Medical Student Columbia University Vagelos College of Physicians and Surgeons Columbia University, Vagelos College of Physicians and Surgeons
Introduction: Surgical disciplines are increasingly recognizing the effects of psychological factors on outcomes. In spine surgery, the majority of work in exploring these topics has focused on depression and anxiety, however relatively little research has explored how other facets of a patient’s mental wellbeing might affect their course of treatment. The purpose of this review is to provide an overview of the effects of these underexplored mental health pathologies in spine surgery and to synthesize recommendations regarding their identification and management.
Methods: A thorough literature search was conducted using PubMed to identify studies for inclusion. To be included, studies needed to evaluate the effects of chronic pain, kinesiophobia, substance use disorders, cognitive impairment, and psychoses in adult patients undergoing spinal surgery for a deformity or degenerative condition. These studies were screened according to PRISMA guidelines, and studies were excluded if they examined pediatric populations or were specific to trauma or oncology indications.
Results: Seventy-three studies met criteria for inclusion. The analysis revealed that patients with unmanaged non-affective psychological factors exhibited higher rates of surgical complications and recovery challenges. Pain catastrophization was associated with numerous disabling characteristics, most consistently with increased likelihood of postoperative pain (OR 1.1-2.0). Substance use, particularly opioids, were strongly associated with higher likelihood of surgical complications (as high as 50% increased risk) and greater risk for persistent opioid use following surgery. Schizophrenia was found to significantly increase wound complications, nonroutine discharges, and 90 day readmissions. Conversely, implementing screening protocols and psychiatric management techniques—such as cognitive-behavioral therapy—resulted in significant improvements in pain control, functional restoration, and quality of life.
Conclusion : Evidence consistently suggests that non-affective psychological factors are important predictors of more challenging clinical courses in spinal surgery patients - these patients are at greater risk for surgical complications, prolonged and diminished recovery, and reduced postoperative satisfaction.
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