Barriers to Adhering to Post-operative Recovery in Spinal Decompression Surgery and Impact on Patient-Reported Outcomes

Study DesignProspective Cohort Study.ObjectivesThis study aimed to (1) compare anticipated and encountered post-operative barriers following lumbar decompression surgery, (2) assess the relationship between encountering barriers and achieving meaningful improvement (MCID) in Oswestry Disability Index (ODI) scores, and (3) evaluate the association between socioeconomic status and encountered barriers via Social Vulnerability Index (SVI).MethodsPatients completed pre-operative surveys assessing anticipated recovery barriers and ODI. Post-operative surveys collected 6 weeks post-operation captured encountered barriers and ODI. Barriers were quantified with a 1-5 Likert scale. Wilcoxon Rank Sign tests assessed differences between anticipated and encountered barriers. Logistic regression evaluated associations between barriers and achievement of ODI MCID. Spearman correlation tested associations between SVI and barrier frequency.ResultsPatients were generally able to predict post-operative barriers accurately. Exercise adherence, financial stress, and care understanding were frequently reported concerns. Five post-operative barriers decreased the likelihood of achieving MCID: difficulty meeting exercise goals (OR = 0.43, <i>P</i> = 0.00036), difficulty obtaining medications (OR = 0.32, <i>P</i> = 0.030), transportation challenges (OR = 0.42, <i>P</i> = 0.036), communication issues with the care team (OR = 0.52, <i>P</i> = 0.015), and limited understanding of care plan (OR = 0.58, <i>P</i> = 0.044). Higher SVI scores correlated with difficulty obtaining medications (<i>P</i> = 0.035) and increased financial stress (<i>P</i> = 0.033).ConclusionsPost-operative recovery challenges-particularly in exercise adherence, medication access, transportation, and care plan comprehension-are associated with reduced odds of functional improvement. Higher social vulnerability exacerbates specific barriers. These findings underscore the importance of individualized peri-operative planning to optimize outcomes in lumbar decompression surgery.