Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;3(3):371-378.
doi: 10.21037/jss.2017.08.05.

Influence of psychosocial distress in the results of elective lumbar spine surgery

Vivian Amaral  1 , Luis Marchi  1 , Heber Martim  1   2 , Rodrigo Amaral  1 , Joes Nogueira-Neto  1 , Ellen Pierro  1 , Leonardo Oliveira  1 , Etevaldo Coutinho  1 , Fernando Marcelino  1 , Nicholai Faulhaber  1 , Rubens Jensen  1 , Luiz Pimenta  1   3
Affiliations

Influence of psychosocial distress in the results of elective lumbar spine surgery

Vivian Amaral et al. J Spine Surg. 2017 Sep.

Abstract

Background: Low back pain can be caused by several pathological entities and its perception can be altered by external factors, for example by some psychological and social factors. The objective of this study was to compare surgical outcomes in patients with or without psychosocial issues.

Methods: Single center, retrospective and comparative study. Patients with indication to elective lumbar spine surgery were screened for some psychosocial factors. As a result of the screening, patients were divided in two groups: mild psychosocial issues (green group) or moderate psychosocial issues (yellow group). The groups were compared using the following variables: demographic and clinical history, depression (HAD-D), anxiety (HAD-A), pain levels [visual analogue scale (VAS)], disability [Oswestry disability index (ODI)] and quality of life [EuroQol 5D (EQ-5D)] at preop and 6-12 months follow-up.

Results: A total of 136 patients were included (51% female) in this study. The 62.5% were allocated at the green group, and 37.5% in the yellow group. Similar pain levels were observed at preop, but the green group evolved with superior improvement in pain levels after surgery (P=0.003). In the ODI and EQ-5D scales, the green group had already shown lower clinical disability at preop (P=0.009 and P=0.003, respectively) and evolved with better outcomes at the final evaluation (P=0.049 and P=0.017). VAS, ODI and EQ-5D scores improved from baseline similarly in both groups.

Conclusions: Presurgical screening identify the presence of psychological distress. Psychosocial factors are correlated with poorer clinical outcomes, both in the baseline and after the surgery. Despite the differences between found, even patients with mild psychosocial impairment can experience clinical improvement with surgery.

Keywords: Spine; anxiety; chronic pain; depression; psychology; surgical outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pain levels assessed by VAS scale at preoperative and final visits for green and yellow group. *, P<0.001; †, P=0.003. The shaded bars represent the MCID values (minimum VAS scores that should be achieved for a clinical perception). VAS, visual analogue scale; MCID, minimal clinically important difference.
Figure 2
Figure 2
Physical disability assessed by ODI scale at preoperative and final visits for green and yellow group. *, P<0.001; †, P=0.009; ††, P=0.017. The shaded bars represent the MCID values (minimum VAS scores that should be achieved for a clinical perception). ODI, Oswestry disability index; MCID, minimal clinically important difference; VAS, visual analogue scale.
Figure 3
Figure 3
Quality of life assessed by EQ-5D scale at preoperative and final visits for green and yellow group. *, P<0.001; †, P=0.03; ††, P=0.017. The shaded bars represent the MCID values (minimum VAS scores that should be achieved for a clinical perception). EQ-5D, EuroQol 5D; MCID, minimal clinically important difference; VAS, visual analogue scale.
See this image and copyright information in PMC

References

    1. Cheriyan T, Harris B, Cheriyan J, et al. Association between compensation status and outcomes in spine surgery: a meta-analysis of 31 studies. Spine J 2015;15:2564-73. 10.1016/j.spinee.2015.09.033 - DOI - PubMed
    1. Moore JE. Chronic low back pain and psychosocial issues. Phys Med Rehabil Clin N Am 2010;21:801-15. 10.1016/j.pmr.2010.06.005 - DOI - PubMed
    1. Stubbs B, Koyanagi A, Thompson T, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry 2016;43:63-70. 10.1016/j.genhosppsych.2016.09.008 - DOI - PubMed
    1. Mathew J, Singh SB, Garis S, et al. Backing up the stories: The psychological and social costs of chronic low-back pain. Int J Spine Surg 2013;7:e29-38. 10.1016/j.ijsp.2013.02.001 - DOI - PMC - PubMed
    1. Teixiera MJ. Chronic pain and depression. Rev Neurocienc 2006;14:44-53.