The use of presurgical psychological screening to predict the outcome of spine surgery

Abstract

Background context: Several previous studies have shown that psychosocial factors can influence the outcome of elective spine surgery.

Purpose: The purpose of the current study was to determine how well a presurgical screening instrument could predict surgical outcome.

Study design/setting: The study was conducted by staff of a psychologist's office. They performed preoperative screening for spine surgery candidates and collected the follow-up data.

Patient sample: Presurgical screening and follow-up data collection was performed on 204 patients who underwent laminectomy/discectomy (n=118) or fusion (n=86) of the lumbar spine.

Outcome measures: The outcome measures used in the study were visual analog pain scales, the Oswestry Disability Questionnaire, and medication use.

Methods: A semi-structured interview and psychometric testing were used to identify specific, quantifiable psychological, and "medical" risk factors for poor surgical outcome. A presurgical psychological screening (PPS) scorecard was completed for each patient, assessing whether the patient had a high or low level of risk on these psychological and medical dimensions. Based on the scorecard, an overall surgical prognosis of "good," "fair," or "poor" was generated.

Results: Results showed spine surgery led to significant overall improvements in pain, functional ability, and medication use. Medical and psychological risk levels were significantly related to outcome, with the poorest results obtained by patients having both high psychological and medical risk. Further, the accuracy of PPS surgical prognosis in predicting overall outcome was 82%. Only 9 of 53 patients predicted to have poor outcome achieved fair or good results from spine surgery.

Conclusions: These findings suggest that PPS should become a more routine part of the evaluation of chronic pain patients in whom spine surgery is being considered.