RF30#188
Rapid Fire
Clinical Meaning of Neutral (score 3) Satisfaction after Lumbar Spine Surgery
Maya Suzuki¹, Koji Tamai¹, Hiroshi Taniwaki¹, Takamitsu Haku², Kazunori Hayashi³, Masatoshi Hoshino², Minori Kato¹, Shinji Takahashi¹, Hiromitsu Toyoda¹, Takashi Namikawa⁴, Hiroshi Kono⁵, Sho Dozono⁶, Hideki Sakanaka⁷, Akinobu Suzuki¹, Akira Matsumura⁴, Hidetomi Terai¹
¹Dept. of Orthopedic surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan ² Saiseikai Nakatsu Hospital, Osaka, Japan ³ Osaka City Juso Hospital, Osaka, Japan ⁴ Osaka City General Hospital, Osaka, Japan ⁵ Ishikiri Seiki Hospital, Osaka, Japan ⁶ Yodogawa Christian Hospital, Osaka, Japan ⁷ Seikeikai Hospital, Osaka, Japan
A subset of patients selects “neutral” (score 3) on a 5-point treatment satisfaction scale after lumbar spine surgery, but its clinical meaning remains unclear. We aimed to clarify the interpretation of neutral satisfaction by examining postoperative outcomes and an additional 4-point overall satisfaction measure.We retrospectively analyzed 513 patients who underwent lumbar spine surgery at our university and affiliated hospitals between 2022 and 2025 and completed pre- and postoperative questionnaires. Treatment satisfaction was assessed on a 5-point scale, and overall satisfaction was assessed on a 4-point scale. We evaluated pre- to postoperative changes (Δ) in the Visual Analog Scale (VAS) for low back pain, leg pain, and leg numbness; the lumbar Japanese Orthopaedic Association (JOA) score; and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Patients were classified into the Good (G) group (“1. very satisfied” and “2. satisfied”), the Neutral (N) group (“3. neither satisfied nor dissatisfied”), and the Poor (P) group (“4. dissatisfied” and “5. very dissatisfied”). Group comparisons were performed using the Kruskal–Wallis test with Steel–Dwass post hoc multiple comparisons. Multivariate analyses were conducted using logistic regression.The G, N, and P groups comprised 418 (81.5%), 61 (11.9%), and 34 (6.6%) patients, respectively. Age differed significantly among groups (p<0.01), with the G group younger than the P group. All outcomes differed significantly among groups (p<0.01), and improvements were greatest in the G group. Compared with the P group, the N group showed significant improvement only in ΔEQ-5D-5L (p<0.05), whereas ΔVAS and ΔJOA did not differ significantly. In logistic regression analyses comparing G versus N and N versus P, ΔEQ-5D-5L independently characterized the N group (p<0.05). Among N patients, 50 (82.0%) selected “satisfied” (scores 1–2) and 11 (18.0%) selected “dissatisfied” (scores 3–4) on the 4-point overall satisfaction scale.Neutral satisfaction (score 3) should not be interpreted simply as neither satisfied nor dissatisfied; rather, it reflects improved quality of life despite limited symptom and functional improvement.
