Effectiveness of Back Surgery May Depend on Patient's Mental State
Nov 18, 1999 (Baltimore) -- People with 'slipped discs' in their lower back are more likely to be dissatisfied with their surgical results if they are very depressed or anxious before undergoing back surgery, according to a recent study by Swedish researchers. Therefore, the study investigators advise that these patients be screened for depression and anxiety before surgery is planned to aid in predicting which patients will be satisfied with their surgery and how much pain they will suffer.
A "slipped," or herniated, disc occurs when the pads, or discs, between the vertebrae herniate, or slip out of alignment. This condition is common in the lower back or the lumbar area. When a "slipped disc" occurs, the nerves coming out of the spine are pinched. The condition is frequently associated with severe pain and an inability to perform many activities, explains Charles Edwards, MD, an orthopedic surgeon and director of spine surgery at the University of Maryland School of Medicine.
To understand the relationship between feelings of depression or anxiety and satisfaction with surgery, the study researchers asked 50 patients to answer a questionnaire designed to screen the patients for depression and anxiety. The patients completed the questionnaire, also called a psychometric test, prior to surgery and again three months and 12 months after surgery.
Two years after surgery, 79% of patients were content with their surgery and 21% were not, the researchers report. Analysis of the psychometric test results showed that patients who later became discontent with their surgical results were significantly more depressed and had significantly more anxiety than the patients who were satisfied with their surgery.
Based on this study, the researchers suggest that psychometric testing before surgery will be useful to help predict who will respond well to surgery. A few earlier studies had found similar results, but they had used more sophisticated psychological tests to screen the patients for depression and anxiety. The questionnaires used in this study were relatively simple to use, and the researchers believe an orthopedic surgeon could easily administer the test without referring to a psychiatrist.
"I don't believe it's necessary to consult a psychiatrist in the management of these patients," Edwards tells WebMD. "Someone with severe back pain or sciatica is bound to be depressed, so the existence of depression is really a chicken-and-egg phenomenon -- which came first? Frequently these patients have other conditions in their spine besides disc herniation that may be the source of some of their pain. We must take the time to dissect out the origins of the patient's pain, and to design an effective treatment."
Because the outcome of spinal surgery is hard to predict, some previous studies have suggested that surgeons should not treat people with herniated discs who are depressed. Edwards disagrees. "This is the kind of thing that causes someone with a legitimate reason for back pain to suffer much more than they should," he says.