Introduction: Grit, defined as perseverance and passion for long-term goals, and self-control, defined as the capacity to regulate impulses in the presence of momentarily gratifying temptations or diversion, have been shown to be important predictors for achievement in professional domains¹. Grit has been previously studied among orthopedic surgeons² as well as orthopedic surgery applicants³ with the goal of predicting success. Although grit and self-control have been well-explored in their relationship with achieving professional achievement, the association between these traits and outcomes following spine surgery has not been studied. We hypothesized that patients with higher grit and self-control scores have greater improvement in their patient-reported outcome measures (PROMs) following lumbar spine surgery.

Methods: This is a retrospective review of prospectively collected patient data. Patients that underwent minimally invasive decompression via laminectomy or laminoplasty and had a minimum of 1-year follow-up were included. Grit and self-control were assessed using the validated 8-Question Short Grit Scale and the 10-Item Self-Scoring Self-Control Scale. PROMs included visual analogue scale (VAS) for leg/back pain, 12-Item Short Form Mental Component Score (SF-12 MCS), and Patient Reported Outcomes Measurement Information System Physical Function (PROMIS-PF). VAS is expected to decrease post-operatively, and SF-12 and PROMIS-PF are expected to increase. The difference was calculated for each post-operative PROM relative to the pre-operative timepoint. Bivariate analysis was performed to assess for the association between grit/self-control and change in PROM. Pearson’s correlation coefficients were generated for each analysis, and a significance threshold of p<0.05 was used.

Results: In total, 66 patients reached at least 1-year follow-up and were included in the analysis. The mean grit and self-control scores for the cohort were 4.00 ± 0.54 and 3.87 ± 0.55, respectively. In bivariate analysis, higher self-control scores were found to be associated with greater improvement in VAS leg pain scores at the 1-year (r=-0.28, p=0.03) and 2-year (r=-0.40, p=0.02) timepoints (Table 1). Grit and self-control were not found to be significantly associated with other PROMs at any of the other timepoints included.

Conclusion: These correlation analyses suggest self-control may play a role in the degree of leg pain improvement among patients undergoing minimally invasive decompression. The association was only seen at 1-year and 2-year follow-ups, which suggests that self-control may be more related to long-term outcomes rather than the immediate post-operative period. Grittier patients, by definition, have more passion and perseverance for their long-term goals. Thus, we expected grit to be associated with improvements in PROMs especially at later post-operative timepoints, but this was not seen in the analysis. While a statistically significant correlation was not shown between grit and the PROMs studied, a more extensive prospective study should be conducted in the future to further understand the role of grit and self-control in PROMs.