CLINICAL ARTICLE J Neurosurg Spine 30:60–68, 2019 P ATIENT-REPORTED outcomes are commonly used to evaluate the benefit offered by medical or surgical treatments. 4,5,22 In this way, they help define pre- operative strategy, shape patient expectations, and guide quality improvement for surgeons, third-party payers, and policymakers. 1,5,16 Although numerous factors may have a role in patient-reported outcomes, one potential character- istic of interest is patient education level. Several authors have reported that patients with less education (i.e., high school education or less) experience increased pain. 9,10,12,13,18,23,28 The Spine Patient Outcomes Research Trial (SPORT) provided multiple subgroup anal- yses illustrating this topic in patients with intervertebral disc herniations (IDHs). In the SPORT, patients with lower education levels had worse postoperative outcomes in the surgically treated IDH cohort and showed less improve- ment with nonoperative therapy than their counterparts with a college education. 8,16,18,24 However, there was no difference in improvement for disability, pain, or physical function scores at 4 years postoperatively for IDH, regard- less of patients’ educational background. 16,18 In contrast, there is no consensus on the association between patient education level and patient-reported out- comes in symptomatic lumbar stenosis. 13–15 The SPORT ABBREVIATIONS EQ-5D = EuroQol–5 Dimensions; GED = General Equivalency Development; IDH = intervertebral disc herniation; MCID = minimum clinically important difference; ODI = Oswestry Disability Index; SPORT = Spine Patient Outcomes Research Trial; VAS = visual analog scale. SUBMITTED February 23, 2018. ACCEPTED June 4, 2018. INCLUDE WHEN CITING Published online October 5, 2018; DOI: 10.3171/2018.6.SPINE18226. Education level as a prognostic indicator at 12 months following decompression surgery for symptomatic lumbar spinal stenosis Galal A. Elsayed, MD, 1 Esther B. Dupépé, MD, MSPH, 1 Matthew S. Erwood, MD, 1 Matthew C. Davis, MD, MPH, 1 Samuel G. McClugage III, MD, 1 Paul Szerlip, PhD, 2 Beverly C. Walters, MD, MSc, FRCSC, 1 and Mark N. Hadley, MD 1 1 Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and 2 Department of Computer Science, University of Central Florida, Orlando, Florida OBJECTIVE The goal of this study was to analyze the effect of patient education level on functional outcomes following decompression surgery for symptomatic lumbar spinal stenosis. METHODS Patients with surgically decompressed symptomatic lumbar stenosis were collected in a prospective ob- servational registry at a single institution between 2012 and 2014. Patient education level was compared to surgical outcomes to elucidate any relationships. Outcomes were defined using the Oswestry Disability Index score, back and leg pain visual analog scale (VAS) score, and the EuroQol–5 Dimensions questionnaire score. RESULTS Of 101 patients with symptomatic lumbar spinal stenosis, 27 had no college education and 74 had a college education (i.e., 2-year, 4-year, or postgraduate degree). Preoperatively, patients with no college education had statisti- cally significantly greater back and leg pain VAS scores when compared to patients with a college education. However, there was no statistically significant difference in quality of life or disability between those with no college education and those with a college education. Postoperatively, patients in both cohorts improved in all 4 patient-reported outcomes at 3 and 12 months after treatment for symptomatic lumbar spinal stenosis. CONCLUSIONS Despite their education level, both cohorts showed improvement in their functional outcomes at 3 and 12 months after decompression surgery for symptomatic lumbar spinal stenosis. https://thejns.org/doi/abs/10.3171/2018.6.SPINE18226 KEYWORDS education; neurosurgery; lumbar stenosis; outcome assessment; adult J Neurosurg Spine Volume 30 • January 2019 60 ©AANS 2019, except where prohibited by US copyright law Unauthenticated | Downloaded 02/16/23 03:42 PM UTC