Influence of psychosocial distress in the results of elective lumbar spine surgery
Open accessAbstract
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.
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Robust literature supports preoperative psychological distress and fear of movement as significant risk factors for poorer post-surgical outcomes.
“Robust literature supports preoperative psychological distress and fear of movement as significant risk factors for poorer post-surgical outcomes, 30,[43][44][45][46]”
From A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients’ Expectations, Experiences, and Satisfaction (2023) · cites this paper as [43]
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Background
- Authors
- Amaral, V., Marchi, L., Martim, H., Amaral, R., Nogueira-Neto, J., Pierro, E., Oliveira, L., Coutinho, E., Marcelino, F., Faulhaber, N., Jensen, R., & Pimenta, L.
- Affiliations
- Instituto de Patologia da Coluna (BR)
- University of California San Diego (US)
- ORCID
- Venue
- Journal of Spine Surgery
- Publisher
- AME Publishing Company
- Published
- 2017-09
- Volume
- 3
- Issue
- 3
- Pages
- 371-378
- ISSN
- 2414-4630 (ISSN-L)
- 2414-469X
- PMC
- PMC5637190
- OpenAlex
- W2753578152
- Cited by
- 45
- References
- 62
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 8 · 2023: 1 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 2
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Spine Surgery (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- psychosocial distress, low back pain, surgical outcomes, depression, anxiety, Oswestry Disability Index, quality of life, disability, psychological factors in pain
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