Preoperative Psychosocial Variables as Predictors of a Spinal Surgery Outcome

Authors: N. Nechanická 1;  P. Harsa 2
Authors‘ workplace: Neurocentrum-neurochirugie, Krajská nemocnice Liberec, a. s. 1;  Psychiatrická klinika 1. LF UK a VFN v Praze 2
Published in: Cesk Slov Neurol N 2013; 76/109(6): 695-701
Category: Review Article


In the context of multidisciplinary care of patients with chronic back pain, surgery is an option for those who do not benefit from conservative treatment. Psychological assessment prior to back surgery aims to identify suitable candidates for surgery and predict possible complications or poor effect of treatment. The aim of this review paper is to discuss the association between pre‑surgical psychological parameters and surgical treatment outcome, to provide justification for implementation of pre‑surgical psychological assessment in routine clinical practice and to present indications for psychological assessment prior to the surgery.

Key words:
low back pain – spine surgery – psychological factors – outcome measures

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15 (Suppl 1): 17– 24.

2. Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes fol­lowing lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Med 2009; 10(4): 639– 653.

3. ÚZIS ČR. Ukončené případy zdravotní neschopnosti pro nemoc a úraz 2011. Praha: Ústav zdravotnických informací a statistiky České republiky 2012.

4. Kadaňka Z. Bolesti zad jako psychologický problém. Neurol Prax 2009; 10(2): 86– 90.

5. Deardorff WW, Goldstein TB. QME spine surgery psychological screening: improving outcomes, avoiding failures. Behavioral Health CE 2009– 2012 [on-line]. Available from URL: http:/ / index.php/ component/ courses/ ?task=view&cid=58.

6. Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar discs: a literature synthesis. J Gen Intern Med 1993; 8(9): 487– 496.

7. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta‑analysis of the literature. Spine 1992; 17(1): 1– 8.

8. Block AR, Gatchel RJ, Deardorff WW, Guyer RD. The Psychology of Spine Surgery. Washington D.C.: American Psychological Association 2003.

9. Krismer M, van Tulder M. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non specific). Best Pract Res Clin Rheumatol 2007; 21(1): 77– 91.

10. Kukan M, Kukanová P. Low back pain a deprese –  vzájemný vztah. Cesk Slov Neurol N 2012; 75/ 108(3): 291– 295.

11. Carragee EJ, Telles CJ. Commentary: revision lumbar surgery and revisiting the role of preoperative depression screening. Spine J 2012; 12(3): 186– 188.

12. Mannion AF, Dvorak J, Müntener M, Grob D. A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation. Eur Spine J 2005; 14(5): 454– 465.

13. LaCaille RA, DeBerard MS, Masters KS, Colledge AL,Bacon W. Presurgical bio­psychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion. Spine J 2005; 5(1): 71– 78.

14. DeBerard MS, Wheeler AJ, Gundy JM, Stein DM, Colledge AL. Presurgical bio­psychosocial variables predict medical, compensation, and aggregate costs of lumbar discectomy in Utah workers’ compensation patients. Spine J 2011; 11(5): 395– 401.

15. Abbott AD, Tyni‑ lenné R, Hedlund R. Leg pain and psychological variables predict outcome 2– 3 years after lumbar fusion surgery. Eur Spine J 2011; 20(10): 1626– 1634.

16. Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson OS, Cheng JS et al. Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 2012; 12(3): 179– 185.

17. Akagi R, Aoki Y, Ikeda Y, Nakajima F, Ohtori S, Takahashi K et al. Comparison of early and late surgical intervention for lumbar disc herniation: is earlier better? J Orthop Sci 2010, 15(3), 294– 298.

18. Andersen T, Christensen FB, Hansen ES, Bünger C.Pain 5 years after instrumented and non‑instrumented posterolateral lumbar spinal fusion. Eur Spine J2003; 12(4): 393– 399.

19. Andersen T, Christensen FB, Bünger C. Evaluation of a Dallas pain questionnaire classification in relation to outcome in lumbar spinal fusion. Eur Spine J 2006; 15(11): 1671– 1685.

20. Arpino L, Iavarone A, Parlato C, Moraci A. Prognostic role of depression after lumbar disc surgery. Neurol Sci 2004; 25(3): 145– 147.

21. Basler H‑ D, Zimmer C, Griss P, Wirth T, Florin I. Predicting Quality of Life after Lumbar Spondylodesis. J Clin Psych Med Set 1997; 4(3): 313– 326.

22. Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J 2001; 1(4): 274– 282.

23. de Groot KI, Boeke S, Van Den Berge HJ, Duiven­voorden HJ, Bonke B, Passchier J. The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery. Pain 1997; 69(1– 2): 19– 25.

24. den Boer JJ, Oostendorp RAB, Beems T, Munneke M,Evers AVM. Continued disability and pain after lumbar disc surgery: the role of cognitive‑ behavioral factors. Pain 2006; 123(1– 2): 45– 52.

25. Derby R, Lee SH , Chen Y, Kim BJ, Lee CH, Hong YKet al. The Influence of Psychologic Factors on Diskography in Patients With Chronic Axial Low Back Pain. Arch Phys Med Rehabil 2008; 89(7): 1300– 1304.

26. Edwards RR, Klick B, Buenaver L, Max MB, Haythornthwaite JA, Keller RBet al. Symptoms of di­stress as prospective predictors of pain‑related sciatica treatment outcomes. Pain 2007; 130(1): 47– 55.

27. Fulde E, Junge A, Ahrens S. Coping strategies and defense mechanisms and their relevance for the recovery after discectomy. J Psychosom Res 1995; 39(7): 819– 826.

28. Graver V, Haaland AK, Magnaes B, Loeb M. Seven‑year clinical follow‑up after lumbar disc surgery: results and predictors of outcome. Br J Neurosurg 1999; 13(2): 178– 184.

29. Hägg O, Fritzell P, Ekselius L, Nordwall A. Predictors of outcome in fusion surgery for chronic low back pain. A report from the swedish lumbar spine study. Eur Spine J 2003; 12(1): 22– 33.

30. Laslett M, Aprill CN, McDonald B, Öberg B. Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography. Eur Spine J 2006; 15(10): 473– 484.

31. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Dvorak J et al. Predictors of multidimensional outcome after spinal surgery. Eur Spine J 2007; 16(6): 777– 786.

32. Papaioannou M, Skapinakis P, Damigos D, Mavreas V, Broumas G, Palgimesi A. The role of catastrophizing in the prediction of postoperative pain. Pain Med 2009; 10(8): 1452– 1459.

33. Saban KL, Penckofer SM. Patient expectations of quality of life following lumbar spinal surgery. J Neurosci Nurs 2007; 39(3): 180– 189.

34. Silverplats K, Lind B, Zoëga B, Halldin K, Gellerstedt M, Brisby H et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: Long‑term follow‑up. Eur Spine J 2010; 19(9): 1459– 1467.

35. Sinikallio S, Lehto S, Aalto T, Airaksinen O, Kröger H,Viinamäki H. Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: a two‑year perspective. BMC Musculoskelet Disord 2010; 11: 152.

36. Soegaard R, Bünger CE, Christiansen T, Christensen FB. Determinants of cost‑effectiveness in lumbar spinal fusion using the net benefit framework: a 2‑year follow‑up study among 695 patients. Eur Spine J 2007; 16(11): 1822– 1831.

37. Voorhies RM, Jiang X, Thomas N. Predicting outcome in the surgical treatment of lumbar radiculopathy using the Pain Drawing Score, McGill Short Form Pain Questionnaire,and risk factors including psychosocial issues and axial joint pain. Spine J 2007; 7(5): 516– 524.

38. Carragee EJ. Psychological screening in the surgical treatment of lumbar disc herniation. Clin J Pain 2001; 17(3): 215– 219.

39. Hobby JL, Lutchman LN, Powell JM, Sharp DJ. The Distress and Risk Assessment Method (DRAM): failure to predict the outcome of lumbar discectomy. J Bone Joint Surg Br 2001; 83(1): 19– 21.

40. Block AR,Gatchel RJ, Deardorff WW, Guyer RD. The psychology of spine surgery. Washington D.C.: American Psychological Association 2003.

41. Deardorff WW. Presurgical psychological screening. In: Phillips FM, Lauryssen C (eds). The Lumbar Intervertebral Disc. New York: Thieme 2010: 142– 147.

42. Mannion AF, Elfering A. Predictors of surgical outcome and their assessment. Eur Spine J 2006; 15(1): 93– 108.

43. Gavin M, Litt M, Khan A, Onyiuke H, Kozol R. A prospective, randomized trial of cognitive intervention for postoperative pain. Am Surg 2006; 72(5): 414– 418.

44. Hampel P, Graef T, Krohn‑ Grimberge B, Tlach L. Effects of gender and cognitive‑ behavioral management of depressive symptoms on rehabilitation outcome among inpatient orthopedic patients with chronic low back pain: a 1 year longitudinal study. Eur Spine J 2009; 18(12): 1867– 1880.

45. Schwartz CE, Finkelstein JA. Understanding inconsistencies in patient‑ reported outcomes after spine treatment: response shift phenomena. Spine J 2009; 9(12): 1039– 1045.

46. Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt M et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine 2011; 36 (Suppl 21): S54– S68.

47. Smékal V. Pozvání do psychologie osobnosti. Člověk v zrcadle vědomí a jednání. 3rd ed. Brno: Barrister && Principal 2004: 17.

48. Main CJ, Spanswick CC. Personality assessment and the Minnessota Multiphasic Personality Inventory. 50 years on: do we still need our security blanket? Pain Forum 1995; 4: 90– 96.

49. Seligman MEP. Learned helplessness and depres­sion in animals and men. In: Spence JT, Carson RC, Thibaut JQ (eds). Behavioral approaches to therapy. Morristown, New Jersey: General Learning Press 1976.

50. Merskey H. The effect of chronic pain upon the response to noxious stimuli by psychiatric patients. J Psychosom Res 1965; 8: 405– 419.

51. Kremer EF, Block AR, Atkinson JJ. Assessment of pain behavior: factors that distort self‑ report. In: Melzack R (ed). Pain management: an assessment. New York: Raven Press 1983: 165– 171.

52. Epker J, Block AR. Presurgical Psychological Screening in Back Pain Patiens: a review. Clin J Pain 2001; 17(3): 200– 205.

53. Robinson ME, Riley JL. The role of emotions in pain. In: Gatchel RJ, Turk DC (eds). Psychosocial factors in pain: critical perspectives. New York: The Guilford Press 1999: 74– 88.

54. Sinikallio S, Aalto T, Airaksinen O, Herno A, Heikki K,Savolainen S et al. Depression is associated with po­orer outcome of lumbar spinal stenosis surgery. Eur Spine J 2007; 16(7): 905– 912.

55. Wasan AD, Davar G, Jamison RN. The association between negative affect and opioid analgesia in patients with discogenic low back pain. Pain 2005; 117(3): 450– 461.

56. Dersh J, Mayer T, Theodore BR, Polatin P, Gatchel RJ.Do psychiatric disorders first appear preinjury or postinjury in chronic disabling occupational spinal disorders? Spine 2007; 32(9): 1045– 1051.

57. Dersh J, Gatchel R, Polatin P, Mayer T. Prevalence of psychiatric disorders in patients with chronic work‑related musculoskeletal pain and disability. J Occup Environ Med 2002; 44(5): 459– 468.

58. Boersma K, Linton SJ. Screening to identify patients at risic profiles of psychological risk factors for early intervention. Clin J Pain 2005; 21(1): 38– 43.

59. Sullivan MJ, Thorn B, Haythomthwaite JA et al. Theoretical perspectives on the relation between pain catastrophizing and pain. Clin J Pain 2001; 17(1): 52– 64.

60. Keefe FJ, Rumble ME, Scipio CD et al. Psychological aspects of persistent pain: current state of the science. J Pain 2004; 5(4): 195– 211.

61. Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009; 9(5): 745– 758.

62. Greenough CG, Fraser RD. The effects of compensation on recovery from low‑ back pain injury. Spine 1989; 14(9): 947– 955.

63. Kaila‑ Kangas L, Kivimaki M, Riihimaki H, Luukkonen R, Kirjonen J, Leino‑ Arjas P. Psychosocial factors at work as predictors of hospitalization for back disorders: a 28‑year follow‑up of industrial em­ployees. Spine 2004; 29(16): 1823– 1830.

64. Klapow JC, Slater MA, Patterson TL, Atkinson JH, Weickgenant AL, Grant I et al. Psychosocial factors discriminate multidimensional clinical groups of chronic low back pain patiens. Pain 1995; 62(3): 349– 355.

65. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin 2007; 25(2): 353– 371.

66. Tunks ER, Crook J, Weir R. Epidemiology of chronic pain with psychological comorbidity. Prevalence, risk, course, and prognosis. Can J Psychiatry 2008; 53(4): 224– 234.

67. Waddell G. The back pain revolution. London: Churchill Livingstone 1998: 10– 280.

68. Bogduk N, McGuirk B. Medical management of acute and chronic low back pain: an evidence‑based approach. Amsterdam: Elsevier 2002: 115– 204.

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