Quality of Life Research

, Volume 22, Issue 1, pp 45–52 | Cite as

Health-related quality-of-life status in Veterans with spinal disorders

  • Maxwell BoakyeEmail author
  • Ryan Moore
  • Maiying Kong
  • Stephen L. Skirboll
  • Robert T. Arrigo



To measure the impact of spinal disorders on health-related quality of life (HRQOL) among Veterans, to describe demographic patterns of Veterans with spinal disorders, and to quantify HRQOL scores as they relate to demographics, medical comorbidities, pain severity, and depressive symptoms.


From 2009 to 2010, 112 lumbar and 56 cervical spinal disorder patients completed SF-12, Oswestry Disability Index, visual analog pain scale, and Beck Depression Inventory surveys. Multivariate analysis identified predictors of HRQOL, disability, and depressive symptoms.


A total of 168 patients completed surveys for this study. The median age of all patients was 60. Nearly 30% of lumbar and 16% of cervical patients were aged 65 or older. Approximately 96% of patients were men. Sixty percent of patients were currently receiving or had pending disability compensation. Nearly 60% of patients were current smokers, approximately 26% reported alcoholism or intravenous drug use, and 26% self-reported post-traumatic stress disorder. The most common lumbar spine diagnoses were disk herniation (36.6%) and stenosis (34.8%), and most common cervical spine diagnoses were stenosis (50.0%) and disk herniation (23.2%). Back pain was reported by 93.8% of lumbar patients and leg pain by 83.0%. Neck pain was reported by 96.4% of cervical patients and arm pain by 69.6%. Median SF-12 physical component scores were more than two standard deviations below the US average. Ninety percent of patients had at least moderate physical disability. Sixty-four percent met criteria for depressive symptoms. Visual analog pain score was the strongest predictor of SF-12 physical (β = −1.32, P < 0.001) and mental (β = −1.63, P < 0.001) HRQOL and was the prime determinant of depressive symptoms (β = 1.52, P < 0.001) and disability index score (β = 4.39, P < 0.0001). Charlson Comorbidity Score and smoking status had no significant impact on HRQOL or disability scores. Age was negatively correlated with depressive symptoms and positively correlated with SF-12 mental component scores.


Spinal disorders have a severe impact on both physical and emotional HRQOL of Veterans and are associated with severe disability and an unusually high prevalence of depressive symptoms. Therapeutic interventions should be targeted to reduce pain, which is a prime determinant of HRQOL, disability, and depressive symptoms. Given high prevalence of multiple risk factors for poor outcomes, studies of spine surgery outcomes in Veterans are needed.


Health-related quality of life Veterans Spine surgery Visual analog pain score 



Health-related quality of life


Physical Component Summary (of SF-12)


Mental Component Summary (of SF-12)


Interquartile range


Visual analog pain scale


Oswestry Disability Index


Neck Disability Index


Beck Depression Inventory


National Spine Network


  1. 1.
    Singh, J. A., & Strand, V. (2009). Health care utilization in patients with spondyloarthropathies. Rheumatology (Oxford), 48(3), 272–276.CrossRefGoogle Scholar
  2. 2.
    Singh, J. A., & Strand, V. (2009). Spondyloarthritis is associated with poor function and physical health-related quality of life. Journal of Rheumatology, 36(5), 1012–1020.PubMedCrossRefGoogle Scholar
  3. 3.
    Butchart, A., Kerr, E. A., Heisler, M., Piette, J. D., & Krein, S. L. (2009). Experience and management of chronic pain among patients with other complex chronic conditions. Clinical Journal of Pain, 25(4), 293–298.PubMedCrossRefGoogle Scholar
  4. 4.
    Sinnott, P., & Wagner, T. H. (2009). Low back pain in VA users. Archives of Internal Medicine, 169(14), 1338–1339. author reply 1339.PubMedCrossRefGoogle Scholar
  5. 5.
    Gironda, R. J., Clark, M. E., Massengale, J. P., & Walker, R. L. (2006). Pain among veterans of operations enduring freedom and Iraqi freedom. Pain Med, 7(4), 339–343.PubMedCrossRefGoogle Scholar
  6. 6.
    Luo, J., Zhang, H. T., Jiang, X. D., Xue, S., & Ke, Y. Q. (2009). Combination of bone marrow stromal cell transplantation with mobilization by granulocyte-colony stimulating factor promotes functional recovery after spinal cord transection. Acta Neurochir (Wien), 151(11), 1483–1492.CrossRefGoogle Scholar
  7. 7.
    Fanuele, J. C., Birkmeyer, N. J., Abdu, W. A., Tosteson, T. D., & Weinstein, J. N. (2000). The impact of spinal problems on the health status of patients: Have we underestimated the effect? Spine, 25(12), 1509–1514.PubMedCrossRefGoogle Scholar
  8. 8.
    Slover, J., Abdu, W. A., Hanscom, B., Lurie, J., & Weinstein, J. N. (2006). Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores. Spine (Phila Pa 1976), 31(11), 1265–1271.CrossRefGoogle Scholar
  9. 9.
    Saban, K. L., & Penckofer, S. M. (2007). Patient expectations of quality of life following lumbar spinal surgery. Journal of Neuroscience Nursing, 39(3), 180–189.PubMedCrossRefGoogle Scholar
  10. 10.
    Singh, A., Gnanalingham, K., Casey, A., & Crockard, A. (2006). Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: Comparison with SF-36. Spine (Phila Pa 1976), 31(6), 639–643.CrossRefGoogle Scholar
  11. 11.
    Slover, J., Abdu, W. A., Hanscom, B., & Weinstein, J. N. (2006). The impact of comorbidities on the change in short-form 36 and Oswestry scores following lumbar spine surgery. Spine (Phila Pa 1976), 31(17), 1974–1980.CrossRefGoogle Scholar
  12. 12.
    Singh, J. A. (2009). Effect of comorbidity on quality of life of male veterans with prevalent primary total knee arthroplasty. Clinical Rheumatology, 28(9), 1083–1089.PubMedCrossRefGoogle Scholar
  13. 13.
    Singh, J. A., & Sloan, J. (2009). Higher comorbidity, poor functional status and higher health care utilization in veterans with prevalent total knee arthroplasty or total hip arthroplasty. Clinical Rheumatology, 28(9), 1025–1033.PubMedCrossRefGoogle Scholar
  14. 14.
    Kazis, L. E., Ren, X. S., Lee, A., Skinner, K., Rogers, W., Clark, J., et al. (1999). Health status in VA patients: Results from the Veterans Health Study. American Journal of Medical Quality, 14(1), 28–38.PubMedCrossRefGoogle Scholar
  15. 15.
    Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 40(5), 373–383.PubMedCrossRefGoogle Scholar
  16. 16.
    Fairbank, J. C., Couper, J., Davies, J. B., & O’Brien, J. P. (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66(8), 271–273.PubMedGoogle Scholar
  17. 17.
    Vernon, H., & Mior, S. (1991). The neck disability index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14(7), 409–415.PubMedGoogle Scholar
  18. 18.
    Luo, X., Lynn George, M., Kakouras, I., Edwards, C. L., Pietrobon, R., Richardson, W., et al. (2003). Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine (Phila Pa 1976), 28(15), 1739–1745.Google Scholar
  19. 19.
    Walsh, T. L., Hanscom, B., Lurie, J. D., & Weinstein, J. N. (2003). Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry disability index, MODEMS, and the SF-36. Spine (Phila Pa 1976), 28(6), 607–615.Google Scholar
  20. 20.
    Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedCrossRefGoogle Scholar
  21. 21.
    Beck, A. T., & Steer, R. A. (1984). Internal consistencies of the original and revised Beck depression inventory. Journal of Clinical Psychology, 40(6), 1365–1367.PubMedCrossRefGoogle Scholar
  22. 22.
    Schotte, C. K., Maes, M., Cluydts, R., De Doncker, D., & Cosyns, P. (1997). Construct validity of the Beck depression inventory in a depressive population. Journal of Affective Disorders, 46(2), 115–125.PubMedCrossRefGoogle Scholar
  23. 23.
    Lustman, P. J., Clouse, R. E., Griffith, L. S., Carney, R. M., & Freedland, K. E. (1997). Screening for depression in diabetes using the Beck depression inventory. Psychosomatic Medicine, 59(1), 24–31.PubMedGoogle Scholar
  24. 24.
    Ware, J., Jr, Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.PubMedCrossRefGoogle Scholar
  25. 25.
    Venables, W. N., & Ripley, B. D. (2002). Modern applied statistics with S. New York: Springer.CrossRefGoogle Scholar
  26. 26.
    Faraway, J. J. (2005). Linear models with R. New York: Chapman & Hall/CRC.Google Scholar
  27. 27.
    Gage, H., Hendricks, A., Zhang, S., & Kazis, L. (2003). The relative health related quality of life of veterans with Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 74(2), 163–169.CrossRefGoogle Scholar
  28. 28.
    Trief, P. M., Ploutz-Snyder, R., & Fredrickson, B. E. (2006). Emotional health predicts pain and function after fusion: A prospective multicenter study. Spine (Phila Pa 1976), 31(7), 823–830.CrossRefGoogle Scholar
  29. 29.
    Trief, P. M., Grant, W., & Fredrickson, B. (2000). A prospective study of psychological predictors of lumbar surgery outcome. Spine (Phila Pa 1976), 25(20), 2616–2621.CrossRefGoogle Scholar
  30. 30.
    Mannion, A. F., & Elfering, A. (2006). Predictors of surgical outcome and their assessment. European Spine Journal, 15(Suppl 1), S93–S108.PubMedCrossRefGoogle Scholar
  31. 31.
    Sinikallio, S., Aalto, T., Airaksinen, O., Herno, A., Kroger, H., Savolainen, S., et al. (2006). Depression and associated factors in patients with lumbar spinal stenosis. Disability and Rehabilitation, 28(7), 415–422.PubMedCrossRefGoogle Scholar
  32. 32.
    Sinikallio, S., Aalto, T., Lehto, S. M., Airaksinen, O., Herno, A., Kroger, H., et al. (2010). Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: A two-year prospective study comparing two age groups. Disability and Rehabilitation, 32(6), 462–468.PubMedCrossRefGoogle Scholar
  33. 33.
    Sinikallio, S., Aalto, T., Airaksinen, O., Herno, A., Kroger, H., Savolainen, S., et al. (2007). Depression is associated with poorer outcome of lumbar spinal stenosis surgery. European Spine Journal, 16(7), 905–912.PubMedCrossRefGoogle Scholar
  34. 34.
    Callahan, C. M., Hui, S. L., Nienaber, N. A., Musick, B. S., & Tierney, W. M. (1994). Longitudinal study of depression and health services use among elderly primary care patients. Journal of the American Geriatrics Society, 42(8), 833–838.PubMedGoogle Scholar
  35. 35.
    Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). National comorbidity survey replication: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289(23), 3095–3105.PubMedCrossRefGoogle Scholar
  36. 36.
    Hankin, C. S., Spiro, A., I. I. I., Miller, D. R., & Kazis, L. (1999). Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: The Veterans health study. American Journal of Psychiatry, 156(12), 1924–1930.PubMedGoogle Scholar
  37. 37.
    Kazis, L. E., Miller, D. R., Clark, J., Skinner, K., Lee, A., Rogers, W., et al. (1998). Health-related quality of life in patients served by the Department of Veterans Affairs: Results from the Veterans health study. Archives of Internal Medicine, 158(6), 626–632.PubMedCrossRefGoogle Scholar
  38. 38.
    Ren, X. S., Kazis, L. E., Lee, A., & Rogers, W. H. (2005). The role of generic and disease-specific measures of physical and role functioning in assessing patient outcomes: a longitudinal study. J Ambul Care Manage, 28(2), 157–166.PubMedGoogle Scholar
  39. 39.
    Fries, J. F., Krishnan, E., Rose, M., Lingala, B., & Bruce, B. (2011). Improved responsiveness and reduced sample size requirements of PROMIS physical function scales with item response theory. Arthritis Res Ther, 13(5), R147.PubMedCrossRefGoogle Scholar
  40. 40.
    Fries, J. F., Cella, D., Rose, M., Krishnan, E., & Bruce, B. (2009). Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing. Journal of Rheumatology, 36(9), 2061–2066.PubMedCrossRefGoogle Scholar
  41. 41.
    Mannion, A. F., Elfering, A., Staerkle, R., Junge, A., Grob, D., Dvorak, J., et al. (2007). Predictors of multidimensional outcome after spinal surgery. European Spine Journal, 16(6), 777–786.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. (outside the USA) 2012

Authors and Affiliations

  • Maxwell Boakye
    • 1
    • 2
    • 3
    • 6
    Email author
  • Ryan Moore
    • 3
  • Maiying Kong
    • 5
  • Stephen L. Skirboll
    • 2
    • 3
  • Robert T. Arrigo
    • 2
    • 4
  1. 1.Outcomes Research LabVA Palo Alto Health Care SystemPalo AltoUSA
  2. 2.Department of NeurosurgeryStanford University Medical CenterPalo AltoUSA
  3. 3.Section of NeurosurgeryVA Palo Alto Health Care SystemPalo AltoUSA
  4. 4.Stanford University School of MedicineStanfordUSA
  5. 5.Department of Bioinformatics and Biostatistics, SPHISUniversity of LouisvilleLouisvilleUSA
  6. 6.Center for Advanced NeurosurgeryUniversity of LouisvilleLouisvilleUSA

Personalised recommendations