Caleb Stone

Elective lumbar spine surgery is among the more frequently delayed orthopaedic procedures in the Australian public hospital system. The extent to which prolonged preoperative wait time affects the eventual postoperative response remains incompletely characterised. This prospective single-centre cohort study examined six-week postoperative outcomes in 23 patients (mean age 58.0 years; 52.2% male) undergoing elective lumbar spine surgery at an Australian public tertiary orthopaedic unit, with preoperative and postoperative assessments using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and the 36-Item Short Form Health Survey (SF-36). Median preoperative wait was 64 days (range 15–288). Paired analyses demonstrated large, statistically and clinically significant improvements across all outcome instruments: composite VAS decreased by 4.4 points (p<0.001), ODI by 20.6 percentage points (p=0.005), and SF-36 component summary scores by 7.4–7.5 T-score points (both p<0.05). At a 2-point VAS minimum clinically important difference threshold, 81% of patients achieved clinically meaningful improvement and none worsened. Longer preoperative wait time was consistently associated with smaller postoperative improvement across VAS (r = -0.43), ODI (r = -0.41), and SF-36 physical component summary (r = -0.39); individual tests did not reach statistical significance, but the consistency of direction and magnitude across three independent instruments suggests a real effect. These findings indicate that surgery delivers substantial benefit in this cohort, and provide hypothesis-generating evidence that prolonged wait time may attenuate that benefit. Confirmation in larger cohorts is required.

The natural history of back pain in patients awaiting elective lumbar spine surgery within a public healthcare system remains incompletely characterised. Understanding how pain evolves over the preoperative waiting period is relevant for resource allocation and the targeting of preoperative interventions. This prospective single-centre cohort study examined back pain trajectories over a six-month waiting period in 40 consecutive patients (mean age 64.7 years; 42.5% male) listed for elective lumbar spine surgery at an Australian public tertiary orthopaedic unit between October 2022 and October 2024. Pain severity was assessed using the Visual Analog Scale across motion, standing, and sitting domains and the 36-Item Short Form Health Survey at recruitment and at six months. Paired analysis demonstrated no statistically or clinically significant change in mean VAS scores across any domain, with mean changes of approximately 0.2 points in all domains and the composite (all p > 0.5). Using a 2-point minimum clinically important difference threshold, 70% of patients (28/40) had no meaningful change, 15% (6/40) improved, and 15% (6/40) worsened. SF-36 results triangulated this finding: no subscale or component summary score showed a statistically significant change over six months. These findings indicate that, contrary to the prevailing assumption, mean preoperative pain remains stable for most patients during a six-month wait, while a minority subgroup deteriorates. The results extend recent international evidence to the Australian public-system context and support a shift toward identifying and targeting patients at risk of meaningful preoperative deterioration rather than universal preoperative interventions.