Gender differences in the recovery experience following spinal arthrodesis

2017

Summary

Prospective study of 1931 consecutive patients undergoing posterior spinal fusion analyzed the differences between men and women in the perception of pain and function. Women experienced more pain pre-op but improved pain (VAS) and function (ODI) more than men by 6 weeks and 1 year postop. Pain medicine use was similar by gender. Women were more likely to have comorbidities, and complications of adjacent level fracture and hardware failure. Gender differences exist in the recovery experience following spinal fusion surgery.

Hypothesis

No significant difference in pain and function between male (M) and female (F) after spinal arthrodesis surgery

Design

Large prospective outcomes series

Introduction

Stereotypes exist regarding perceived gender differences involving the perception of pain. Some studies suggest that women have a lower tolerance to painful mechanical, electrical, and thermal stimuli than men. This study analyzed gender differences in pain and function after spinal fusion.

Methods

Prospective data from 1931 consecutive adults (F-1219; M-712) underwent posterior fusion by 5 surgeons, divided M vs F, followed 7 yrs (24-189mo). Outcomes analyzed by: diagnosis, single vs multilevel fusion, primary (1045) vs revision fusion (886), age (18-53 yrs, 54-63 yrs, 64-71 yrs, 71-91 yrs), comorbidities, BMI, revision vs no revision during follow-up, and complications. VAS, ODI, pain medication were collected pre-op, 6wks, 3mo, 6mo, 1yr. Complications were analyzed over average 7 years followup.

Results

Avg age 60 yrs (18-90yrs); 45% revision surgery. Predictors of preop pain: F, comorbidities, longer fusions, degenerative diagnosis, and BMI. F had more comorbidities (p<.002). M had higher pre-op BMI (29.7 vs 28.7; p<0.01). Preop VAS/ODI for F worse than M (6.5/49.7 vs 6.1/46.5; p=0.00005), 6 wks (4.3 vs 4.0; p=0.013), but was similar at 3mo (p=0.57), 6mo (p=0.61), 1yr (p=0.84). At 1 year, F had greater improvement (VAS p=0.002; ODI p=0.0007); pain medication use was similar (p=0.66). For degenerative group, F had lower function and higher pain preop: VAS/ODI 6.7/52 vs 6.2/47(p=0.00004); For deformity, F had more pain but similar function (6.3/46 vs 5.9/44;p=0.037, p=0.11). Older F (71-91yrs) had greater ODI improvement at 6wks and 1yr vs M (p=0.002). Degenerative spondy had the largest difference M vs F (p<0.0001). Of patients who required revision surgery, F improved VAS more than M (p=0.04); F had more adjacent fractures (p=0.07), hardware loosening (p=0.003).

Conclusions

Women had more pre-op pain but improved more at 6 weeks and 1 year than men, regardless of diagnosis, age, or levels fused. F had more pre-op co-morbidities and M had higher BMI, both affecting outcomes. Gender differences exist in the recovery experience after spinal arthrodesis.