Article Abstract

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

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


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.