthopaedics Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.

Correspondence should be sent to Dr T. Okoro; e-mail: tosanwumi{at}hotmail.com

We compared a group of 46 somatised patients with a control group of 41 non-somatised patients who had undergone elective surgery to the lumbar spine in an attempt to identify pre-operative factors which could predict the outcome. In a prospective single-centre study, the Distress and Risk Assessment method consisting of a modified somatic perception questionnaire and modified Zung depression index was used pre-operatively to identify somatised patients. The type and number of consultations were correlated with functional indicators of outcome, such as the Oswestry disability index and a visual analogue score for pain in the leg after follow-up for six and 12 months.

Similar improvements in the Oswestry disability index were found in the somatised and non-somatised groups. Somatised patients who had a good outcome on the Oswestry disability index had an increased number of orthopaedic consultations (50 of 83 patients (60%) vs 29 of 73 patients (39.7%); p = 0.16) and waited less time for their surgery (5.5 months) (SD 5.26) vs 10.1 months (SD 6.29); p = 0.026). No other identifiable factors were found. A shorter wait for surgery appeared to predict a good outcome. Early review by a spinal surgeon and a reduced waiting time to surgery appear to be of particular benefit to somatised patients.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General